Intussusception is a process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction.
History - The pts is usually an infant, often /w ОРЗ;
Sx:
Vomiting: Initially, nonbilious and reflexive, but when the intestinal obstruction occurs, vomiting becomes bilious
Abdominal pain: Pain in intussusception is colicky, severe, and intermittent
Passage of blood and mucus: Parents report the passage of stools, by affected children, that look like currant jelly; this is a mixture of mucus, sloughed mucosa, and shed blood; diarrhea can also be an early sign of intussusception
Lethargy: This can be the sole presenting symptom of intussusception, which makes the condition’s diagnosis challenging
Palpable abdominal mass
Physical examination
a right hypochondrium sausage-shaped mass and emptiness in the right lower quadrant (Dance sign). This mass is hard to detect and is best palpated between spasms of colic, when the infant is quiet. Abdominal distention frequently is found if the obstruction is complete.
Diagnosis
Radiography: Plain abdominal radiography reveals signs that suggest intussusception in only 60% of cases
Ultrasonography: Hallmarks of ultrasonography include the target and pseudokidney signs
Contrast enema: This is the traditional and most reliable way to make the diagnosis of intussusception in children
Management
Nonoperative reduction - Therapeutic enemas include the following:
Hydrostatic: With barium or water-soluble contrast
Pneumatic: With air insufflation; this is the treatment of choice in many institutions, and the risk of major complications with this technique is small
Surgical reduction
Traditional entry into the abdomen is through a right paraumbilical incision. The intussusception is delivered into the wound, and manual reduction is attempted. It is important that the intussusception be milked out of the intussuscipiens.
If manual reduction is not possible or perforation is present, a segmental resection with an end-to-end anastomosis is performed.
Laparoscopy has been added to the surgical armamentarium for intussusception and can be performed in all cases of intussusception.