Intussusception

Intussusception: Description, Causes and Risk Factors:ICD-10: K56.1IntussusceptionIntussusception is when one segment of intestine "telescopes" inside of another causing an intestinal obstruction. Although it can occur anywhere in the gastrointestinal tract, it usually occurs at the junction of the small and large intestine. The obstruction can cause swelling & inflammation that can lead to tearing of the intestines.The causes of intussusception are not fully known. Viral infections of the intestine may possibly contribute to intussusception in infancy. Intussusception is very rare in older children in whom the presence of a polyp or a tumor may trigger the intussusception. A polyp or tumor is a common cause of intussusception in adults.Risk factors:Carcinoma of appendix.
  • Adenomyoma in a Meckle's diverticulum.
  • Submucous lipoma.
  • Extramedullary haematopoietic tumour.
  • Hemangioma of small bowel.
  • Endometriosis of terminal ileum.
  • Peutz Jegher's polyp.
  • Metastatic testicular germ cell tumour.
  • `Vanished' colonic tumour with deposits in glands.
  • Pneumatosis coli.
  • Coeliac disease.
  • Ileal aberrant pancreas.
  • Duodenal villous adenoma.
  • Metastatic melanoma of ileum.
  • Bowel wall hematoma.
  • Gastroduodenal due to gastric carcinoma.
Intussusception occurs most commonly in between the ages of 3 to 24 months, but may occur at any age. It is seen in approximately 1 in 1,200 children with increased frequency in boys. Intussusception occurs most frequently in the fall and winter months during viral season, but may occur at anytime during the year.Symptoms:The characteristic signs and symptoms of intussusception are episodic, severe, crampy abdominal pain alternating with periods of lethargy. Small children may draw their knees up to their chest. Other possible symptoms of intussusception include:Nausea and vomiting and rectal bleeding (red jelly-like stools) sometimes mixed with mucus.These symptoms begin abruptly, usually one week after a non-specific viral illness.Diagnosis:Intussusception is associated with an abdominal mass, which may be felt upon physical examination. Ultrasonography is able to identify the mass with 100 percent accuracy and is now the first radiologic test prescribed for patients with suspected intussusception. Two other radiologic tests--barium enema and air contrast enema--also are used to help diagnose intussusception.Treatment:There are two ways of treating intussusception:Nonsurgical: Air Enema: An air enema is carried out in the x-ray department and you can usually be present with your child if you wish. A tube is placed into your child's bottom. Air is passed into the tube by gentle pressure which can push the telescoped part of the intestine back into place, clearing the blockage.If an air enema is successful your child will return to the ward and be allowed a drink after a few hours. Your child will continue to be monitored for a few days.Sometimes air enemas do not cure the intussusception and an operation will be needed.Surgical correction: If the air enema did not resolve the intussusception or if the surgeon thinks your child is too unwell to have an air enema, an operation will be required to surgically correct the intussusception. The operation will be carried out under a general anaesthetic.The surgeon will make a cut and locate the telescoped part of the intestine. The surgeon will then gently push the telescoped part back into place, clearing the blockage. If the intestine is damaged where the blockage had been, it may be necessary to remove this section and join the ends together.The wound will be stitched on the inside of the skin with dissolvable stitches. Sometimes paper tapes called `Steris-Strips' are also applied.After the operation your child will be monitored closely; if your child has been very unwell this may be in the children's intensive care unit. After the operation the intestine will not begin to work normally immediately, usually it takes a few days. During this time your child will continue to have a drip and the nasogastric tube will stop the feeling of sickness.Drinks will be given to your child once their intestine has started to work normally again (this will be indicated by the color of fluid changing in the nasogastric tube and the volume getting less). Medicines will also be given to stop pain.Once your child is eating and drinking normally again and is having his/her bowels open you will be able to go home. This may be several days later.Note: Risks and benefits of the surgery must be discussed with your surgeon.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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