1. Presented by PGY 吳和益 Data:2014.04.22

2. Identified Information
Name: 陳○渝
Sex: F
Age: 1y/o 11m/o
Date of Admission: 2014/04/08
Data provider: Father
Chief Complaint
Abdominal pain for 1 day

3. Clinical Course
4/5 ▼
4/7
morning ▼
4/7
night ▼

4. Clinical Course
4/8
morning ▼
4/8
noon ▼

5. Past History Birth History:
G2P2, C/S, GA: 39+1 weeks, Birth weight: 3310 g,
DIOC (-), PROM (-), prolonged labor (-)
Apgar score: 910
Feeding: On full diet
Vaccination:
As schedule, pneumococcal vaccine 13 (+), rotaviral vaccine (-), Influenza vaccine (-)
Growth and Development:
Weight: 12.9 kg (85 th%), body length: 89.8 cm (85~97 th%), head circumference: 47.0 cm (50 th%)
Developmental milestones: WNL
Medical History: Denied other major disease
delay of initial crying
premature rupture of membrane
prolonged labor
within normal limit

6. Physical Examination
4/8
afternoon ▼

7. Laboratory Data

8. mesenteric lymph nodes within this target lesion
Image
Target sign
Psudokidey sign
mesenteric lymph nodes within this target lesion

9. Barium reduction

10. Barium reduction
Spring coil sign

11. Barium reduction

12. Barium reduction

13. Barium reduction
Ileo-colic type

14. Clinical Course
4/8 ▼
4/9 ▼
4/9 ▼

16. EPIDEMIOLOGY
Intussusception：Invagination of a part of the intestine into itself
The most common abdominal emergency of intestinal obstruction between 6 ~ 36 month-old
<2 ys (80~90%)
Less common before 3 months and after 6 years old
Male predominance Male : Female : 3:2
Higher incidence in spring and autumn
 may suggest a preceding viral infection
Viral infection : adenovirus, rotavirus, and human herpesvirus 6
 has been reported to be associated with intussusception

17. Causes & Predispositions
90 % intussusceptions : ileo-colic

18. CLINICAL MANIFESTATIONS
Sudden onset ,intermittent, severe, crampy, progressive abdominal pain
inconsolable crying
drawing up of the legs toward the abdomen
episodes with 15 to 20 minute intervals
Vomiting may follow episodes of abdominal pain

19. CLINICAL MANIFESTATIONS
Abdominal pain : sudden onset of
Intermittent
Severe
Crampy
Bloody stool
Currant-jelly stool
Sausage-shaped abdominal mass
Right side of abdomen <15% at the time of presentation

20. Diagnosis Ultrasonography : Sensitivity and specificity
approach 100 %
Monitor the success of reduction
Less radiation exposure

21. Target sign, Doughnut sign
Sandwish sign
Pseudokidney sign

22. Management Non-operative Reduction
Hydrostatic technique
Pneumatic technique
Risk of perforation ：1 %
Failure of reduction : 10%
After successful reduction
Should be admitted for 12 to 24 hours
10% recurrent rate after radiologic reduction
Surgical intervention

23. Management Surgical Indications Recurrent rate: about 1%
Evidence of perforation
Nonoperative reduction not available
Nonoperative reduction unsuccessful
For evaluation or resection of pathological lead point
Recurrent rate: about 1%

24. Take Home Massage Surgical Indications
The most common abdominal emergency of intestinal obstruction between 6~36 month-old
Clinic triad：
Abdominal pain
Bloody stool
Abdominal mass
Management
Non-operative Reduction
Risk of perforation ：1 %
Failure of reduction : 10%
Surgical intervention
Surgical Indications