IntussusceptionIntussusception

Rory MurphyRory Murphy

History.

HPC• 80 ♂

• 4/7; general malaise.

• 1/7; nausea, profuse vomiting, diarrhoea & “crampy” lower abdominal pain.

• Recent campylobacter gastroenteritis.

PMHx•Chronic Renal Failure. (Dialysis* 3 a week.).•HTN

Physical Exam.

Vitals.

• HR 80 Hypertensive Apyrexial SaO2 95%

Abdominal,• Soft Non-tender. • No gaurding, rigidity or

organomegaly,• Hernial orifices clear. BS+ • PR/FOB not documented

Initial Investigations.

Bloods.

Hb 13

WCC 7.78

Neutophils 6.7

Urea 31

Na 134

Creat 848

LFT’s NAD

Amylase

CRP 26

Stool Culture,Ova&Oocytes.

Neg

Imaging.

PFA:

No gaseous distension of the bowel.

Abdominal U/S:

NAD.

OGD;

Hiatus Hernia Mild Antral Gastritis

Initial Differential Diagnosis and Treatment.

Post-Infectious gastroenteritis/Malabsorptive State.

Nausea and Vomiting intermittently.

9 days post admission symptoms improved.

Resolved gastroenteritis.

Aspiration pneumonia.

Repeat Investigations.

PFA x 2 revealed dilated loops of small bowel.

However clinical discordence patient passing bowel motions and non distended.

Intra-operative Images.

Intussusception exists when a proximal segment

of bowel (intussusceptum) telescopes into the

lumen of the adjacent distal segment.

1 % of all bowel obstructions,

5% of all intussusceptions,

Adult Intussusception.

• Intussusception is a different entity in adults than it is in chlidren.

• Pathology is found in 70% to 90% of cases in the adult population.

• Intraluminal lesions alter normal bowel peristalsis and form leading

edges for the intussusceptum. 9'0

• Adults may present with acute, intermittent, or chronic reported problems."

• The predominant symptoms usually are those of bowel obstruction and, consequently,intussusception often is misdiagnosed initially in the adult population.