Intussusception

Intussusception is caused most commonly by hypertrophied Peyer's patches in the terminal ileum, followed by polyps, lymphoma or other tumors, and Meckel's diverticulum. It commonly presents in infants between 8 months to 1 year of age as intermittent paroxysms of crampy abdominal pain and emesis. The patient may feel well between these episodes. Diagnosis is confirmed by x-ray which reveals a RUQ or midepigastric mass with an "empty" RLQ (Dance's Sign). Treatment is dependent on the progression of symptoms. If no peritoneal signs are present, air enema is performed in an attempt to reduce the intussusception. Post-reduction x-ray should reveal reflux of air into multiple small bowel loops and resolution of symptoms. Failure of conservative therapy mandates surgery which involves gentle milking of the bowel out of the intussusception. If the affected bowel is gangrenous, resection is performed.

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