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==Introduction==

==Description==

[[Image:intussusception.jpg|thumb|right|300px|Diagram of intussuscception (Courtesy of Elspeth Milne)]]

[[Image:intussusception.jpg|thumb|right|300px|Diagram of intussuscception (Courtesy of Elspeth Milne)]]

'''Intussusception''' is the invagination of one portion of the gastrointestinal tract into the lumen of the adjacent portion.  The '''intussusceptum''' is the invaginated segment and the '''intussuscipien''' is the enveloping segment. A normograde intussusception is most common, but retrograde intussusception has also been reported.   

'''Intussusception''' is the invagination of one portion of the gastrointestinal tract into the lumen of the adjacent portion.  The '''intussusceptum''' is the invaginated segment and the '''intussuscipien''' is the enveloping segment. A normograde intussusception is most common, but retrograde intussusception has also been reported.   

Depending on the site and severity, an intussusception results in a partial or complete obstruction to the gastrointestinal tract causing hypovolaemia, dehydration and shock. The condition is potentially serious and should be treated as an emergency.   

Depending on the site and severity, an intussusception results in a partial or complete obstruction to the gastrointestinal tract causing hypovolaemia, dehydration and shock. The condition is potentially serious and should be treated as an emergency.   

===Pathogenesis===

===Pathogenesis===

Intussusception results from abnormal peristalsis. Vigorous contractions force the more proximal intestine to invaginate into the adjacent distal portion, taking its mesenteric attachment with it. Obstruction of the gastrointestinal tract causes distention which may lead to rupture and peritonitis. Compression of the mesenteric vessels cause vascular compromise to the instestine, resulting in venous congestion, oedema and if the aterial supply is damaged, full thickness necrosis. An inflammatory exudate is released from the serosal surface and fibrinous adhesions may form, making the structure irreducible.

Intussusception results from abnormal peristalsis. Vigorous contractions force the more proximal intestine to invaginate into the adjacent distal portion, taking its mesenteric attachment with it. Obstruction of the gastrointestinal tract causes distention which may lead to rupture and peritonitis. Compression of the mesenteric vessels cause vascular compromise to the intestine, resulting in venous congestion, oedema and if the aterial supply is damaged, full thickness necrosis. An inflammatory exudate is released from the serosal surface and fibrinous adhesions may form, making the structure irreducible.

Intussusception normally occurs due to gastrointestinal disease, although it is often hard to identify the cause. It is associated with any condition that increases peristalsis such as

Intussusception normally occurs due to gastrointestinal disease, although it is often hard to identify the cause. It is associated with any condition that increases peristalsis such as

*Diarrhoea- bloody and mucoid  

*Diarrhoea- bloody and mucoid  

*Tenesmus and Haematochezia in cases of ileocaecocolic intussusception

*Tenesmus and Haematochezia in cases of ileocaecocolic intussusception

====Chronic Intussusception====

====Chronic Intussusception====

===Radiography===

===Radiography===

Plain abdominal radiographs do not always provide a definitive diagnosis. In cases of complete obstruction distented loops of intestine and a tubular soft tissue mass are usually obvious, but a partial obstruction will produce much more subtle signs which may be missed.

Plain abdominal radiographs do not always provide a definitive diagnosis. In cases of complete obstruction distented loops of intestine and a tubular soft tissue mass are usually obvious, but a partial obstruction will produce much more subtle signs which may be missed.

A barium enema or upper gastrointestinal contrast study can be useful in identifying the site of obstruction but may result in delay of treatment and should be used cautiously as leakage of contrast into the abdominal cavity will result in peritonitis.  

 

A barium enema or upper gastrointestinal contrast study can be useful in identifying the site of obstruction but may result in delay of treatment and should be used cautiously as leakage of contrast into the abdominal cavity will result in peritonitis.

The classic appearance of an intussusception is described as a 'coiled spring'.  

===Ultrasound===

===Ultrasound===

==Treatment==

==Treatment==

[[Fluid Therapy|Fluid therapy]] and correction of electrolyte and acid-base abnormalities should be carried out prior to surgical correction.  

[[Principles of Fluid Therapy|Fluid therapy]] and correction of electrolyte and acid-base abnormalities should be carried out prior to surgical correction.  

Surgery is required to manually reduce the intussusception, it may be necessary to resect and anastomose the intestine in cases where the  adhesions have formed.  This decision depends on the viability of the intestines, as determined by the colour, vascular supply and presence or absence of peristalsis.It is important to preserve as much of the intestine as possible to avoid [[Short Bowel Syndrome|short bowel syndrome]].  

'''Surgery''' is required to manually reduce the intussusception, it may be necessary to '''resect and anastomose''' the intestine in cases where the  adhesions have formed.  This decision depends on the viability of the intestines, as determined by the colour, vascular supply and presence or absence of peristalsis.It is important to preserve as much of the intestine as possible to avoid [[Short Bowel Syndrome|short bowel syndrome]].  

Complications include dehiscence at the site of anastomosis, [[Peritonitis - Cats and Dogs|peritonitis]], recurrence (11-20%, most common within 1-5 days post surgery), ileus, intestinal obstruction and short bowel syndrome. Recurrence can be prevented by enteroplication of the small intestine, or by a left-sided gastroplexy of the fundus in cases of gastroesophageal intussusception.  

Complications include dehiscence at the site of anastomosis, [[Peritonitis - Cats and Dogs|peritonitis]], recurrence (11-20%, most common within 1-5 days post surgery), ileus, intestinal obstruction and short bowel syndrome.  

 

Recurrence can be prevented by '''enteroplication''' of the small intestine, or by a left-sided gastroplexy of the fundus in cases of gastroesophageal intussusception.

==Prognosis==

==Prognosis==

This depends on the location, completeness and duration of the intusussception.  The prognosis is good in animals treated with early surgical intervention and aggressive supportive care.  The prognosis is poor for animals with perforated intestine and peritonitis.

This depends on the location, completeness and duration of the intusussception.  The prognosis is good in animals treated with early surgical intervention and aggressive supportive care.  The prognosis is poor for animals with perforated intestine and peritonitis.

==References==

==References==

*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.

*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.

*Tilley, L.P. and Smith, F.W.K.(2004)'''The 5-minute Veterinary Consult(Third edition)''' ''Lippincott, Williams & Wilkins''.

*Tilley, L.P. and Smith, F.W.K.(2004)'''The 5-minute Veterinary Consult(Third edition)''' ''Lippincott, Williams & Wilkins''.

[[Category:Intestine_-_Physical_Disturbances]]

[[Category:Intestine_-_Physical_Disturbances]]

[[Category:To_Do_-_lizzyk]]

[[Category:Intestinal Diseases - Dog]][[Category:Intestinal Diseases - Cat]]

[[Category:Dog]][[Category:Cat]]

[[Category:Expert_Review]]

[[Category:Expert_Review]]