0:00 Interseception is the 0:08 invagination telescoping of a proximal segment of a bowel into the distal 0:13 bowel lumen. This causes an obstruction preventing the passage of food that is 0:18 being digested through the intestine. The commonous site is a segment of the 0:23 isleum moving into the colon through the iliosecal valve. Here is a diagram 0:29 representing normal to abnormal. The triad of intermittent abdominal pain, 0:36 a palpable abdominal mass, and red currant jelly stools only occur in about one 0:42 third of children. Interseception may occur at any age but most commonly 0:47 between two months and two years. 0:54 Most cases of interceception is idiopathic, 90%, meaning no exact cause. 1:01 However, in older children a lead point can be found. A lead point is a growth 1:07 or a lesion that can trigger interceception. Essentially the lesion 1:12 sort of carries the small bowel into the sickam, forming interceception or 1:21 causing interceception. So when identified lead points are pathologic 1:27 lesions. Lead points include hypertrophic lymphoid tissue in payers 1:31 patches, mesenteric lymphadenopathy, merkels diverticulum, Hinachshundland 1:38 perpyrra, enteric duplication cysts, luminal polyps such as in pew yager 1:46 syndrome, and lymphoma. Additional risk factors for developing 1:52 interception include viral enteritis and bacterial enteritis, recent rotavirus 1:58 vaccination, and recent bowel surgery. 2:03 Let's just recap some anatomy quickly. The intestines are divided into the 2:12 small 2:12 and large intestines. The small intestine or small bowel include the 2:17 duodenum, jejunum, and isleum. The large bowel or large intestine include the 2:23 seekum, ascending transverse, descending colon, and sigmoid and rectum. So the 2:30 clinical presentation of interceception, which is again most commonly 2:35 idiopathic, presents with intermittent abdominal pain or distress. 2:39 Episodes can recur within minutes to hours, and may increase in frequency over 2:44 the next 12 to 24 hours. The child may appear very well between these episodes 2:50 of intermittent pain, but they would look lethargic. Vomiting is usually a 2:55 prominent feature. As interceception progresses it can lead to bowel 3:00 obstruction. Bowel obstruction causes venous congestion, which if long enough 3:07 can cause bowel wall ischemia. Vomiting can become biostain vomiting, a sign of 3:14 bowel obstruction. Diarrhea is quite common initially and can lead to a 3:18 misdiagnosis of gastroenteritis. The rectal bleeding or the classic red 3:24 current jelly stool are late signs, suggesting bowel ischemia or infarction. 3:32 So on examination an abdominal mass may be felt, typically a sausage shaped 3:36 mass 3:37 in the right abdomen, crossing the midline into the epigastium or behind the 3:43 umbilicus. The abdominal mass may be subtle and examination is best performed 3:47 when the child is settled in between episodes. Abdominal distension suggests 3:53 a bowel obstruction. Bowel obstruction, which can then cause bowel ischemia, 3:59 can 3:59 actually then lead to bowel perforation, and this will obviously lead to per 4:03 itonitis 4:04 and shock. This is of course the worst-case scenario. Tendenous or guiding 4:09 suggests perforation and peritonitis. 4:15 The management include analgesia and resuscitation, which should proceed any 4:23 investigation, secure intravenous access in all children suspected of 4:27 interceception before diagnosing with imaging. Treat hypovolemic shock with 4:33 intravenous bolus or normal saline, give adequate analgesia, involve the 4:38 surgical team early, keep nil by mouth, you can pass in nasogastric tube if 4:44 there's a bowel obstruction. The initial treatment can include contrast or gas 4:48 enema. An enema is a procedure that involves injecting a liquid or gas into 4:53 the rectum. The enema may be used diagnostically and therapeutically. Enema 4:57 can identify an obstruction point, but it can also help the bowel fold back 5:03 into 5:03 correct position. There is a small risk of bowel perforation and bacteremia 5:07 during 5:08 the gas enema. This is contraindicated if the child has peritonitis shock 5:13 perforation or is unstable. If enemas do not work, then there is surgery. 5:24 So what are these investigations that you would order during this whole process 5:28 ? 5:28 Well typically you would include blood tests such as glucose, venous gas, full 5:35 blood count, electrolyte, urea, creatinine, group and hold prior to theater. An 5:39 abdominal ultrasound is highly sensitive and specific when performed by an 5:45 experienced sonographer. 5:51 Then you can have an abdominal x-ray which may suggest signs of intersusception 5:55 and 5:55 this includes abnormal gas patterns with an empty right lower quadrant and 6:03 visible soft tissue mass in the upper quadrant. Such as sort of in this x-ray 6:11 you can see a soft tissue mass on the upper right quadrant and you can also see 6:22 a 6:22 crescent lucency of bowel gas. This is called the crescent sign. The actual 6:28 lead 6:28 point of the intersusception is pointing up to the right upper quadrant as 6:36 shown 6:36 here. You can also see lack of fecal matter in the large bowel typically 6:42 because again the poo is not passing from the small intestine into the 6:48 secum because that's where the intersusception is. You can also see signs of 6:53 small bowel obstructions such as in this x-ray of an infant. You can see 6:56 horizontal lines indicating air fluid levels. This is an indication of bowel 7:03 obstruction and of course numa peritoneum where you can see gas underneath the 7:08 diaphragm will indicate bowel perforation. 7:13 So in summary intersusception is the 7:19 inevagination of the proximal segment of the bowel into the distal bowel 7:24 lumen. The commonest site is a segment of the ilea moving into the colon 7:29 through 7:30 the ileo sickle valve. The triad of intermittent abdominal pain, palpable 7:35 abdominal mass and red currant jelly stools is not as common as one thinks. 7:40 Treatment includes gas, enema and surgery is definitive treatment if this 7:48 does not work. Thank you. 8:00 [BLANK_AUDIO]
