Makindo Medical Notes

Related Subjects: |Encopresis in Children |Enuresis/Bedwetting in Children |Acute Glomerulonephritis in Children |Nephrotic Syndrome in Children |Acute Appendicitis in Children |Gastro-oesophageal reflux in Children |Intussusception in Children |Panayiotopoulos Syndrome in Children |Reflex anoxic attacks in Children

Paediatric intussusception is the commonest cause of intestinal obstruction in infants 👶. It occurs when one segment of bowel telescopes into another, causing obstruction 🚫 and compromised blood flow 🩸. Early recognition is essential ⚠️: untreated, it can lead to bowel ischaemia, perforation, and death 💀.

Introduction

• Most common between 5–12 months of age 📆.
• Male:female ratio ≈ 3:1 ♂️:♀️.
• Unlike adults (where tumours are common), most infant cases are idiopathic 🤔, often following viral illness 🦠 and Peyer’s patch hypertrophy.

Clinical Presentation

• Colicky abdominal pain 🤯: Episodes of inconsolable crying 😭, with legs drawn up to the abdomen.
• Vomiting 🤮: Initially non-bilious, may become bilious if obstruction worsens.
• Red-currant jelly stool 🍓💩: Mixture of blood and mucus – a late and ominous sign.
• Sausage-shaped abdominal mass 🌭: Typically palpable in the right hypochondrium or epigastrium.
• Intermittent wellness 🙂: Between painful episodes, the child may appear well.
• Advanced cases: lethargy 💤, shock ⚡, or moribund appearance 🪫.

Diagnosis and Tests

• Ultrasound 🖼️: Investigation of choice – shows the classic “target” or “doughnut” sign 🍩. Also used for guided reduction.
• Air enema 💨: Gold-standard for both diagnosis and treatment ✅. Safer than barium (lower perforation risk).
• Abdominal X-ray 📸: Non-specific – may show soft-tissue mass, paucity of distal gas, or perforation signs.
• CT scan 🖥️: Rarely used in children due to radiation ☢️; reserved for atypical cases.

Management

• Initial stabilisation 🏥: IV fluids 💧, NG tube decompression, cross-match blood 🩸, and analgesia.
• Non-surgical reduction 💨: Air enema = first-line if no perforation or peritonitis.
• Surgical intervention 🔪: Required if enema fails, perforation suspected, or necrotic bowel present. May involve manual reduction or resection.

Special Considerations

• Children >4 years 👦: Less often idiopathic – look for lead points such as Meckel’s diverticulum, Peutz–Jeghers polyps, lymphoma, cystic fibrosis, Henoch–Schönlein purpura.
• Presentation may be more subacute ⏳, with obstructive symptoms or chronic abdominal pain.

Recurrence and Prognosis

• Recurrence rate 🔁: ~5–15% after successful enema reduction.
• Prognosis 🌟: Excellent if diagnosed promptly. Delay risks bowel necrosis 🩸, perforation 💥, sepsis 🦠, and death 💀.

Key Clinical Pearls 💡

• Think of intussusception in any previously healthy infant 👶 with sudden episodic pain + vomiting 🤮.
• Red-currant jelly stool 🍓💩 = late sign – don’t wait for it before suspecting diagnosis.
• Air enema 💨 = both diagnostic and therapeutic.