Intussusception - causes, symptoms, diagnosis, treatment, pathology

Summary

Intussusception is a serious condition where a part of the intestine folds into another, causing an obstruction. Common in infants and young children, it can also affect adults. Often occurring in the ileocecal region, this 'telescoping' can lead to severe symptoms like abdominal pain, vomiting, and 'red currant jelly' stool due to intestinal ischemia. Rapid diagnosis and treatment, including imaging, barium or air enemas, and surgery, are crucial to prevent complications like bowel ischemia and perforation. Early intervention can significantly reduce risks associated with this condition.

Takeaways

• 🔍 Intussusception is an intestinal condition where one part of the intestine folds into another, causing obstruction.
• 👶 It is most common in infants and young children, with about two-thirds occurring in infants under one year of age.
• 📍 The ileocecal region, where the small and large intestines meet, is the usual site of intussusception.
• 🌡️ In adults, it's often caused by an abnormal growth like a polyp or tumor, while in infants, it's commonly due to lymphoid hyperplasia.
• 👶 In children, viral infections like rotavirus or norovirus can cause the lymphoid tissue to enlarge, leading to intussusception.
• 🩺 Intussusception can also be caused by a Meckel’s diverticulum, an abnormal outpouching of gastrointestinal tissue.
• ⚠️ Most cases are idiopathic, meaning they occur without a clear cause, and risk factors include previous occurrences or family history.
• 🤢 Symptoms include intermittent abdominal pain, vomiting, and a hard, sausage-like mass in the abdomen.
• 🩸 Complications can include intestinal ischemia and infarction, leading to 'red currant jelly' stools and potential sepsis.
• 🏥 Diagnosis often requires imaging techniques like ultrasound, X-ray, or CT scan, which can reveal the characteristic 'bull's-eye' sign.
• 🛑 Rapid treatment is crucial, with options including a barium or air enema, or surgery if necessary to prevent serious complications.

Q & A

What is intussusception and how is it commonly described?

Intussusception is a condition where a part of the intestine folds into another section, causing obstruction. It's commonly described as telescoping, similar to how one part of a collapsible telescope retracts into another.

Which age group is most commonly affected by intussusception?

Intussusception most commonly affects infants and young children, with about two-thirds of cases occurring in infants under one year of age.

Where in the intestines does intussusception usually occur?

Intussusception usually occurs in the ileocecal region, where the ileum of the small intestine meets the cecum of the large intestine.

What typically causes intussusception in adults compared to infants?

In adults, intussusception is usually caused by an abnormal growth like a polyp or tumor that serves as a lead point. In infants, it's often caused by lymphoid hyperplasia, where enlarged lymphoid tissue acts as a lead point.

What are Peyer's patches and their role in intussusception?

Peyer's patches are small lymph nodes scattered throughout the intestines, particularly in the ileum. They can enlarge due to a viral infection and sometimes act as a lead point that causes intussusception.

What is a Meckel’s diverticulum and how can it cause intussusception?

A Meckel’s diverticulum is an abnormal outpouching of gastrointestinal tissue from the ileum. It can invert and serve as a lead point, causing the ileum to telescope into the cecum, leading to intussusception.

What are the common symptoms of intussusception in children?

Common symptoms of intussusception in children include intermittent abdominal pain, vomiting, a hard sausage-like mass in the abdomen, and the presence of 'red currant jelly' stool.

What is the significance of 'red currant jelly' stool in intussusception?

'Red currant jelly' stool refers to a mixture of sloughed intestinal mucosal tissue, blood, and mucus in the stool, a sign of ischemic and infarcted bowel tissue in intussusception.

What imaging techniques are used to diagnose intussusception?

Intussusception is often diagnosed using imaging techniques like ultrasound, X-ray, or CT scan, which can reveal a classic bull's-eye pattern and signs of intestinal obstruction.

What are the treatment options for intussusception?

Treatment options for intussusception include a barium or air enema, which can unfold the intussusception, especially in children. If this is unsuccessful or complications arise, surgery may be necessary to free the telescoped intestine and remove any dead tissue.

Outlines

00:00

🌀 Understanding Intussusception

Intussusception is a medical condition where a section of the intestine invaginates into an adjacent part, causing an obstruction. Commonly referred to as telescoping, this phenomenon is most prevalent in infants under one year of age but can also occur in adults. The ileocecal region, where the small and large intestines meet, is the usual site of this occurrence. In adults, it's often triggered by abnormal growths like polyps or tumors, whereas in infants, it's frequently due to lymphoid hyperplasia in response to viral infections. Other causes include Meckel's diverticulum, an abnormal pouch in the ileum. Most cases are idiopathic, without a clear cause. Risk factors include a previous occurrence or a sibling with the condition, and intestinal malrotation. Symptoms include intermittent abdominal pain, vomiting, and a hard, sausage-like abdominal mass. Complications can lead to 'red currant jelly' stools, indicating ischemia and tissue death. Intussusception can cause volvulus and sepsis if left untreated. Diagnosis is often made with imaging techniques like ultrasound, X-ray, or CT scan, which can reveal the characteristic 'bull's-eye' sign. Treatment involves a barium or air enema to reduce the intussusception, or surgery if necessary.

