INTUSSUSCEPTION INTUSSUSCEPTION

Dr.B.SELVARAJ MS;Mch;FICS; Dr.B.SELVARAJ MS;Mch;FICS;

• Neonatal & Pediatric Surgeon

• Associate Professor

• Melaka Manipal Medical college

• Melaka- 75150

• Malaysia

OBJECTIVES

• To discuss the etiology and

pathophysiology of Intussusception

• To discuss the differential diagnosis

and to make you to clinch the correct

diagnosis

• To discuss various treatment options

• Ultimately to make you confident in

managing a case of Intussusception

PLAN • Definition

• Etiology

• Types and Pathology

• History and Physical

• Differential Diagnosis

• Workup

• Preoperative preparation

• Management

• Complications

INTUSSUSCEPTION

Definition • Telescoping a segment of bowel into

the adjacent segment

• Usually proximal to distal

• If distal to proximal�Retrograde

Intussusception

INTUSSUSCEPTION

Etiology

• Idiopathic

• Respiratory viral infection�

Hypertrophy of Peyer’s patches

• Meckel`s diverticulum,

polyp,NHL, submucosal

hematoma�can act as Lead

Point

INTUSSUSCEPTION

Types and Pathology

• Ileoileal

• Ileocolocolic

• Colocolic

• Intussusceptum

• Intussuscipiens

• Strangulating obstruction

INTUSSUSCEPTION

History & Physical

• Age: 2 months to 2 years

• Male: Female 4:1

• Well built male baby with

intermittent colicky pain

• Blood and mucus in stool� Red

Currant Jelly stool

• Bilious vomiting

INTUSSUSCEPTION

History & Physical

• Mass in colonic region�

Sausage shaped

• RIF empty� Signe de Dance

• PR� may feel the mass

• Mass coming out of Anus D/d

Prolapse Rectum

INTUSSUSCEPTION

Differential Diagnosis • Anal Fissure

• Juvenile Polyp

• Multiple Polyposis

• Colitis

• Intestinal Duplication

• Malrotation with Volvulus

• Meckel`s Diverticulitis

• Dysentery

• Hemorrhoids

INTUSSUSCEPTION

workup

• AXR-- Erect� Small bowel

obstruction

• Barium Enema� Spincer

shaped ending / Spring coil

appearance/ Meniscus sign

• USG Abdomen� Target Sign

and Pseudo Kidney

appearance

INTUSSUSCEPTION

Imaging Studies

INTUSSUSCEPTION

Imaging Studies

INTUSSUSCEPTION

Preoperative Preparation

• NPO

• NGT aspiration

• I.V. Antibiotics

• If in Shock � Resuscitate

• CBD and I/O Chart

• Type and crossmatch group

specific wholeblood

INTUSSUSCEPTION

Management

• Barium enema reduction

• Hydrostatic saline reduction

• Pneumo reduction

• Laparotomy and Manual

Reduction “Milking manuver”

• Laparotomy and Resection of gut

with anastomosis

INTUSSUSCEPTION

Pneumoreduction

INTUSSUSCEPTION

Pneumoreduction

INTUSSUSCEPTION

Hydrostatic Reduction

INTUSSUSCEPTION

Operative Management

INTUSSUSCEPTION

Operative Management

INTUSSUSCEPTION

Operative Management

INTUSSUSCEPTION

Operative Management

INTUSSUSCEPTION

Operative Management

INTUSSUSCEPTION

Complications

• Wound infection

• Short bowel syndrome

• Fecal fistula