Surgical management

1. INTUSSUSCEPTION
Presenter : Dr Nyangu
Moderator : Dr Mukunyandela

2. • Intussusception is a process in which a
segment of intestine invaginates into the
adjoining intestinal lumen, causing bowel
obstruction.
• It is the most common cause of Intestinal
obstruction in infants 6 to 18 months
• Types: 1. Simple ileocolic; most common
type. 2. compound ( ileoileocolic). 3.
Retrograde jejunogastric intussusception

4. • PARTS
• 1. intussuscipiens: outer tube (distal bowel
which receives the intestines)
• 2. intussusceptum : proximal bowel( inner
tube ) which eneters distal segment
• 3.Apex : part which advances further into
the distal bowel
• 4. Neck the narrowest part of the
intussusception .

6. AETIOLOGY
1. IDIOPATHIC ; usually seen in infants.
• Predisposing Factors ; Recent viral
infection(URTI), Recent operation ,
Henöch-Schonlein purpura , cystic fibrosis ,
coeliac disease , hemophilia
• 2. ADULT INTUSSUSCEPTION: causes
include ; Meckels diverticulum , polyps,
tumors , submucous lipoma , carcinoma
colon

7. PATHOPHYSIOLOGY
• As the apex advances, it drags the
mesentery containing blood vessels which
get obstructed at the neck resulting in
mucosal ulcers and hemorrhages . marked
lymphadenopathy and hypertrophy of
Peyer's patch is found at operation .
• if neck is too tight, gangrene sets in very
early as in ileocolic intussusception
• All features of strangulation, dehydration,
distention and septicemia shock develop

8. CLINICAL PRESENTATION
• HX : pts comes in with hx of URTI,
symptoms include vomitting,
• Abdominal pain: Pain in intussusception is
colicky, severe, and intermittent
• Passage of blood and mucus
• Lethargy
• Palpable abdominal mass( sausage like
mass)
• Dance sign ( emptiness in right iliac fossa)

11. DIAGNOSIS
• Plain abdominal radiography reveals signs
that suggest intussusception in only 60%
of cases
• Ultrasonography: Hallmarks of
ultrasonography include the target and
pseudokidney signs, Doughnut sign with
doppler
• Barium enema: shows Claw (pincer
ending) . also called meniscus sign

15. MANAGEMENT
• NON OPERATIVELY : Therapeutic
enemas
• Hydrostatic ; With barium or water-soluble
contrast
• Pneumatic: With air insufflation
• SURGICAL INVERVENTION :
• laparatomy and reduction

16. References
• Lloyd DA, Kenny SE. The surgical
abdomen. In: Pediatric Gastrointestinal
Disease: Pathopsychology, Diagnosis,
Management, 4th ed, Walker WA, Goulet
O, Kleinman RE, et al (Eds), BC Decker,
2004. p.604.
• Ntoulia A, Tharakan SJ, Reid JR,
Mahboubi S. Failed Intussusception
Reduction in Children: Correlation
Between Radiologic, Surgical, and