Intussusception physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sargun Singh Walia M.B.B.S.[2]

Overview

Patients with intussusception usually appear in distress . Physical examination of patients with intussusception is usually remarkable for Dance's sign, sausage shaped palpable mass, and abdominal distension. On rectal examination the intussusceptum might be felt. Classical sign of intussusception is currant jelly stools, and may present in a minority of cases at a later stage of the disease. Patient with intussusception usually appear chubby and there may be loss of appetite.

Physical Examination

The presence of following findings on physical examination is highly suggestive of intussusception.

• Dance's sign - Scaphoid (empty) right lower abdomen.
• "Sausage Shaped" palpable mass in the right mid or lower abdomen.
  • This is hard to palpate. It is best palpated between episodes of spasm especially when the infant is quiet.
• Abdominal distention is seen when intestinal obstruction is complete.
• Rigidity and involuntary guarding (suggests peritonitis secondary to intestinal gangrene and infarction)

Other features

• Episodic lethargy or altered consciousness, alternating with crying spells

• Episode lasts 15 to 30 mins

Appearance of the patient

• Patient with intussusception are usually chubby and healthy.
• Intussusception is uncommon in malnourished patients.
• Patients with intussusception usually appear in distress.

Vital signs

• Hypotensive if in shock
• Fever and leukocytosis indicate transmural gangrene and infarction (late signs)

Skin

• Pallor - Infant can be pale and diaphoretic

Abdomen

• Dance's sign - Scaphoid (empty) right lower abdomen.
• "Sausage Shaped" palpable mass in the right mid or lower abdomen.
  • This is hard to palpate. It is best palpated between episodes of spasm especially when the infant is quiet.
• Abdominal distention :- seen when intestinal obstruction is complete.
• A palpable abdominal mass in the right/left upper/lower abdominal quadrant
• Hematochezia and currant jelly stools (classic sign)
• Guarding - Rigidity and involuntary guarding (suggests peritonitis secondary to intestinal gangrene and infarction)

Rectal examination

• Intussusceptum may be felt by the finger