05:06

🏥 Treatment and Awareness of Intussusception

Intussusception, a condition causing intestinal obstruction and potentially cutting off blood supply to the intestines, requires prompt medical attention. The video emphasizes the importance of rapid treatment, which can involve a barium or air enema to reduce the telescoping of the intestines. If these non-surgical interventions fail or complications arise, surgery may be necessary. The video concludes with a call to action for viewers to support the channel through Patreon donations, subscriptions, or by spreading awareness on social media.

Keywords

💡Intussusception

Intussusception is a medical condition where one part of the intestine folds into another, leading to an obstruction. It is likened to the action of a collapsible telescope retracting into itself, hence the term 'telescoping.' This term is central to the video's theme as it describes the primary subject. The video explains that it is the most common cause of intestinal obstruction in infants and young children, with most cases occurring in the ileocecal region where the small and large intestines meet.

💡Telescoping

Telescoping is a descriptive term used to explain the mechanism of intussusception, where one section of the intestine retracts into another, similar to the action of a collapsible telescope. This keyword is crucial for understanding the visual and mechanical aspect of how intussusception occurs and is used throughout the script to describe the folding action of the intestines.

💡Peristalsis

Peristalsis refers to the wave-like muscular contractions of the intestines that help move food through the digestive tract. In the context of the video, it is mentioned that peristalsis can inadvertently cause intussusception by pulling a leading edge, such as a polyp or enlarged lymphoid tissue, into the section of the bowel ahead of it.

💡Lymphoid hyperplasia

Lymphoid hyperplasia is the enlargement of lymphoid tissue, particularly Peyer's patches in the ileum. The video explains that this condition often results from a viral infection in the gastrointestinal tract, leading to the enlargement of Peyer's patches which can then serve as a lead point for intussusception in children.

💡Peyer’s patches

Peyer’s patches are clusters of lymphoid tissue found in the intestines, especially in the ileum. The video describes how these patches can enlarge in response to infections, such as those caused by rotavirus or norovirus, potentially leading to intussusception by acting as a lead point.

💡Meckel’s diverticulum

Meckel’s diverticulum is an abnormal outpouching of gastrointestinal tissue that can extend from the ileum into the peritoneal cavity. The video mentions that it can sometimes invert and serve as a lead point for intussusception, dragging the ileum into the cecum.

💡Idiopathic

Idiopathic refers to a condition that arises without a clear or known cause. In the video, it is noted that the majority of intussusception cases in children are idiopathic, meaning they occur without an identifiable cause, despite the well-known mechanisms discussed.

💡Ischemia

Ischemia is a condition where there is a lack of blood flow to tissues, which can lead to tissue damage or death. The video explains that the pressure from the intussusception can cause ischemia in the affected section of the bowel, which is a serious complication that necessitates prompt treatment.

💡Infarction

Infarction is the death of tissue due to a blockage of the blood supply. In the context of the video, infarction can occur when the blood vessels in the intestinal wall are squeezed shut by the pressure of the intussusception, leading to tissue death and potentially severe complications.

💡Red currant jelly stool

The term 'red currant jelly stool' is used to describe a symptom of intussusception where the stool has a characteristic red and jelly-like appearance due to the presence of blood and mucus. This is a significant sign that can indicate the severity of the condition and the need for immediate medical attention.

💡Barium or air enema

A barium or air enema is a medical procedure used to diagnose and treat intussusception. The video explains that this non-surgical method involves using air or a contrast medium to gently push the intussuscepted intestine back into place. It is a first-line treatment approach, particularly in children.

Highlights

Intussusception occurs when a part of the intestine folds into another section, leading to obstruction.

This condition is commonly referred to as telescoping due to its similarity to a collapsible telescope.

Intussusception is the most common cause of intestinal obstruction in infants and young children, particularly in infants under one year old.

In adults, intussusception is usually caused by an abnormal growth like a polyp or tumor, which serves as a lead point.

In infants, the leading edge causing intussusception is often lymphoid hyperplasia, especially in the ileum.

Viral infections like rotavirus or norovirus can cause Peyer’s patches in the ileum to enlarge, potentially leading to intussusception.

A Meckel’s diverticulum, an abnormal outpouching of tissue, can also serve as a lead point for intussusception.

The majority of intussusception cases are considered idiopathic, meaning they occur without a clear cause.

Risk factors include having had intussusception previously, having a sibling with the condition, or intestinal malrotation.

