Intracolonic resection of non-reducible intussusception

Abstract

A survey has been presented of well known factors regarding intussusception, particularly those referrable to diagnosis and prognosis. It is intimated that there may be an essential difference in intussusception in infants as compared to that of the adult, the latter apparently tolerating better both the disease and its operative correction. For the latter reason one might do well in not unreservedly applying to the surgical treatment of intussusception in the infant procedures proved successful in the case of the adult. Optimal requirements for surgical treatment for the irreducible intussusception have been considered, namely, removal of the devitalized or gangrenous bowel with re-establishment of intestinal continuity of satisfactory blood supply throughout the intestinal tract and of normal physiologic intestinal function. A survey is presented of the available procedures applicable in the surgical treatment of non-reducible intussusception. A particular description is presented of the so-called Barker procedure which aims at the direct approach of the invaginated bowel segment employing an incision directly through the overlying colon wall, thus making possible intracolonic resection of the extruding gangrenous bowel. A detailed description with illustrations is presented of a surgical technic successfully employed by the author in two cases and representing what may be considered an essential modification of the original Barker approach. The procedure maintains the transcolonic incision with freeing of invaginated bowel. In addition, transection of the involved distal ileum, mesentery and mesocolon permits an intentional, manual and near maximal invagination of these latter structures into the head of the invaginated bowel mass, thus transforming the anatomically complicated ileocolocolic intussusception into the much simpler colocolic type. The everted mass with the colon segment can then be resected intracolonically. After closure of the proximal colon segment the now remaining opening into the colon can be utilized for re-establishment of intestinal continuity through an ileocolostomy. The procedure may prove particularly applicable in the irreducible ileocolic or ileocolocolic intussusception with a great mass of invaginated bowel with poor or absent mobility of the involved bowel segment in an adult patient in poor general condition. It is believed not to be wise to employ a similar procedure in nonreducible intussusception in children.