Intussusception

Dr/ Hytham Nafady

Definition

• Telescoping invagination of an intestinal segment into the lumen of a proximal segment.

Intussuscpetion

Without a leading point With a leading point

ESENTERY

Lymphoid hyperplasia

EtiologyAdults Children

Spontaneous: (without anatomical leading point):•Celiac disease.•Scleroderma.•Whipple disease.

Spontaneous: (without anatomical leading point) in 90% of cases:•Mucosal edema & lymphoid hyperplasia after viral gastroenteritis.

Leading point (90%):•Tumor:Usually benign in small intestine & malignant in large intestine.•Polyp,•Ulcer,•Foreign body.

Leading point:•Meckel’s diverticulum.•Polyp.•Enterogeneous cyst.•Ectopic pancreas.•Purpura.

C.PAdults Children (6M-2Y)

Recurrent abdominal pain.

Abrupt onset of violent crampy abdominal pain.

Vomiting.Bloody stool. Redcurrant jelly stool.

Palpable abdominal mass.

Palpable Abdominal mass.

Types

Adults Children Ileo-ileal.Ileo-colic.

Ileo-colic.Ileo-ileal.Colo-colic.

Redcurrant jelly stool

األحمر الكشمش

Plain x-ray abdomen

• May be normal.• Meniscus sign:• Crescent of gas within colonic lumen that

outlines the apex of intussusceptum.• Little air in small intestine.

Meniscus sign

Meniscus sign

U/S

• Target sign:

Barium enema

• Coil spring appearance:• Trapping of barium between the edematous

mucosal folds of the returning limb of intussusceptum & wall of intussuscepian.

• Meniscus sign:• Convex intraluminal mass.

The main contraindication of enema is perforation

Coil spring sign

Colo-colic intussusception with a leading point of adenocarcinoma