The recurrence rate of intussusception after nonoperative reduction is usually less than 10% but has been reported to be as high as 15%. Most intussusceptions recur within 72 hours of the initial event.

X-ray is only 60% sensitive in such cases. U/S is more reliable (some studies suggest a sensitivity & specificity of more than 95%). But barium enema is usually the most reliable.

The hallmark physical findings in intussusception are a right hypochondrium sausage-shaped mass and emptiness in the right lower quadrant (Dance sign). This mass is hard to detect and is best palpated between spasms of colic, when the infant is quiet. Abdominal distention frequently is found if obstruction is complete.

Patients with intussusception often have no classic signs and symptoms, which can lead to an unfortunate delay in diagnosis and disastrous consequences.
Maintaining a high index of suspicion for intussusception is essential when evaluating a child younger than 5 years who presents with abdominal pain or when evaluating a child with Henoch-Schönlein Purpura or hematologic disorders.

Etiology:
The most common cause is viral pathogens (most frequently rotavirus).
Bacterial causes include: campylobacter jejuni, shigella, non-typhoidal salmonella, and vibrio cholera.
Parasitic causes like giardia and entomoeba histolytica.

Viral pathogens generally cause less severe illness than bacterial pathogens.
Relative to viral gastroenteritis, bacterial disease is more likely to be associated with high fevers, shaking chills, bloody bowel movements (dysentery), abdominal cramping, and fecal leukocytes.

Nevertheless, identifying the specific etiologic agent responsible for the acute gastroenteritis rarely changes management. However, it may be helpful to differentiate between viral, bacterial, parasitic, and noninfectious causes of diarrhea.

The history and physical examination serve 2 vital functions:

1- differentiating gastroenteritis from other causes of vomiting and diarrhea in children.
2- estimating the degree of dehydration which is the vital to determine the course of management.

Frequent, watery stools are more consistent with viral gastroenteritis, while stools with blood or mucous are indicative of a bacterial pathogen. Similarly, a long duration of diarrhea (>14 days) is more consistent with a parasitic or noninfectious cause of diarrhea.
In general, pain that precedes vomiting and diarrhea is more likely to be due to abdominal pathology other than gastroenteritis.

بالنسبة للـ treatment فهو بسيط نسبيًا: ببساطة الهدف منه هو تصحيح الـ dehydration إن وُجِد وهاهية.

أكو لقاح للـ rotavirus وُجِد أنه ممكن يسبب intussusception لأن يُعتَقَد أنه يسوي lymphoid hyperplasia بجدار الأمعاء وهالشي رح يشتغل كـ lead point ويحشر الأمعاء وحدة ببطن الثانية.
اللقاح تم سحبه من الأسواق، بس أكو أنواع ثانية هم شافوا أنها تزيد خطر الـ intussusception بس بنسبة قليلة مقارنةً بالأول فإستخدامهن مستمر لحد هسة على حد علمي.

أما الـ treatment مال الـ gastroenteritis فهو مثلما يكول احمد عدوية: "يا عيني الواد بيعيط، الواد عطشان اسقوه"

1:20

In developing countries, clinicians can use WHO ORS sachets or a homemade solution of 3g (1 tablespoon) salt and 18g (6 tablespoons) sugar added to 1L of clean water.

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