Intussusception: Examination and Diagnosis

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?