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  • • 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

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Epidemiology

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  • • Rectal prolapse more common in older multiparous women

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Symptoms and Signs

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  • • Patients present with clinical evidence of bowel obstruction

    • -Colicky abdominal pain

    • Vomiting

    • Hyperperistaltic bowel sounds

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Laboratory Findings

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  • • No specific findings

    • Leukocytosis, acidosis suggestive of bowel compromise

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Imaging Findings

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  • • 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

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  • • Other causes for bowel obstruction:

    • -Neoplasm

      -Hernia

      -Adhesions

    • Diverticulitis

    • Appendicitis

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Rule Out

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  • • Neoplasm as lead point for intussusception

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  • • Barium enema

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When to Admit

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

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

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  • • Operation for reduction

    • IV hydration

    • NG decompression

    • IV broad-spectrum antibiotics

    • Barium or air-constrast enema

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Surgery

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Indications

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  • • 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

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Medications

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  • • IV antibiotics

    • Glucagon may assist in reduction efforts

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Complications

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  • • Hypovolemia/shock

    • Sepsis

    • Strangulation of bowel, infarction/necrosis

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Prognosis

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  • • 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

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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]

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