Surgery: Intussusception

by Kevin Pei, MD

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    00:01 Welcome back.

    00:02 Thanks for joining me on this discussion of intussusception in the section of pediatric surgery.

    00:10 Intussusception, why does it happen? We don't exactly know, but there are some theories.

    00:17 Most intussusception are idiopathic and they occur at the terminal ilium to the cecum.

    00:23 This is also known as ileocolic.

    00:26 This is the type that often happen in infants and toddlers.

    00:30 Here, you see another anatomy picture of the terminal ilium actually invaginating itself into the colon.

    00:39 There may be some truth behind probably lymph node hypertrophy.

    00:44 Why? Because commonly this follows a recent respiratory infection.

    00:50 We think with a systemic infection that the lymph nodes may actually hypertrophy and creating itself a lead point or idiopathic ileocolic intussusception.

    01:03 Here is a picture of, intraoperatively, what we find in intussusception.

    01:07 As you can see from this image, a segment of small intestines is invaginating into another.

    01:13 This is the reason why it may cause obstruction and/or abdominal pain.

    01:20 How does the intestines become ischemic during this process? I’ll show you using this image and the next few slides.

    01:29 First, recognize that the lymphatic obstruction is actually what occurs first.

    01:34 Commonly, when people think about intestinal ischemia, they think that the arterial supply is actually compromised first.

    01:41 But there's a protective mechanism whereby the arterial blood pressure is usually the last to go.

    01:47 After lymphatic obstruction, the venous side drainage is obstructed.

    01:52 And now you can imagine, with lymphatics and venous obstruction, the inflow or arterial supply is subsequently obstructed.

    02:01 This is like a multiple car accident.

    02:04 There's going to be a pylon.

    02:06 And towards the end of that scenario is arterial obstruction, and subsequently ischemia.

    02:12 This is also a reason why, intraoperatively, you often see ischemic bowel very dilated.

    02:17 That's because of the venous and lymphatic congestion.

    02:22 Let's take a look at the schematic of what happens during an intussusception.

    02:26 On the left side of the screen, as we already previously discussed, are potential etiologies of intussusception.

    02:33 Remember, the vast majority of these are still idiopathic in kids.

    02:37 Enlarged Peyer’s patches, particularly as associated with a viral upper respiratory infection, increases the chance of a lead point.

    02:45 Additionally, some children may have an inflamed appendix, demonstrated in the left side of the screen.

    02:51 As you can see on the right top half of the screen, the intestines proximally actually invaginates into the proximal small bowel.

    02:59 And as a result, in the right lower quadrant of the screen, you notice that the intussusceptum, or the portion of the bowel that enters the proximal bowel, now appears edematous.

    03:10 Upstream of this edematous bowel can present with small bowel obstruction.

    03:15 As you can imagine, when venous and lymphatic drainage is obstructed, it may need to ultimately arterial obstruction and subsequent bowel ischemia.

    03:25 Remember, lead points may not always be present.

    About the Lecture

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

    Included Quiz Questions

    1. Lymphatic obstruction, venous obstruction, arterial obstruction
    2. Lymphatic obstruction, arterial obstruction, venous obstruction
    3. Arterial obstruction, lymphatic obstruction, venous obstruction
    4. Arterial obstruction, venous obstruction, lymphatic obstruction
    5. Venous obstruction, arterial obstruction, lymphatic obstruction
    1. Ileocolic
    2. Colocolic
    3. Ileo-ileo-colic
    4. Ileoileal
    5. Retrograde

    Author of lecture Surgery: Intussusception

     Kevin Pei, MD

    Kevin Pei, MD

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