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Intussusception: DR Phillipo Leo Chalya

This document discusses intussusception, which is the invagination of the proximal intestine into the distal intestine. It defines intussusception and provides details on its epidemiology, aetiology, pathophysiology, diagnosis, and treatment. The key points are that it commonly affects children ages 4-9 months, the pathophysiology involves progressive shortening and obstruction of the intussuscepted bowel, and treatment involves non-operative or operative reduction/resection depending on the severity of the case.

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Sibabaong'ombe Masaka
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133 views19 pages

Intussusception: DR Phillipo Leo Chalya

This document discusses intussusception, which is the invagination of the proximal intestine into the distal intestine. It defines intussusception and provides details on its epidemiology, aetiology, pathophysiology, diagnosis, and treatment. The key points are that it commonly affects children ages 4-9 months, the pathophysiology involves progressive shortening and obstruction of the intussuscepted bowel, and treatment involves non-operative or operative reduction/resection depending on the severity of the case.

Uploaded by

Sibabaong'ombe Masaka
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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INTUSSUSCEPTION

Dr Phillipo Leo Chalya


SEMINAR PLAN
• Definition
• Epidemiology
• Aetiology
• Pathophysiology
• Diagnosis
• Treatment
DEFINITION

• Invagination of proximal intestine into


lumen of distal intestine.
• Intussusceptum (proximal)
• Intussuscepiens (distal)
EPIDEMIOLOGY
• Common cause of childhood IO.
• Age: mainly 4-9 months.
• Diet: Associated with weaning.
• Sex: Male:Female,Upto 5:1
Epidemiology 2
• Race: worldwide occurrence.
• Genetical: ------
• Incidence: varies with hospital.
• Mortality: rare except in gangrene.
• Types:ileo-ileal,ileo-colic,caeco-colic.
AETIOLOGY
• Idiopathic: Ass. viral infections with
hypertrophy of Payer's patches.
• Other associated lesions.
ASSOCIATED LESIONS
• Bowel wall/mucosa abnormality(lead points)
• Polyps
• Tumors & diverticula
• Parasitic infestations & enteric cysts.
ASSOC. LESIONS 2
• Intramural haematoma(Henoch-Schonlein
purpura)
• Surgery: tumors & appendix.
• Foreign bodies & inspissated faeces (cystic
fibrosis)
PATHOPHYSIOLOGY
• Lead Point.
• Increased peristaltic activity.
• Progressive shortening of Intussuscepiens.
• Indrawn me sentry & vessels compression.
PATHOPHYSIOLOGY 2
• Increased length of Intussusceptum.
• Obstruction of veins leading to oedema.
• Mechanical intestinal obstruction.
• Ischaemia , gangrene & perforation.
• Apparent rectal prolapse ,mucus & capillary
wall breakdown causing currant jelly stool.
DIAGNOSIS

HISTORY
• 20% typical presentation.
4-9 months infant.
Healthy suddenly unwell.
Vomiting
Abdominal colic.
Lethargic
Refuses feeds.
Mucoid bloody stools (red currant jelly)
EXAMINATION
• Ill looking & lethargic.
• Pale ,dehydrated &mildly wasted.
• Slight abdominal distention.
• Vague tenderness except in perforation.
EXAMINATION 2
• Palpable abdominal mass (sausage shaped).
• Rectally: Intussusceptum ,bloody mucoid
stools OR blood on examining finger.
EXAMINATION 3 -Atypical
• 35% without mass palpable.
• 35% without rectal blood / mucus.
• 20% without obvious colic / periodic drawing
up of knees with crampy abdominal pain.
INVESTIGATIONS
A. BASELINE
• Hb, Grouping & crossmatcing.
• CBC & ESR.
• Serum Electrolytes.
B. SPECIFIC
• Abdominal Ultrasound
• Plain Abdominal x-rays.
• Contrast Barium Enema
DIFFERENTIAL DIAGNOSIS

• Constipation.
• Gastroenteritis.
TREATMENT
A. PATIENT:
• Resuscitation
• Antibiotics.
• Analgesics.
B. DISEASE CONDITION:
• Operative OR Non operative
TREATMENT 2
A. REDUCTION
B. RESECTION
INDICATIONS 4 SURGERY:
• Perforation :clinical ,radiological OR above 48
hours.
• Failed hydrostatic Barium reduction.
• Age: < 2 months & > 2 years.
• Post operative cases.
• More than 2 episodes treated by hydrostatic
reduction.
OPERATIVE & POST OPERATIVE
MANAGEMENT
• Transverse incision .
• 10% require resection with end to end
anastomosis.
• POST OPERATIVELY:
 NGT SUCTION
 INTRAVENOUS FLUIDS 3—4 DAYS.
5% COMPLICATED: Recurrent CASES.

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