Symptoms of intussusception include intermittent abdominal pain, vomiting, and a hard sausage-like mass in the abdomen.

Ischemia and infarction of the bowel can occur due to pressure on the blood vessels, leading to severe complications.

A classic sign of intussusception is the presence of 'red currant jelly' stool, indicating sloughed-off intestinal tissue mixed with blood and mucus.

Intussusception can be diagnosed through imaging techniques like ultrasound, X-ray, or CT scan, which can show a bull's-eye sign.

Rapid treatment is necessary to prevent complications, with options including a barium or air enema, and surgery if needed.

During surgery, the telescoped section of the intestine is freed, obstructions are cleared, and any dead tissue is removed.

Transcripts

Intussusception is a condition that occurs when a part of the intestine folds into another

section of intestines, resulting in obstruction.

This is commonly referred to as telescoping, because it’s similar to how one part of

a collapsible telescope retracts into another part.

Intussusception is the most common cause of intestinal obstruction in infants and young

children, with about two-thirds of them happening among infants under one year of age, though

adults can occasionally have intussusception too.

Now, intussusception usually happens in the ileocecal region of the intestines, which

is where the ileum of the small intestine and cecum of the large intestine meet, and

almost all intussusceptions happen when the ileum folds, or telescopes, into the cecum.

In adults, telescoping is usually caused by an abnormal growth in the intestine, like

a polyp or a tumor, which serves as a lead point or leading edge.

What happens is that the normal wave-like contractions of the intestine, called peristalsis,

grab this leading edge and pull it into the part of the bowel ahead of it.

In babies the leading edge is most often caused by lymphoid hyperplasia, or the enlargement

of lymphoid tissue.

There are a ton of tiny lymph nodes sprinkled throughout the intestines called Peyer’s

patches, and they’re particularly common in the ileum.

When a child gets some sort of viral infection in the gastrointestinal tract, usually caused

by rotavirus or norovirus, the Peyer’s patches enlarge to help fight off the infection, and

sometimes become a lead point that drags the ileum into the cecum, causing intussusception.

Intussusception can also be caused by a Meckel’s diverticulum, which is an abnormal outpouching

of gastrointestinal tissue, that sticks out of the ileum and into the peritoneal cavity.

Occasionally, the diverticulum can invert and stick back into the intestine, allowing

it to serve as a lead point that again drags the ileum into the cecum.

Although these are well known mechanisms for intussusception, the majority of cases are

considered idiopathic, meaning that they happen without a clear cause.

Risk factors include having had one previously or having a sibling with intussusception,

as well as having intestinal malrotation - which is a condition where the intestine doesn't

rotate correctly during fetal development.

Now, when an intussusception develops, the first sign is intermittent abdominal pain

that worsens with peristalsis, sometimes causing a child to guard their abdomen—for example,

they may swat away the hands of a caretaker—or draw their knees up toward the chest.

Other classic findings include vomiting, and the presence of a hard sausage-like mass in

the abdomen.

There’s also a lot of pressure on the walls of the trapped section of bowel which squeezes

shut the tiny blood vessels running in the walls, causing ischemia—or lack of blood

flow—and infarction—death of the tissues.

Ischemic and infarcted tissue results in the sloughing off of intestinal mucosal tissue,

blood, and mucus into the gut.

This can result in "red currant jelly" stool, which is a food-inspired visual for the berry

jelly consistency of the stool.

Fever isn’t usually a symptom of intussusception, but in serious cases, like with infarction,

the intestines can tear and release bacteria into the body cavity, causing sepsis and fever.

Intussusception can also prevent food or fluid from passing through the intestines, causing

an obstruction.

This can lead to a large mass in the intestines, which can potentially cause the intestine

to become twisted, a condition called volvulus.

In children, intussusception can sometimes be felt by finger while doing a digital rectal

examination, but a definite diagnosis often requires imaging techniques.

An ultrasound, X-ray or computerized tomography (or CT) scan can reveal a classic bull's-eye,

which represents the telescoped intestine shown on end, as well as signs of intestinal

obstruction.

Intussusception can develop suddenly and because of the possibility of intestinal ischemia,

rapid treatment is necessary.

A barium or air enema, can be used to unfold the intussusception, especially in children.

If it doesn’t work or if there’s a complication, then surgery may be necessary.

During surgery, the portion of the telescoped intestine is freed, any obstruction is cleared,

and any tissue that died is removed.

Alright, as a quick recap, intussusception occurs when part of the intestine slides into

an adjacent part of the intestine, a process called telescoping.

Q Intussusception can lead to intestinal obstruction and can also cut off the blood supply to that

part of the intestines, resulting in bowel ischemia.

Rapid treatment is important and can be done with a barium or an air enema, as well as

surgery, if needed.

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