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Intussusception
B T Winslow1, J M Westfall, R A Nicholas
1University of Colorado Health Sciences Center, Denver, USA.
Insights
Intussusception, a serious bowel condition, most often affects infants. Early diagnosis and treatment are crucial to prevent complications, with imaging like ultrasound aiding detection.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Intussusception involves one bowel segment telescoping into another, a critical condition.
- It predominantly affects infants aged 5-9 months, but can occur at any age.
Observation:
- While abdominal pain, vomiting, and bloody stools are classic symptoms, lethargy and irritability are more common presentations.
- Rectal examination for occult blood is a key diagnostic step, often yielding positive results.
Findings:
- Barium enema remains the gold standard for diagnosing intussusception and can also be therapeutic.
- Ultrasound is a highly accurate, low-risk screening tool when performed by experienced professionals.
Implications:
- Prompt diagnosis is vital to minimize morbidity and mortality associated with delayed treatment.
- Surgical intervention is reserved for cases where non-operative reduction fails or is contraindicated, or when a lead point is identified.
Abstract:
Intussusception is the invagination of one bowel segment into another. It is an emergent condition that most commonly affects infants between five and nine months of age, but it can also occur in other age groups. The etiology is usually idiopathic in infants five to nine months of age; neonates, older children and adults more commonly have lead points such as a Meckel's diverticulum or a neoplasm. Early diagnosis is essential to avoid treatment delays, which can increase morbidity and mortality. It has been reported that patients with intussusception present with abdominal pain, vomiting and bloody stools, but this classic triad is often absent. More commonly, lethargy and irritability are the presenting signs. A rectal examination, with testing for occult blood, is an important part of the evaluation and is frequently positive. Barium enema is the gold standard for diagnosis and also has therapeutic potential for reducing the intussusception. Ultrasound is an accurate, low-risk screening tool when performed and interpreted by an experienced ultrasonographer. Surgical reduction is performed if nonoperative reduction is contraindicated or unsuccessful, or if a lead point is suspected.