Welcome to the channel where medical topics are made easy.
In this video, we’re going to talk about intussusception including what it is,
the symptoms, how it’s diagnosed, and how it’s managed.
At the end of the video, there will be high-yield buzzwords and learning points
you need to know for board exams, so make sure to watch until the end.
As always, you can find all of the notes for this video linked down below.
The timestamps for the video can also be found in the description.
So turn on the captions and read along, and let’s get right into it!
First we have to ask ourselves, what is intussusception?
It occurs when a portion of bowel or intestine folds in on itself, like a telescope,
and this can lead to a bowel obstruction.
So what do we mean by that?
Normally the intestines are shaped like a tube,
and content travels through the tube with no problem.
During intussusception a part of the intestine folds in on
itself at a more distal segment downstream.
This is called “telescoping” because it folds in on itself like a telescope.
Content will now have a harder time passing through the intestine,
and this can lead to an obstruction.
The telescoping of the intestine may also cut off blood supply to the affected area of the bowel.
This can cause the area to become even more swollen or edematous,
which can cut off blood supply even more.
And this can lead to worsening obstruction, bowel ischemia, and bowel necrosis.
Let’s go over some of the main features of intussusception.
The majority of cases occur between 6 and 36 months of age.
More than half of cases occur at less than 12 months with a median age of about 9 months.
Intussusception can also affect younger or older patients,
and even adults, however this is less common.
Intussusception is more common in males than females.
And it's the most common cause of bowel obstruction in pediatric patients.
Intussusception is most common at the ileocolic region,
which is the junction of the ileum and cecum of the colon.
The information in red is important for board exams.
Often the question stem for intussusception will have a 6-36 month old male presenting
with signs of a bowel obstruction and symptoms associated with the condition.
Let’s talk about those symptoms now.
So what are the symptoms to look out for?
There are 3 main symptoms to remember with intussusception.
The triad commonly seen on board exams includes vomiting that may be bilious,
intermittent colicky abdominal pain, and “currant jelly” bloody stools.
Let’s take a closer look at each of these.
The first symptom is vomiting,
which makes sense because if there is a bowel obstruction,
then the patient may experience vomiting since the content can’t pass through the bowel.
As a result, the vomiting may be bilious or yellow-green in color.
The next symptom is abdominal pain.
It is often described as sudden onset intermittent colicky pain occurring in episodes.
Episodes are usually in 15-20 minute intervals.
And during an episode, the infant may suddenly cry loudly
and draw their legs up to their chest or curl up in a ball.
The third symptom is bloody stools.
The common buzzword on board exams is “currant jelly” stools, so remember that.
Bloody stools may be a late finding and could be a sign that the affected bowel is not receiving
enough blood supply, called ischemia, and subsequent tissue death or necrosis may be occurring.
Finally, there is one more important buzzword to know.
This is more of a sign rather than a symptom, but commonly shows up on board exams.
There may be a “sausage-shaped” abdominal mass on palpation during the physical exam.
“Sausage-shaped” abdominal mass is a common buzzword.
So the 2 important buzzwords to know here are highlighted in red.
Remember “currant jelly” stools and “sausage-shaped” abdominal mass.
If we organize these symptoms,
typically what you will see in infants less than 12 months of age
is emesis, irritability, and bloody stools.
Younger infants may also present with lethargy or altered levels of consciousness,
so always keep intussusception in the back of your mind.
Patients older than 12 months of age usually have abdominal pain as a more common symptom.
So what’s the cause of intussusception?
In many uncomplicated cases, we don’t know the cause.
It’s believed it could be secondary to viral infections.
Viral infections involving the GI system can cause
inflammation of lymphatic tissue in the intestines.
This can lead to the intestine folding
in on itself and subsequent development of intussusception.
Intussusception can also be caused by underlying pathology
such as Meckel’s diverticulum, intestinal polyps, hemangioma, neurofibromas, or lymphoma.
Any of these can potentially cause the intestine to telescope.
Let’s talk about how intussusception is diagnosed.
Ultrasound has a high sensitivity and specificity for diagnosing intussusception.
There is no radiation making it safe in pediatric patients.
And it can be performed at bedside if the clinician has experience.
In the short axis, ultrasound may show a “target sign” or “bull’s eye”.
These are common buzzwords used on board exams, so make sure you remember them.
This is due to the intestine folding in on itself, which creates a target or bull’s eye appearance.
In the long axis, you might see a “hayfork” or “pseudo-kidney” appearance.
Again this is caused by the telescoping of the intestine.
Abdominal x-rays can potentially diagnose intussusception as well.
You may see signs of intestinal obstruction or other radiological signs to suggest
intussusception, however this has a lower sensitivity and specificity than ultrasound.
While ultrasound is commonly used for diagnosis, some of the treatments for
intussusception can potentially be diagnostic and therapeutic as well.
This brings us to the management which we'll talk about next.
So how do you treat intussusceptions?
Many small bowel-to-small bowel cases are transient and resolve on their own.
And they may not require intervention, especially if they’re uncomplicated.
Uncomplicated small bowel cases might be caused by viral infections
which can self resolve as the viral infection and lymphatic inflammation improve.
Having said that, there are features, risk factors, and underlying causes that may require
intervention in these cases, so it’s always good to discuss with the appropriate teams.
The majority of intussusception cases are ileocolic,
which typically require intervention.
If it is determined the intussusception requires treatment,
then there are a couple different options.
First, if the intussusception is uncomplicated,
an air or contrast enema can be performed to try to reduce it.
If the first attempt is unsuccessful, then a repeat attempt could potentially
be made in about 30 minutes to 4 hours under certain circumstances.
The patient would need to be stable without signs of peritonitis or any other complications.
And again this should be a joint decision between surgical,
radiological, and any other appropriate teams.
A successful second attempt could potentially avoid the need for surgery.
That brings us to the second form of treatment which is surgical intervention.
Surgery would be necessary if non-operative approaches fail,
or there are complications such as an unstable patient,
bowel perforation, peritonitis, or any other contraindications to a non-operative approach.
If intussusceptions are not treated or do not resolve on their own,
then that can lead to complications.
This might include ischemic bowel, sepsis, bowel perforation, or peritonitis to name a few.
Let’s wrap it up with the main learning points and buzzwords you might see on exams.
Remember intussusception is “telescoping” of the intestines.
The question stem will usually have a 6-36 month old male infant
as that is the common age and gender.
Remember the triad of symptoms including vomiting which can be bilious,
intermittent colicky abdominal pain, and bloody stools described as “currant jelly”.
There may be a “sausage-shaped” abdominal mass on physical exam.
Diagnosis is usually made with ultrasound that can show a “target sign” or a “bull’s eye”.
Treatment will depend on the case and may involve observation, air or contrast enema, or surgery.
The main buzzwords you will see on exams are highlighted in red.
Hopefully this helped you better understand intussusception.
If you found the video useful please show your support and hit that subscribe button.
Don’t forget to like and comment as well.
As always, you can find all of the notes and pictures for this video on
the website linked down below in the description.
Thanks for watching and hope you check out future videos.