Pediatric Intussusception
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This document discusses intussusception, which is the invagination of one part of the intestine into another. It is most common in infants and toddlers, with 90% occurring in children within 3 years of age. There are different types including general, specific, anatomic. Treatment involves admission, hydration, antibiotics, and intervention such as intussusception reduction through open surgery, USG guided hydrostatic reduction, or C-arm guided pneumatic reduction. C-arm guided pneumatic reduction has benefits such as being quick, ensuring procedure completion under anesthesia with less risk of complications compared to other methods. Exploration surgery may be needed if reduction fails or there are issues like bowel gangrene or perforation.
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Acute Pancreatitis
The panel discussion summarized:
1) Serum amylase and lipase levels are reliable markers for acute pancreatitis during pregnancy.
2) MRCP is the best imaging modality for evaluating the bile duct for choledocholithiasis in pregnancy due to lack of radiation exposure, though EUS provides the highest accuracy.
3) Therapeutic ERCP can be performed safely in pregnancy with precautions to minimize radiation exposure to the fetus, and is safest during the second trimester.
Asbo
Based on the information provided:
- This study aims to determine whether early operation and age affect outcomes of ASBO in pediatric patients, so it falls under the category of prognosis.
- The study design is a retrospective chart review, which is considered a cohort study. This fits with a level 2b level of evidence according to the Oxford Centre for Evidence-Based Medicine.
- A few limitations are noted - the retrospective design, incomplete data, inability to determine why surgeons made clinical decisions. However, overall it seems like a reasonably well-conducted study to address the research question.
- The results suggest that delaying operation beyond 48 hours and younger age (under 1 year) are associated with worse outcomes like more bowel
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- 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;
- 9. X ray -Erect
- 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
- 30. Thank You