Intussception Flashcards
Resuscitation
Initiate-
Aggressive fluid resuscitation using - and - if indicated
-placement and drainage
Urethral catherization
-antibiotice including -cover
IV access
Crystalloids and blood transfusion
NG tube
Broad spectrum ,anaerobic
Nonoperative treatment
Hydrostatic reduction
Pneumatic reduction
BOTH
USS guided
Flouroscopy Guided
Hydrostatic reduction uses
Saline
Barium
Gastrograffin
Hydrostatic reduction
Method
1)done under _
2)dilute barium/warm saline not cm above patient
3)Rule of 3’s _ , and _
Sedation
>100cm
Height(can at height of 3feet above patient),duration(about 3mins) and attempts (3attempts)
Success rate(65-85%) of hydrostatic reduction
Intussceptum moves - through - junction
Endpoint should be_ in _ with disappearance of target sign
Patients symptoms resolve
Backward,ileocecal
Free flowing fluid,terminal illeum
Hydrostatic reduction
Complications rate
Perforation in 1-2%
Recurrence in 8-20%
Pneumatic Reduction
Method:
Tight anal seal
Air insufflation limited to maximum _pressure of -mmhg(younger),-mmhg (older)
Rule of 3’s
Resting pressure
80mmhg
120mmhg
Success rate (75-90%)
must observe air in terminal illeum
Less recurrence(5-10%)
Low perforation rate(1%)
Non operative reduction
Contraindications
Absolute inflammation
-_ signs of inflammation
-suspected perforation
Relative contraindication
Symptoms >-hrs
Rectal bleeding
Poor prognostic indicators
Peritoneal signs
24-48hrd
Factors associated with failure
Symptoms>48hts
Rectal bleeding
Small bowel obs radiographically
Ileocolic or small bowel types
Presence of mechanical lead point
Age <3months
Operative management
Indications
-Non operative treatment failed
Successful non op treatment but residual -
Signs of -
Presence of a pathologic lead point
Radiographic evidence of -
-Non operative treatment failed
Successful non op treatment but residual luminal filling defect
Signs of peritonitis
Presence of a pathologic lead point
Radiographic evidence of pneumoperitoneum
Recurrent intussception
May follow either treatment in -
% in 24hrs,% in 6monthsb
Generally non op treatment is adopted
Operative treatment adopted if
1)patient has -episodes,ff previous Mon op management
2)1st recurrence in a child -yrs with previous non op management
3)pathological lead point suspected
2-20%casesv
20%
70
>1
2yrs
Post op intussception
Maybe be mistaken for -
Occurs usually within -
Op reduction is effective
Post op adhesive OBS
A month of initial procedure
Complications
Dehydration
Aspiration from emesis
Bowel perforation with peritonitis
Shock
Septicemia
Anastomotic leak
Short bowel syndrome
Recurrence
Prognosis
100% fatality with no treatment
Excellent if diagnosed early
Proximal portion
Intussceptum
Distal/recieving bowel
Intussuscepiens
Aetiology
Hint:VITAMINS ABCDEK
I-hypertrophy of Peyers patches due to RTI/gastroenteritis
Idiopathic-90% of cases
Pathological lead point from above 3yrs
VITAMINS ABCDEK
Vascular-bleed or blocked
Infectious/inflammatory
Traumatic/toxic
Autoimmune/allergy
Metabolic
Iatrogenic/idiopathic
Neoplastic
Social-social reason
Alcohol
Behavioural
Congenital -all
Degenerative
Drug related
Endocrine/exocrine problems
Karotype/genetic disorders
Classification of intus
Idiopathic/sec
Anatomical location:
Enterocolic :ileocolic ,ileo-ileocolic
Enteroenteric :jejunojenal
Colocolic :caecolic
Single /double
Anterograde/retrograde
Pathophysiology
Edema and swelling of the -leads to -occlusion and - occlusion
Transmural necrosis of -,peritonitis and perforation
- leads to 3rd space loss,- and -
- results in sepsis,MODS and ultimately Death
Intusscepien
Luminal and mesenteric vascular
Intususceptum
Fluid sequestration
transmural bacterial migration.
Classical triad
Intermittent abd pain,vomiting and bloody stool
Clinical features
Early symptoms
1)paroxysmal and pain
2)separated by periods of apathy
3)Vomitting
Late symptoms
1)Worsening vomitting becoming bilious
2)abd distention
3)initial normal stool ,then red currant jelly stool
4)dehydration(progressive)
Physical examination
Healthy looking child
Palpable abd mass in early presentation
Irritable,weak and lethargic
Febrile pale and dehydrated or -(in late presentation)
- sign
Abd distention and features of peritonitis
Rectal examination(- and -s)
Healthy looking child
Palpable abd mass in early presentation
Irritable,weak and lethargic
Febrile pale and dehydrated or in shock(in late presentation)
Dance sign
Abd distention and features of peritonitis
Rectal examination(blood mucoid stool,palpable mass)
Prolapsed intus Vs rectal prolapse
Possiblity to freely insert index finger between anal wall and the prolapsed
Epid
Noticed to occur more at time of weaning especially in well nourished children
Incidence is less than 30% in malnourished children
90% of cases are btw ages 3months -3yrs
There is seasonal variation
Noticed to occur more at time of weaning especially in well nourished children
Incidence is - in malnourished children
90% of cases are btw ages - to -
There is seasonal variation
Definitive surgery for intussception
Laparotomy through right extended upper transverse incision
Viability must be assessed before intussusceptions reduction:
If bowel is viable,-of intussusceptum from intussuscepiens for manual reduction
If viability but manual reduction difficulty cause of edema then use -around intussusceptions for 10mins then manualy reduce
If reduction impossible after above then -
If viability questionable,saline soaked and towel is wrapped and oxygen delivery is increased to -for -mons from initial -%
Then bowel is reassesed-viability achieved-manual reduction
If no viability,reaction and anastomosis is done immediately
If bowel is viable,milk apex of intussusceptum from intussuscepiens for manual reduction
If viability but manual reduction difficulty cause of edema then used saline soaked abd towel around intussusceptions for 10mins then manualy reduce
If reduction impossible after above -bowel resection and anastomsis
If viability questionable,saline soaked and towel is wrapped and oxygen delivery is increased to 100% for 10mins from initial 69%
Then bowel is reassesed-viability achieved-manual reduction
If no viability,reaction and anastomosis is done immediately
