Clinical findings:
Triad < 50% - Abdominal Pain
- Red Currant Jelly Stool
- Palpable Abdominal Mass
Radiologic findings:
- Plain film - Lehman (1914)
- Soft tissue mass
- Target sign
- Abscence of cecal gas and stool
- Meniscus sign
- Loss of visualization of tip of liver
- Paucity of bowel gas
- Can identify intussusception - 50%
- Ultrasound - Bowerman, Swischuk (1980)
- Transverse
- Hypoechoic outer rim and central echogenic core, doughnut sign
- Longitudinal
- Hyperechoeic center - tubular shape in continuity with interstinal lumen on each side by hypoechoic layer-sandwich or pseudokidney sign
- Accuracy 100%
- Spontaneous reduction of intussusception - real time
- lead points - 5%
- other intraabdominal disease - 4%
- doppler - abscence of blood flow - ischemia and necrosis
- US guided saline reduction of intussusception
Target Lesions:
- Intussusception
- Feces
- Psoas muscle
- Crohn's disease
- Hematoma
- Volvulus
Lead Points:
- Neonates:
- Meckel diverticulum
- Duplication cysts
- Hamartoma
- Mesenchymoma
- Older Children:
- Mechel diverticulum
- Polyps
- Duplication cysts
- Non-Hodkin Lymphoma
- Celiac disease
- Henoch-Schönlein purpura
- Hemophilia
- Kawasaki syndrome
- Polyarteritis nodosa
- Post-op neuroblastoma
Contraindications for reduction:
- Peritonitis
- Perforation
- Septic Shock
Treatment:
Barium Enema Therapy
- Advantages
- Maximum experience with this method
- Good results with optimized method (55-90% of cases)
- Good evaluation of ileoileal residual intussusceptions
- Low perforation rate (0.39-0.7%)
- Disadvantages
- X-ray exposure required, thus limiting procedure time
- Perforation causes chemical peritonitis
- Visualization of only intraluminal content
Air Enema Therapy
- Advantages
- Excellent results (70-90% of cases)
- Less x-ray exposure than with barium enema
- Easy, quick, clean technique
- Disadvantages
- X-ray exposure required, thus limiting procedure time
- Higher perforation rate (0.14-2.8%) with risk of tension pneumoperitoneum
- Visualization of only intraluminal content
- Less control of residual ileoileal intussusceptions
US-guided Saline Enema Therapy
- Advantages
- No x-ray exposure, thus procedure time not limited
- Excellent results (79-95.5% of cases)
- Visualization of all components of the intussusception
- Easier recognition of lead points and residual intussusceptions
- Lower perforation rate (0.26%)
- Disadvantages
- Sonographer or sonologist needed
Post-operative Intussuception:
- 0.5-0.8% of all laparotomies
- Rectal bleeding less than 60% of cases
- Mean 10 days (3-36 days), 90% occuring in first 2 weeks
- Post-operative obstruction 2 weeks or more after surgery in 75%
- Intestinal tubes, intestinal suture lines and inverted appendiceal stumps- lead points
- Handling of bowel during surgery - return of peristalsis