Recurrent Intussusception

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Recurrent Intussusception

  1. 1. RECURRENT INTUSSUSCEPTION IN AN INFANT Dr. Rashidi Ahmad Emergency Department HUSM
  2. 2. OBJECTIVES • Incidence of recurrent intussusceptions • Radioimaging diagnosis and therapeutics • The best option of intussusceptions management in ED
  3. 3. INTRODUCTION • The commonest cause of intestinal obstruction among infant and young childhood • Leading cause of mortality of GI emergencies Jay L Grosfeld. Intussusception Then and Now: A historical Vignette. J Am Coll Surg, 2005:830-832
  4. 4. MANAGEMENT OPTIONS • Management option surgical non-surgical pneumatic barium ● Non-surgical reduction proves to be superior to surgery Eur J Pediatr 1999;158:707- 710.
  5. 5. ISSUES • Risk of recurrence is 0-5.4% (post surgery) • The recurrence may be overlooked by junior or inexperienced doctors Koh C-C, Sheu J-C, Wang N-L, et al. Pediatr Surg Int 2006 September);22:725- 728
  6. 6. Recurrent intussusception post surgical reduction • What is the best tool to detect intussusceptum and intussuscepient • Conservative (barium or pneumatic reduction) versus surgical reduction
  7. 7. CASE PRESENTATION CHIEF COMPLAINT 10/12 old boy with acute onset of abdominal pain and vomiting PRESENTING ILLNESS abdominal pain and vomiting since early morning NBO and crying throughout the day Less active and poor oral intake
  8. 8. PAST MEDICAL HISTORY Intussusception at 8/12 old –underwent surgical reduction (? type of surgery) (? reason for failed non-surgical reduction) CLINICAL FINDINGS Vitals sigs:Normal Afebrile Fairly hydrated Abdomen: soft, no palpable mass Other systems unremarkable
  9. 9. Supine abdominal radiograph
  10. 10. Plain abdominal radiograph • Normal radiograph does not exclude the diagnosis • Significant signs: - target sign - paucity of air in the bowel - little or no stool in the colon or small - bowel soft tissue mass in the RUQ (50%) - SBO James D’Agostino, 2002
  11. 11. SIEMENS Elegra MEDISonoline
  12. 12. Color Doppler USG • Estimate the reducibility - color signal within intussususceptum • Predicts bowel ischemia - does not always true
  13. 13. Urgent pneumatic reduction • Patient was sedated • Prone position • Foley’s catheter sized 22F inserted into the rectum • Air inflated till 120 mmHg and sustained at about 80 mmHg for 30 min
  14. 14. 1st trial 2nd trial
  15. 15. PSEUDOKIDNEY? • Thick-walled “doughnut” (intussuscepiens) with inner echogenic mesenteric fat (intussusceptum)
  16. 16. CLINICAL PROGRESSION • Close observation in pediatric surgical ward • Discharged well on the second day of pneumatic reduction
  17. 17. FINAL DIAGNOSIS RECURRENT INTUSSUSCEPTION
  18. 18. RECURRENT INTUSSUSCEPTION • Early diagnosis is crucial • Index of suspicious • Ultrasonography has a high diagnostic accuracy rate for intussusception and safer than x-rays • Pseudokidney? S & S (94%) • Suggestion: NO MORE x-ray in suspected intussusception Harrington et al. Ultrasonography and Clinical Predictors of Intussusception. Journal of Paed 1997;132:836-839
  19. 19. • Factors affecting the successfulness of pneumatic reduction –Coexisting intestinal pathology –Delay in diagnosis Journal of Pediatric Surgery 2007;42:1504-1508
  20. 20. CONCLUSION • Ultrasonography is the best diagnostic method of intussusception • A successful pneumatic reduction of intussusception require a multidisciplinary approach Harrington et al. Journal of Pediatrics 1997;132:836-838 K Rosenfeld, K McHugh. Clinical Radiology 1999;54:452-458

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