INTUSSUSCEPTION - the hand over & take over Dr.A.S.Baisya, Silchar Medical College, Silchar INTRODUCTION John Hunter is credited with first pathological description of intussusception Early descriptions of this condition can be traced back.
Download ReportTranscript INTUSSUSCEPTION - the hand over & take over Dr.A.S.Baisya, Silchar Medical College, Silchar INTRODUCTION John Hunter is credited with first pathological description of intussusception Early descriptions of this condition can be traced back.
Slide 1
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 2
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 3
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 4
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 5
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 6
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 7
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 8
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 9
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 10
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 11
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 12
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 13
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 14
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 15
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 16
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 17
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 18
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 19
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 20
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 21
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 22
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 23
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 24
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 25
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 26
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 27
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 28
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 29
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 30
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 31
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 32
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 2
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 3
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 4
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 5
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 6
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 7
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 8
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 9
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 10
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 11
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 12
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 13
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 14
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 15
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 16
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 17
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 18
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 19
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 20
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 21
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 22
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 23
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 24
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 25
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 26
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 27
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 28
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 29
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 30
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 31
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4
Slide 32
INTUSSUSCEPTION
- the hand over & take over
Dr.A.S.Baisya,
Silchar Medical College,
Silchar
INTRODUCTION
John Hunter is
credited with first
pathological
description of
intussusception
Early descriptions of
this condition can be
traced back to
Hippocrates.
PATHOPHYSIOLOGY
Intussusception is the most
common cause of intestinal
obstruction in infants under
2 years of age.
The median age of
presentation is 7 months
In India an increased
incidence of intussusception was reported in the
summer months
(WHO/V&B/00.23, 2000)
PATHOPHYSIOLOGY
Invagination of a bowel segment (usually small
bowel) into the lumen of the more distal bowel
(usually colon) occurs. The invaginated segment
(intussusceptum) is carried distally by peristalsis.
Mesentery and vessels become involved with
the intraluminal loop and are squeezed within
the engulfing segment (intussuscipiens). Almost
all occurrences are acute. Venous congestion is
a major factor both in symptomatology and in the
characteristic presence of blood in the stool.
AGE INCIDENCE
Aetiology
An idiopathic aetiology was reported in 42
to100% of patients in 20 studies.
An association with a prior respiratory
infection or acute gastroenteritis was
reported in some studies.
The diagnostic difficulty in differentiating
between acute gastroenteritis or bacillary
dysentery and intussusception is present in 17% of
patients who present with rectal bleeding alone.
These patients were treated for three to five
days for bacillary dysentery before the diagnosis of
intussusception was established.
It is recommended that intussusception should be
excluded in patients with acute rectal bleeding or if
abdominal distension followed an episode of
gastroenteritis or enterocolitis.
The delay in appropriate treatment caused
by misdiagnosis contributes to the
resection rate and mortality (Jain et al.,
1990).
In another study, 52% of patients had a
preceding history of diarrhoea and had
been treated with antidiarrhoeal agents
(Yadav, 1986) (WHO/V&B/00.23, 2000)
(WHO/V&B/02.19, 2002)
(WHO/V&B/02.19, 2002)
Symptoms and signs present in
intussusception patients
Abdominal pain
Vomiting
Bile-stained
Non-specific
Pallor ‡
Lethargy
Rectal bleeding/bloody
stool (including red
currant)
Blood on rectal exam
Abdominal mass
Abdominal distension
Rectal mass
Hypovolaemic shock ‡
Plain abdominal X-rays
Intestinal obstruction
Soft-tissue mass
Non-specific
Ultrasound
Soft-tissue mass
Abnormal bowel sounds
Rectal prolapse
A male predominance is observed
Crying or irritability interpreted by the
parents or doctor as a manifestation of
abdominal pain is reported in all patients
The classic triad of intussusception,
described as vomiting, rectal bleeding and
abdominal pain, was observed in only 43%
of patients
Most
intussusceptions are acute and
present in a well-nourished infant with
signs and symptoms of bowel obstruction
as follows:
Cramping abdominal pain
Poor feeding
Vomiting
The
infant usually has one or more
episodes of diarrhoea mixed with blood
and mucus (i.e., currant-jelly stool), which
is related to venous congestion
A palpable, slightly tender, sausageshaped mass in the abdomen is
characteristic
In
some patients, intussusception is
painless; the infant may appear pale,
diaphoretic, or lethargic
The physician may not suspect
intussusception if unusual symptoms
present or if symptoms mask an upper
respiratory infection
INVESTIGATIONS
Abdominal radiograph: Dilated small bowel and
absence of gas in the region of the caecum
Ultrasound
Transverse: a mass with a swirled appearance of
alternating sonolucent and hyperechoic bowel wall of
the loop-within-a-loop
Longitudinal: shows a submarine sandwich-like
appearance of the intussuscipiens and the
intussusceptum. There appear to be multiple layers,
which represent the walls of the intussuscepted bowel
loops
X-RAY
ULTRASOUND
Case 1
Case 2
Case 3
Case 4