Intussusception: A Primary Care Primer

A 2-year-old boy was hospitalized because of acute abdominal pain. He had no other symptoms. The child's temperature was 37.3°C (99.1°F). He was irritable and had generalized abdominal tenderness. A stool test was positive for blood. Results of laboratory investigations were normal.

A plain abdominal radiograph (A) demonstrated the absence of the usual gas images of the normal cecum and ascending colon; the head of an intussusception is clearly seen in the air column in the transverse colon. Intestinal perforation was excluded.

An ultrasonogram (B) revealed the “doughnut” sign-a hypoechoic rim of homogeneous thickness and contour with a central hypoechoic core, seen on a transverse view. This confirmed the diagnosis of intussusception. Anterior (C) and posterior (D) films taken during a barium enema study show the typical coil spring appearance of the barium column.

Hydrostatic reduction was unsuccessful, and laparotomy was performed. An ileocolic intussusception was gently milked out, and an appendectomy was done. There were no complications, and the child recovered fully.

Intussusception is an emergency condition that may occur at any age. Dr Samer Alkhuja of Greenwich, Conn, cautions that early diagnosis is essential to avoid delay in treatment. The classic triad of symptoms consists of abdominal pain, vomiting, and bloody stool, but it is often absent. In the hands of an experienced practitioner, ultrasonography is an accurate, low-risk screening tool.¹ Barium enema is the gold standard for diagnosis and also has the potential for reducing the intussusception.²

REFERENCES:
1. Del-Pozo G, Albillos JC, Tejerdor D. Intussusception: US findings with pathologic corelation-the crescent-in-doughnut sign. Radiology. 1996;199:688-692.
2. Winslow BT, Westfall JM, Nicholas RA. Intussusception. Am Fam Physician. 1996;54:213-217.