Intussusception

Also known as telescopic botty. It is a medical condition in which a

proximal part of the bowel (intussusceptum) invaginates into a distal part of the bowel (intussuscipiens).

Epidemiology
Naraynsingh V, Raju GC. Adult intussusceptions in

Trinidad. Journal of the Royal College of Surgeons of Edinburgh 1987: 32(1): 22-23 Adult intussusception is quite uncommon and accounts for only 4% of all intestinal obstruction over the age of 12 years.

Pathogenesis

 Occurs near the ileocaecal junction most

commonly. Predisposing Factors: Intestinal malrotation Meckels diverticulum Tumours: Benign: Peutz-Jeghers Syndrome, juvenile polyposis, Cowden Syndrome, Cronkhite-Canada syndrome-egs. of Hamartomatous polyps, lipomas Malignant- adenocarcinomas, carcinoid tumours Lymphoma Ulcerative colitis and Crohns disease

 During surgery, it was realized that R.B had

intestinal malrotation where the small intestines where localized to the right and the large intestines localized to the left. Two polyps were found at the ileocaecal junction.

Clinical Presentation
Classic triad of abdominal pain, palpable

abdominal mass (sausage shaped) and currant jelly stool. Pain is usually colicky and intermittent with a range in duration of weeks to years. Other associated features include vomiting, constipation, diarrhoea, abdominal distension and tenderness.

 Fever can be a late complication due to due

sepsis that can occur. Arterial blockage can lead to bowel ischemia, necrosis with subsequent perforation and sepsis. Malaise Differential Diagnoses: Acute gastroenteritis- abdominal pain, vomiting, stool with blood and mucus Rectal prolapse Henoch-Schonlein purpura-small vessel vasculitis that causes GIT bleeding, colicky abdominal pain and change in bowel habitus.

Diagnosis
A good history and clinical examination

Abdominal X-ray: less sensitive and specific,

may show distended bowel loops absent of colonic gas and an abdominal mass.
Ultrasound: highly sensitive and specific (88-

100%), shows target or doughnut sign and a pseudokidney sign.

Target sign

Pseudokidney sign

 Contrast enema: contraindications include

peritonitis and perforation. CT scan

Management

Treated with a barium or water soluble

enema or an air contrast enema. Both can diagnose and reduce it; has a recurrence rate of 5-10% within 24 hrs.