Aug 29, 2006

Intussucception

Intussucception occurs when one part of bowel invaginates (intussusceptum) into an adjacent section (intussuscipiens) which results in intestinal obstruction and venous compression. If uncorrected it can result in arterial insufficiency and necrosis. It is the commonest abdominal emergency between 3 months and 2 years . Peak incidence is between 6 and 9 months. Most cases are idiopathic with the lead point due to enlarged Peyer's patches, Usually due to a viral infection.5% are due to polyp, Meckel's diverticulum, duplication cyst or tumour .Commonest site involved is the ileocaecal junction.

Clinical features are Intermittent colicky abdominal pain and vomiting, Each episode classically last 1-2 min and recurs every 15-20 min, there is Passage of blood - 'red currant jelly' per rectum. Per abdomen a Sausage shaped abdominal mass is felt in upper abdomen. Diagnosis confirmed with water soluble contrast enema or ultrasound.

Treatment is Resuscitation with intravenous fluids and nasogastric tube. Attempt reduction with air or contrast enema under radiological guidance. If peritonitis, shock or failed reduction requires surgery , If bowel necrosis require resection with primary anastomosis

1 comments:

Manjul said...

My child of 19 months was reluctant to eat one morning and laid on his stomach and cried. An USG revealed intussusceptum and was reduced with Barium enema. The next day he had normal food but that afternoon, USG revealed an reoccurance and same procedure was repeated. He was then under NPO for 48hrs and seems normal. We are wondering if recurrances again is possible- and if surgical operations would be required.