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Intusussception (Clinical
presentation (Anorexia, Vomiting
May be bile…
Intusussception
Clinical
presentation
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Pain
Site: general
Onset: paroxysymal
Character: colicky
Associated: circumoral pallor, draws legs up (pallor)
Timing: intermittent
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Pathophysiology
Defect
Invagination (telescoping) of proximal bowel
into distal (usually ileum to caecum via ileocaecal valve)
Mechanism
Obstruction to bowel contents
Can lead to stretching and constriction of
mesenetrym causing venous obstruction, engorgement,
bleeding then perfoation, peritonitis and necrosis
Pooling of fluid in gut, may cause hypovolemia
Causes
Often idiopathic
Sometimes caused by viral infection causing enlarged Peyers patches
Older children, may be due to a Meckel's diverticula or polyp
Diagnosis
Examination
Abdo exam
Pallor, irritable, dehydrated, colic
Sausage shaped mass, distension
Investigations
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Imaging
USS with air enema/contrast: target/donut sign
AXR: RLQ opacity, perforation,distended bowel,
absence of gas in distal colon/rectum
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History
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POH
Scans, bloods, growth, gestation,
delivery, weight, complications
PC/HPC
Abdo pain, vomiting, red stool,
anorexia, poor feeding, irritable
SH
Living arrangements,
school/nursery
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Epidemiology
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Occurs from any age, peak age 3m-2y
Management
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Definitive
Conservative
Information, advice, support
Admit to hospital
Surgical
Rectal air insufflation
Indication: 1L
MOA: insertion of air enema
iinto rectum to unfold bowel
SE: perforation
Surgical fixation
Indication: perforation, unsuccesful air insufflation
MOA: laparoscopy/laparotomy, repair and
removal of any necrotic bowel
Medical
Analgesia
Indication: pain
E.g. paracetamol, NSAID
Fluids
Indication: resus
E.h. NaCl, Hartmanns
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