Skip to Main Content

+

  • • Invagination of proximal intestine into adjacent distal bowel, resulting in luminal obstruction

    • Can occur in the small bowel, or anorectum (rectal prolapse)

    • Prolonged obstruction can lead to vascular compromise, first venous, then arterial, eventual bowel infarction

    • Less common in adults than children

    • A lead point is often identified in adults and must be sought out in those in whom this condition develops

++

Epidemiology

+

  • • Rectal prolapse more common in older multiparous women

++

Symptoms and Signs

+

  • • Patients present with clinical evidence of bowel obstruction

    • -Colicky abdominal pain

    • Vomiting

    • Hyperperistaltic bowel sounds

++

Laboratory Findings

+

  • • No specific findings

    • Leukocytosis, acidosis suggestive of bowel compromise

++

Imaging Findings

+

  • • Barium enema may be both diagnostic and therapeutic: "coiled spring" sign

    • After radiographic resolution of obstruction (which is often not possible in adults) the patient must be evaluated thoroughly to identify the anatomic lead point

+

  • • Other causes for bowel obstruction:

    • -Neoplasm

      -Hernia

      -Adhesions

    • Diverticulitis

    • Appendicitis

++

Rule Out

+

  • • Neoplasm as lead point for intussusception

+

  • • Barium enema

++

When to Admit

+

  • • Diagnosis of intussusception requires admission even if successfully reduced nonoperatively

    • -This is rarely possible in adults, and the diagnosis usually requires operation for resolution

+

  • • Operation for reduction

    • IV hydration

    • NG decompression

    • IV broad-spectrum antibiotics

    • Barium or air-constrast enema

++

Surgery

++

Indications

+

  • • Intussusception should be reduced by pushing the lead point, avoiding pulling

    • If reduction cannot be carried out without creating serosal tears, resection and anastomosis should be performed

++

Medications

+

  • • IV antibiotics

    • Glucagon may assist in reduction efforts

++

Complications

+

  • • Hypovolemia/shock

    • Sepsis

    • Strangulation of bowel, infarction/necrosis

++

Prognosis

+

  • • Recurrence rates vary from 1-3% whether barium or operative reduction performed

    • Deaths are rare but do occur if treatment of gangrenous bowel is delayed

++

References

Jenkins JT: Secondary causes of intestinal obstruction: rigorous preoperative evaluation is required. Am Surg 2000;66:662.  [PubMed: 10917478]
Scaglione M et al: Helical CT diagnosis of small bowel obstruction in the acute clinical setting. Eur J Radiol 2004;50:15.  [PubMed: 15093231]
Zalcman M et al: Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction. Am J Roentgenol 2000;175:1601.  [PubMed: 11090385]

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.