Intussusception (medical disorder): Difference between revisions

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* [[Idiopathic]]
An earlier version of the [[rotavirus vaccine]] that is no longer used was linked to intussusception, but the current versions are not clearly linked.<!-- <ref name=WHO2013/> --> Due to a potential risk, they are thus not recommended in babies who have had intussusception.<ref name=WHO2013>{{cite journal|title=Rotavirus vaccines. WHO position paper – January 2013.|journal=Releve epidemiologique hebdomadaire / Section d'hygiene du Secretariat de la Societe des Nations = Weekly epidemiological record / Health Section of the Secretariat of the League of Nations|date=1 February 2013|volume=88|issue=5|pages=49–64|pmid=23424730|url=|deadurlurl-status=nolive|archiveurl=|archivedate=22 December 2015|df=}}</ref>
An anatomic ''lead point'' (that is, a piece of intestinal tissue that protrudes into the bowel lumen) is present in approximately 10% of intussusceptions.<ref>[ Chapter X.4. Intussusception ] {{webarchive|url= |date=2012-08-26 }} from Case Based Pediatrics For Medical Students and Residents, by Lynette L. Young, MD. Department of Pediatrics, University of Hawaii John A. Burns School of Medicine. December 2002</ref>
The trapped section of bowel may have its blood supply cut off, which causes [[ischemia]] (lack of oxygen in the tissues). The [[mucosa]] (gut lining) is very sensitive to [[ischemia]], and responds by sloughing off into the gut. This creates the classically described "red currant jelly" stool, which is a mixture of sloughed mucosa, blood, and mucus.<ref name=Toso>{{cite journal|vauthors=Toso C, Erne M, Lenzlinger PM, Schmid JF, Büchel H, Melcher G, Morel P|title=Intussusception as a cause of bowel obstruction in adults|journal=Swiss Med Wkly|date=2005|volume=135|issue=5–6|pages=87–90|pmid=15729613|url=|deadurlurl-status=nolive|archiveurl=|archivedate=2015-09-24|df=}}</ref> A study reported that in actuality, only a minority of children with intussusception had stools that could be described as "red currant jelly", and hence intussusception should be considered in the differential diagnosis of children passing ''any'' type of bloody stool.<ref>{{cite journal|last=Yamamoto|first=LG|author2=Morita, SY |author3=Boychuk, RB |author4=Inaba, AS |author5=Rosen, LM |author6=Yee, LL |author7= Young, LL |title=Stool appearance in intussusception: assessing the value of the term "currant jelly."|journal=The American Journal of Emergency Medicine|date=May 1997|volume=15|issue=3|pages=293–8|pmid=9148991 |doi=10.1016/s0735-6757(97)90019-x}}</ref>
[[File:Invagination 001 CT cor.png|thumb|Small intestinal invagination on computed tomography]]
[[File:UOTW 4 - Ultrasound of the Week 1.webm|thumb|An ultrasound showing intussusception<ref>{{cite web|title=UOTW #4 Answer - Ultrasound of the Week|url=|website=Ultrasound of the Week|accessdate=27 May 2017|deadurlurl-status=nolive|archiveurl=|archivedate=5 November 2017|df=}}</ref>
An intussusception is often suspected based on history and physical exam, including observation of [[Dance's sign]]. A digital [[rectal examination]] is particularly helpful in children, as part of the intussusceptum may be felt by the finger. A definite diagnosis often requires confirmation by diagnostic imaging modalities. [[Ultrasound]] is the imaging modality of choice for diagnosis and exclusion of intussusception, due to its high accuracy and lack of radiation. The appearance of target sign (also called "doughnut sign" on a sonograph, usually around 3&nbsp;cm in diameter, confirms the diagnosis. The image seen on transverse [[Medical ultrasonography|sonography]] or [[Computed tomography of the abdomen and pelvis|computed tomography]] is that of a doughnut shape, created by the [[hyperechogenicity|hyperechoic]] central core of [[Human gastrointestinal tract#Lower gastrointestinal tract|bowel]] and [[mesentery]] surrounded by the [[hypoechogenicity|hypoechoic]] outer [[edema]]tous bowel.<ref name=Park/> In longitudinal imaging, intussusception resembles a sandwich.<ref name=Park>{{cite journal |vauthors=Park NH, Park SI, Park CS, Lee EJ, Kim MS, Ryu JA, Bae JM |title=Ultrasonographic findings of small bowel intussusception, focusing on differentiation from ileocolic intussusception|journal=Br J Radiol|date =2007|volume=80|issue=958|pages=798–802 |pmid=17875595 |issn=0007-1285|doi=10.1259/bjr/61246651 |url= }}</ref>
An [[x-ray]] of the abdomen may be indicated to check for intestinal obstruction or free intraperitoneal gas. The latter finding implies that bowel perforation has already occurred. Some institutions use [[air enema]] for diagnosis, as the same procedure can be used for treatment.<ref>{{cite web |author=C Surendranath Singh |author2=M.l. Prakash |url= |title=Adult Intussception : A Case Report |publisher=Webmed Central |doi=10.9754/journal.wmc.2011.002052 |issn=2046-1690 |date=28 Jul 2011 |access-date=June 5, 2016 |deadurlurl-status=nolive |archiveurl= |archivedate=June 10, 2016 |df= }}</ref>{{Citation needed |reason=this source does not talk about enemas |date=June 2016}}
=== Classification===
The condition is diagnosed most often in infancy and early childhood. It strikes about 2,000 infants (one in every 1,900) in the United States in the first year of life. Its incidence begins to rise at about one to five months of life, peaks at four to nine months of age, and then gradually declines at around 18 months.
Intussusception occurs more frequently in boys than in girls, with a ratio of approximately 3:1.<ref name="">{{Cite web|url=|title=Pediatrics: Intussusception|accessdate=2006-06-05|year=2006|author=Lonnie King|deadurlurl-status=nolive|archiveurl=|archivedate=2006-05-18|df=}}</ref>
In adults, intussusception represents the cause of approximately 1% of [[bowel obstruction]]s and is frequently associated with [[neoplasm]], [[cancer|malignant]] or otherwise.<ref name=gayer>{{cite journal | vauthors = Gayer G, Zissin R, Apter S, Papa M, Hertz M | title = Pictorial review: adult intussusception--a CT diagnosis | journal = Br J Radiol | volume = 75 | issue = 890 | pages = 185–90 | year = 2002 | pmid = 11893645 | url = | deadurlurl-status = nolive | archiveurl = | archivedate = 2010-05-09 | df = }}</ref>
== References ==