Paediatric Intussusception
Lesson Objectives
By the end of this lesson, learners should be able to:
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Define intussusception and describe its pathophysiology.
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Identify typical age groups and epidemiology.
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Recognize the classic clinical signs and symptoms.
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Outline appropriate investigations for diagnosis.
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Describe non-operative and surgical management strategies.
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Implement preoperative stabilization and supportive care.
Description
Intussusception is the telescoping of a segment of the intestine into an adjacent segment, causing bowel obstruction. It is the most common abdominal emergency in early childhood, particularly in children younger than two years. Ileocolic intussusception accounts for 90% of cases, typically presenting between 6 and 36 months.
Clinical Features
| Feature | Notes |
|---|---|
| Abdominal pain | Intermittent, severe, crampy, sudden onset; paroxysms with relative calm in between |
| Crying / Behavior | Inconsolable crying, drawing legs to abdomen |
| Vomiting | Non-bilious initially, may become bilious |
| Stool | Red blood and mucus, “currant jelly” appearance |
| Palpable mass | Sausage-shaped mass in right upper quadrant |
| Systemic signs | Progressive weakness, lethargy; may progress to shock, fever, peritonitis |
Investigations
| Investigation | Utility / Findings |
|---|---|
| Ultrasound | Diagnostic modality of choice; shows “target sign” |
| Plain abdominal X-ray | Rule out perforation or obstruction |
| Other labs | Baseline CBC, electrolytes, and coagulation if surgery anticipated |
Management
Stabilization (Pre-reduction / Pre-surgery)
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Assess ABCDE.
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Correct dehydration, electrolyte imbalance, hypovolaemia.
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Establish IV access and monitor vital signs.
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Administer analgesia judiciously, avoid masking peritonitis signs.
Reduction Strategies
| Method | Indications / Notes |
|---|---|
| Non-operative reduction | Hydrostatic (saline) or pneumatic (air) enema; indicated if no perforation and facilities & expertise available |
| Surgical intervention | Required if perforation present, patient is acutely ill, or radiologic reduction is unavailable/fails |
⚠️ Non-operative reduction should be performed urgently after diagnosis to prevent bowel necrosis.
Key Summary
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Intussusception is a paediatric surgical emergency, most common in children <2 years.
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Classic triad: intermittent abdominal pain, vomiting, currant jelly stool.
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Diagnosis is usually confirmed with ultrasound (target sign).
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Pre-reduction stabilization is critical: ABCDE, fluids, electrolytes.
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Non-operative reduction is preferred if feasible; otherwise, urgent surgical intervention is required.
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Delay in treatment increases risk of bowel necrosis, perforation, and shock.