Pediatric Intussusception - An Overview
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Transcript of Pediatric Intussusception - An Overview
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