INTUSSUSCEPTION

What is it?

Obstruction caused by bowel telescoping

into the lumen of adjacent distal bowel;

may result when peristalsis carries a

“leadpoint” downstream

What is its claim to fame?

Most common cause of small bowel

obstruction in toddlers ( 2 years old)

What is the usual age at

Disease of infancy; 60% present from 4 to

presentation?

12 months of age, 80% by 2 years of age

What is the most common

Terminal ileum involving ileocecal valve

site?

and extending into ascending colon

What is the most common

Hypertrophic Peyer’s patches, which act

cause?

as a lead point; many patients have prior

viral illness

What are the signs/

Alternating lethargy and irritability (colic),

symptoms?

bilious vomiting, “currant jelly” stools,

RLQ mass on plain abdominal film,

empty RLQ on palpation (Dance’s sign)

What is the intussuscipiens?

Recipient segment of bowel (Think:

recipiens intussuscipiens)

What is the intussusceptum?

Leading point or bowel that enters the

intussuscipiens

Identify locations 1 and 2 on

1. Intussuscipiens

the following illustration:

2. Intussusceptum

Chapter 67 / Pediatric Surgery 555

How can the spelling

Imagine a navy ship named The

of intussusception be

U.S.S. U.S.—INTUSSUSCEPTION

remembered?

What is the treatment?

Air or barium enema; 85% reduce

with hydrostatic pressure (i.e., barium

meter elevation air maximum

of 120 mm Hg); if unsuccessful, then

laparotomy and reduction by “milking”

the ileum from the colon should be

performed

What is it?

Remnant of the omphalomesenteric

duct/vitelline duct, which connects the

yolk sac with the primitive midgut in the

embryo

556 Section III / Subspecialty Surgery

What are the possible

Intestinal hemorrhage (painless)—50%

complications?

Accounts for 50% of all lower GI

bleeding in patients younger than

2 years; bleeding results from

ectopic gastric mucosa secreting

acid S ulcer S bleeding

Intestinal obstruction—25%

Most common complication in

adults; includes volvulus and

intussusception

Inflammation ( perforation)—20%

What other pediatric disease

Enteric duplications

entity can also present with

GI bleeding secondary to

ectopic gastric mucosa?

What is the most common

Meckel’s diverticulum with ectopic

cause of lower GI bleeding

gastric mucosa

in children?

What is the “rule of 2s”?

2% are symptomatic

Found 2 feet from ileocecal valve

Found in 2% of the population

Most symptoms occur before age 2

One of 2 will have ectopic tissue

Most diverticula are about 2 inches long

Male:female ratio 2:1