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

Intussusception is often suspected based on history and physical exam, including observation of Dance's sign. Per rectal examination is particularly helpful in children as part of the intussusceptum may be felt by the finger.

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) - If intestinal gangrene and infarction has occurred.

Other features

• Episodic Lethargy or altered consciousness, alternating with crying spells

• Episode lasts 15 - 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 (late signs) - indicate transmural gangrene and infarction.

Skin

• Pallor :- Infant can be pale and diaphoretic

Abdomen

• Dancer 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) - If intestinal gangrene and infarction has occurred.
• Rectal examination :- intussusceptum may be felt by the finger

Extremities

• Pitting/non-pitting edema of the upper/lower extremities