Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary 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] Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.