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Pediatric Intussusception

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Intussusception
Dr. Arjun A. Pawar
MBBS, MS, M. Ch. Pediatric
Surgery,
DNB Pediatric Surgery, FMAS,
FIAGES.
Divine Pediatric Surgery Centre.
Intussusception--the invagination of
one part of the intestine into another
•most frequent - acute bowel obstruction-
infants and toddlers
•second most common- acute abdominal
pain in infants and preschool children after
constipation
•more males than females - 2:1
Age:
•90% in children within 3 years of age.
•75% within 2 yrs
•More than 40% are seen between 3 and 9
months of age.
Intususcepiens
Intususceptum
PLP
Parts of intussusception
Intussuscepiens
Pediatric Intussusception
Pediatric Intussusception

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Pediatric Intussusception

  • 1. Intussusception Dr. Arjun A. Pawar MBBS, MS, M. Ch. Pediatric Surgery, DNB Pediatric Surgery, FMAS, FIAGES. Divine Pediatric Surgery Centre.
  • 2. Intussusception--the invagination of one part of the intestine into another •most frequent - acute bowel obstruction- infants and toddlers •second most common- acute abdominal pain in infants and preschool children after constipation •more males than females - 2:1 Age: •90% in children within 3 years of age. •75% within 2 yrs •More than 40% are seen between 3 and 9 months of age.
  • 7. Types of intussusception four main types: general, specific, anatomic, and other 1.General types: permanent (fixed, 80%) and transient (sponta reduction) 2.Specific types: idiopathic (no pathologic lead point [PLP], 95%), PLP (4%), postoperative (1%); 3.Anatomic types: ileocolic (85%); ileoileocolic (10%); appendicocolic, cecocolic, or colocolic (2.5%); jejunojejunal, ileoileal (2.5%); and those occurring around indwelling tubes;
  • 10. USG
  • 11. Treatment •Admission, Strict NBM, •Blood investigations-CBC,KFT,SE,LFT, Sos ABG. •Hydration •Antibiotics •Steroids •Antispasmodics •NSAIDS •Intervention- Intussusception reduction
  • 12. Intussusception reduction- Techniques •Open Surgery- Exploration •USG guided Hydrostatic reduction •C-Arm guided Pneumatic reduction
  • 13. Open Surgery •100 % success •PLP can be dealt with (4%) •Morbidity associated with surgery •Increased cost •Increased hospital stay •Delayed recovery due to ileus •Chances of serosal tears •Postop pain due to wound •Chance of bowel adhesion •Poor cosmesis •Time- 1 to 2 hours
  • 14. USG guided Hydrostatic reduction •No anesthesia required •Cost-effective c.t open •Less time c.t. open •Quick recovery • Operator dependant • Very difficult in non cooperative child • Chances of hypothermia due to fluids used for reduction • Repeated balloon expulsion during procedure • Chances of under correction • Due to technical errors/ inadequate expertise • Need to shift in OT if reduction fails- Time lapse • Time required- 20 minutes to 30 minutes for reduction plus peri-procedure time • Chances of bowel perforation due to excess fluids • Can not be done if excess bowel gas
  • 15. C-Arm guided Pneumatic reduction • More success rate c.t. USG • Quick procedure less than 5 min • Procedure in controlled condition- under Anesthesia • Surety of procedure completion and no need for follow up USG unless symptomatic • Child comfort • No risk of hypothermia • No time laps if procedure fails Exploration trolley kept ready in OT • Very much Cost effective • Quick recovery- Less hospital stay • No procedure pain • Need for anesthesia • Risk of bowel perforation • Sometimes difficult if excess gas as claw sign can be missed.
  • 19. Failed Reduction •Long duration •Bowel gangrene •PLP •Gross abdominal distension due to obstruction •Complication- Bowel perforation during hydrostatic/ pneumatic reduction Exploratory Laparotomy