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Intussusception def., causes, diagnosis, pathology, types, treatment

In this article, we are going to discuss Intussusception which is a serious disorder and it can cause intestinal obstruction with its known complications.
We are going to discuss the definition, aetiology (causes), pathology, clinical picture (symptoms and signs), investigations, differential diagnosis, and treatment (management) of Intussusception .

What is meant by Intussusception ?

Definition: One portion of gut becomes invaginated into another immediately adjacent portion .
Etiology
Primary intussusception
1.      Idiopathic:
2.      Infant between 6th – 7th months.
3.      In terminal 50 cm of ilium
4.      Theories: à Change of diet, Seasonal incidence
Secondary intussusception (Occurs 2ry to):


1.      Polyp.
2.      Submucous lipoma.
3.      Papilleferous carcinoma.
4.      Inverted Mickle’s diverticulum.


Pathology
Intussusception

·         The intussusception is made up of: Entering layer, Returning layer, Outer sheath, Apex., Base.
·         The apex is the part which advances.
·         The base of the sheath will contract on the intussusceptum constricting its lumen & its mesenteric vessels.
Types of intussusception:

1.      Ileo-caecal:
2.      Ileo-ileal
3.      Ileo-colic
4.      Colo-colic
5.      Retrograde
6.      Multiple

Clinical picture of 1ry intussusception:

Age & sex: à Usually a healthy boy 6 : 24 months old.
Symptoms :.
Pain à Attacks in which child cries & draws up his legs & screams.
Vomiting à starts after 24 hours
Constipation à blood & mucous per anus (red-current jelly)
Distension à starts after 24 hours
Signs
General….
Local
Inspection
1. Rigidity
2. Distension of the abdomen
3. Visible peristalsis.
Palpation
1. Guarding, tenderness & Rebound tenderness (if complicated)
2. Sausage-shaped mass à concave towards umbilicus.
3. Sign de dance à right iliac fossa feels empty
Percussion à Tympanitic abdomen.
Auscultation à mad abdomen
PR:
1.      The finger is stained with mucous & blood.
2.      apex of the intussusception may be felt.
3.      Very rarely à intussusception protrudes through the anus.
Investigations:
Barium enema (Diagnostic & Therapeutic) à “Claw” sign
Saline enema & U/S
Differential diagnosis:


Acute enterocolitis
Prolapse of rectum
Henoch’s purpura


Treatment:

Pre-operative preparation: à 
1.      Ryle & suction.
2.      Line: restoration of water & electrolyte balance.
3.      Catheter.

4.      Chart.
                              5. Atropine 0.2 mg I.M.
Operation:
-          The mass is reduced
-          If irreducible or gangrenous à resection & anastomosis.

Recurrence à stitch terminal ileum to the caecum.
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Tamer Mobarak

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