Postoperative intussusception: a diagnostic dilemma

Abstract

Intussusception as a cause of intestinal obstruction in the postoperative period is still a perplexing problem to most surgeons. From 1980 to 1988, four cases of postoperative intussusception (POI) were seen at the Kobe Children's Hospital, representing 5.4% of all intussusceptions managed during this period. There were two females and two males, ages ranging from 1 to 18 months. In two, the initial operation was nephrectomy; one had operative reduction of an ileocolic intussusception (postoperative intussusception was ileo-ileal); and the fourth had a laparotomy performed for suspected pyloric stenosis. All four presented with bilious vomiting, abdominal distension, and increasing bile-stained aspirate via a nasogastric tube during the 1st week following surgery. Radiological and laboratory parameters were not helpful in arriving at a correct diagnosis. Ileo-ileal intussusception was found at operation in all four, with no evidence of a pathological lead point. In all cases manual reduction was carried out successfully and the convalescence was unevenful. In view of the difficulty in establishing the diagnosis of POI, a literature review has been made that enables a common pattern of symptomatology to be identified. It is hoped that this will serve as a guide permitting earlier recognition of this postoperative complication.