Ria Rumondang Bulan

Fadil Ahmad

Supervisor : dr. Dian Adi S., Sp.BA
One of the most common cause of bowel
obstruction in infants and toddlers.
First described in 1674 by Paul Barbette;
defined by Treves (1899) as prolapse of one
part of the intestines into the lumen of the
immediately adjoining part.
First successful operation for intussuception
performed by John Hutchinson in 1873.

Derived from Latin words intus (within) and
suscipere (to receive)
Is the invagination of one part of the intestine
into another
Involving three cylinders of intestinal wall:
a) Inner and middle cylinders are invaginated
bowel (intussuceptum)
b) Outer cylinder is the recipients of the
invaginated bowel (intussuscipiens)
Occurs in approximately 1 in
2000 infants and children
Incidence: 1.5 to 4 per 1000
live births
Male to female ratio is 2:1 or
3:2
Occurs more often in white
children
75% occurs within the first 2
year of life and more than 40%
are seen between 3 and 9
months of age
Family history-related

No identifiable
etiology
Often preceded by a
viral illness
(Adenovirus and
Rotavirus ) such as
gastroenteritis that
contribute to the
hypertrophy of
Peyers patches in
ileum

Common pathological
lead points
antegrade
peristalsis of bowel
with hypertrophic
Peyers patches or
lead points
proximal bowel
(intussusceptum)
invaginate into the
distal bowel
(intussuscipiens)
compression of
the proximal
bowels
mesentery and
vessels
impaired venous
return and edema
of the bowel
congestion
bleeding and
mucus discharge
(currant jelly
stool)
dilatation of
proximal
bowel
absence
intervention lead
to gangrene in the
innermost layers
of the bowel
vascular
compromise
perforation
Intussusception can be categorized into four
types: general, specific, anatomic, and other
Classic presentation : intermittent & crampy
abdominal pain associated with currant jelly
stools and palpable mass on physical
examination (sausage-shaped mass/banana
sign)
Worsen obstructive and bowel ischemia
develop dehydration, fever, tachycardia, and
hypotension
History : 15-30 mins interval of abdominal colic
(drawing up legs and crying ), quite episode,
vomiting, streaks of blood in stools
Physical examination : abdominal distention
sausage-shaped mass, currant jelly stools,
febrile
Radiology
Plain abdominal film
(only 45% accuracy) :
soft tissue shadow in
the right upper
quadrant, paucity of
gas in the right lower
quadrant. Air fluid
level, dilated bowel
loops

Ultrasonography (up to 100% accuracy) : target
sign/doughnut sign, pseudokidney sign
target
sign
pseudokidney
Fluid resuscitation
NGT decompression
Prophylaxis antibiotic
Resuscitation
Pneumoenema
Hydrostatic
Nonoperative
Reduction
Laparotomy (manual reduction)
Operative
Reduction
Radiologic
Perforation
Surgical
Wound infection
Wound
dehiscence
Evisceration
Adhesive small
bowel obstruction