Intussusception: Clinical presentation, Radiological investigations, Management: Surgery

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Intussusception: Introduction, Clinical presentation, Radiological investigations, Management -
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Introduction 📖 -
Intussusception is a serious and potentially life-threatening condition where a part of the intestine telescopes into an adjacent segment, causing an obstruction. It most commonly occurs in infants and young children, typically between the ages of 6 months and 3 years. In adults, intussusception is rare and often associated with an underlying pathology such as a tumor. In children, it is usually idiopathic, but viral infections, swollen lymph nodes, or Meckel's diverticulum can be contributing factors.

Clinical Presentation 🩺 -
The symptoms of intussusception in children often come on suddenly and may include:
- Acute abdominal pain 🩹: Colicky pain episodes, where the child may cry intensely and pull their knees to their chest.
- Vomiting 🤢: Non-bilious at first, but can become bilious (greenish) as the condition progresses.
- “Currant jelly” stool 🍓: Bloody stools mixed with mucus, a characteristic sign in more advanced cases.
- Lethargy 💤: Children may become weak and drowsy between pain episodes.
- Palpable sausage-shaped mass: A firm mass may be felt in the abdomen, usually in the right upper quadrant.
- Shock symptoms ⚠️: In advanced cases, dehydration and shock may occur, manifesting as pale, clammy skin, and a rapid heart rate.
- In older children or adults, the symptoms may be less specific, and chronic intermittent pain might be the only presenting symptom.

Radiological Investigations 🖼️ -
Ultrasound (USG) 📡: First-line investigation and the gold standard for diagnosing intussusception in children. The classic “target sign” or “doughnut sign” is seen on a transverse view, while a “pseudokidney sign” is seen on a longitudinal view.
Abdominal X-ray 🖼️: May show signs of bowel obstruction such as dilated loops of bowel and air-fluid levels, but is not diagnostic for intussusception itself.
Contrast Enema (Air or Barium) 🩸: Both diagnostic and therapeutic. The telescoped segment of the bowel can be visualized, and often the enema can reduce the intussusception by exerting pressure from inside the bowel.

Management 🏥 -
Management of intussusception is an emergency because prolonged obstruction can lead to ischemia, necrosis of the bowel, perforation, and peritonitis.

Non-Surgical Reduction 🔄:
Air or Barium Enema Reduction: This is the first line of treatment in stable children. The pressure from the enema can push the telescoped bowel back into its normal position.
Success rates with air enema are quite high, around 85-90%, especially when done early after the onset of symptoms. Immediate surgery is considered if reduction fails.

Surgical Management 🏥:
Indications for Surgery:
Failed enema reduction
Signs of bowel perforation
Peritonitis
Hemodynamic instability
Adult patients (due to higher likelihood of pathological lead points like tumors)
Procedure: In surgery, manual reduction is attempted, or if necessary, the affected segment of the intestine is resected if necrosis is present.

Postoperative Care 🛏️-
Monitoring for recurrence (which occurs in about 10% of cases)
Fluid resuscitation and management of electrolytes
Antibiotics if perforation or sepsis is suspected

Complications ⚠️ -
Bowel ischemia: Lack of blood flow to the telescoped segment can lead to tissue death.
Bowel perforation: This can result from untreated intussusception or unsuccessful reduction attempts.
Peritonitis: In case of perforation, infection can spread into the abdominal cavity, leading to sepsis.

Recurrence 🔄: Intussusception can recur, especially in cases with underlying pathology or incomplete reduction.

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