PDA

View Full Version : Intussusception (Etiology-Pathology-Clinical picture-Complications-Investigations-Treatment)



Medical Videos
05-02-2008, 09:05 AM
m Definition : Invagination of proximal loop of intestine into a distal one.
Retrograde intussusception is very rare = Distal loop in proximal one e.g. jejunogastric intussusception through gastrojejunostomy.
m Predisposing Factors :
Leading causes:
Wide iliocecal angle.
Hypertrophied iliocaecal Valve.
Bloodless band of Treves between mesentery of ileum and caecum; may be a guide for ileum into the caecum .
Mickle's diverticulum.
Pedunculated tumors of the intestine .
Increase mobility by:
Gastroenteritis so, it is common between. 6 : 24 ms. (period of weaning)
Mobile caecum.

m Pathology:
1- Proximal to obstruction
2- Distal to obstruction
3- At site of obstruction:
Entering layer

Returning layer

Ensheathing layer

Head

Intussuscepiens

Intussusceptum

Neck


- Structure :
- Varieties: 5 Types :
1- Ileo-caecal intussusception.( the commonest type)
2- Ileo-ileal intussusception.
3- Ileo-colic intussusception.(start as ileo-ileal)
4- colo-colic intussusception
5- Retrograde intussusception
- Fate :
- As the entering layer proceeds , it draws the mesentery behind.
- The venous flow is obstructed at first causing congestion and edema.
- The arterial flow is obstructed later causing ischaemia and gangrene resulting in perforation.
- In rare cases, the entering loop may proceed down to the rectum and even protrude through the anus.
m Clinical Picture:
1- Common in summer ( G.E ).
2- Pain: the child draw his legs over abdomen with continuos crying.
3- Vomiting : At the onset, and late cases
4- Visible Peristalsis: Early : Vigorous. Late : faint.
5- Abd. distention: Mild.
6- Constipation: Red currant jelly stool.
7- General condition: Dehydration and toxemia.
8- Mass:
* Site: changeable.
* Shape: sausage shape with concavity looks towards the umbilicus due to traction of the mesentery.
9- De Dance sign: Empty Rt. iliac fossa due to ascend of the caecum.
10- In Late cases: Protruding mass from the anus. ( in rare cases )
m Investigations:
1- PR: Head of intussuceptum or Red currant jelly stool
2- Plain x-ray : Multiple fluid level
3- Barium enema : ( Diagnostic )
Barium arrest with typical circular folds of barium in colonic haustrotions.
m Differential diagnosis :
1-Gastroenteritis.( Vomiting and diarrhea )
2- Rectal prolapse No obstruction & Mucosa is continous with skin




m Treatment :
1- N/G suction. 2- I.V. fluids.
3- Operation:
(A) Try to reduce it simply by milking the head not by pulling the intussusceptum.
(B) If failed; try dilatation of the neck by finger, then, try milking again.
(C) If failed : open the ensheathing layer and deliver the intussusceptum.
If intusseptum is viable, reduce and close the ensheathing layer.
If intussusceptum is gangrenous, do Rt. hemicolectomy with iloiotransverse colostomy.
F N.B. In early cases; reduction by hydrostatic pressure (Barium enema under
screen) may be tried but we must avoid reduction of gangrenous loop.
SOURCE: DR. AYMAN SALEM'S BOOK
Copyright: Vascular Society of Egypt (www.vsegypt.org (http://www.vsegypt.org/)) &Medical Engineering Forums (www.mediengi.com (http://www.mediengi.com/))
Not to be reproduced without permission of Vascular Society of Egypt