INTUSSUSCEPTIO
Intussusceptio is a form of bowel obstruction caused by invagination of one part of the bowel into the other. For some reason part of the bowel wall moves distally with the peristalsis taking the rest of the intestine inside-out into the distal part of the intestine.
Most often small bowel is invaginated into the large bowel, more rarely the large bowel into itself, and very seldom the small bowel itself.
The cause is often unknown. It is commonly believed that a previous virus infection causes edema (swelling) of the lymphatic plaques in the bowel wall, and that swelling is taken distally by the peristaltic movements, acting as the head (the caput) of the intussusceptio.
Sometimes there is an obvious cause to the Intussusceptio as for instance a tumor in the intestinal wall, a TBC ulcer, a pedunculated polypus or a Meckel’s diverticulum.
The diagnosis is often suspected from the clinical findings. In children one can usually palpate (feel) a movable sausage-like tumor and emptiness in the RLQ (right lower quadrant of the abdomen). The differential diagnosis is bowel obstruction due to ascaris impaction (see page ASCARIS IMPACTION). If needed an ultrasound scanning will resolve the question. Anyhow both conditions need laparotomy.
A rectal examination will often give more than a clue. Sometimes the intussusceptio can be felt like a mass with the finger. More often the exploring finger will disclose “current jelly” - bloody mucus.
In advanced cases the intussusceptio is obvious as it is protruding through the anus.
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It can easily be differentiated from a rectal prolapse (see page RECTAL PROLAPSE) since in intussusceptio there is a palpable groove between the protruding mass and the rectal wall which is not the case with rectal prolapse.
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Never use traction when reducing the intussusceptio – only squeezing. Be patient and use steady manual pressure to reduce the edema making reduction possible.
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Reduction of Intussusceptio ← click for video
After reduction scrutinize for underlying causes to the intussusceptio. A dimple representing an inverted Meckel’s diverticulum can easily be missed.
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A colon into colon intussusceptio due to a tumor was protruding through the anus. It was reduced primarily back into the rectum after which a laparotomy with resection was performed
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↑ Click for video |
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In case of gangrene….
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…obviously a resection and ileo-colic anastomosis has to be done. In this case an end-to-end anastomosis was chosen.
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