Intussusception: Examination and Diagnosis

by Kevin Pei, MD

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    00:01 Physical findings common for intussusception.

    00:04 This may be difficult to differentiate from other signs of abdominal pain.

    00:10 Patients may vomit.

    00:12 Initially, the vomiting is non-bilious.

    00:14 This is reflexive.

    00:16 Don't be confused.

    00:17 This is not a diagnosis of hypertrophic pyloric stenosis, which, as you know, results, in non-bilious emesis and projectile vomiting.

    00:26 Later, however, the emesis is usually bilious.

    00:29 Now, the emesis is due to a small bowel obstruction.

    00:36 The patient may have abdominal pain.

    00:38 Particularly with worsening abdominal pain, you should be concerned about ischemia or impending ischemia.

    00:46 And sometimes, passage of bloody stools.

    00:50 I hope you don't like currant jelly stool because this is what is classically described as bloody stools in intussusception.

    00:59 What laboratory findings might you find? On chemistry, due to the vomiting, you may classically find low sodium, low chloride and low bicarb.

    01:10 Additionally, particularly with signs of ischemia, you may find a child with an elevated white blood cell count or leukocytosis.

    01:19 Let's move on to imaging to help diagnose.

    01:22 Ultrasound, remember, is incredibly helpful in the young.

    01:26 We try not to expose our babies and infants to radiation as much as possible.

    01:31 Again, to remind you, the abdominal wall of a child is usually thin and quite amenable to ultrasound techniques.

    01:39 As you can see on this ultrasound image, this is a classic target sign.

    01:44 Notice the white circle in the middle of the screen, that's the portion of the intestines that’s invaginated or telescoped into the proximal bowel.

    01:54 Also important to notice, the thick black band around the inside circle is edematous proximal bowel.

    02:01 Remember our discussion about venous and lymphatic congestion.

    02:05 This finding is consistent with potentially ischemic bowel and this patient may need surgery.

    02:14 Abdominal x-rays unfortunately are much less reliable.

    02:18 However, we’ll shortly discuss why contrast studies may actually be both diagnostic and therapeutic.

    02:28 This is a cross-sectional CAT scan of the abdomen and pelvis clearly in an adult.

    02:33 I want to point out to you that intussusception can happen in adults as well.

    02:37 And it's rare for us to get a CAT scan in children.

    02:40 Do you notice the target sign here shown by the white arrow? It looks remarkably similar to the ultrasound, doesn't it?

    About the Lecture

    The lecture Intussusception: Examination and Diagnosis by Kevin Pei, MD is from the course Special Surgery.

    Included Quiz Questions

    1. Non-bilious vomiting later followed by bilious vomiting
    2. Tenderness of the abdomen at McBurney's point
    3. Vomiting and diarrhea
    4. Bilious vomiting later followed by non-bilious vomiting
    5. Erythema of the abdominal wall
    1. Currant jelly stool
    2. Mucus in stool
    3. Green stool
    4. Clay-colored stool
    5. Persistent black stool

    Author of lecture Intussusception: Examination and Diagnosis

     Kevin Pei, MD

    Kevin Pei, MD

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