Acute Intestinal Obstruction In Children Research Articles

A CASE SERIES ON THE MANAGEMENT OF INTUSSUSCEPTION IN INFANTS: CHALLENGING ENTITY WHILE DEPLOYED IN REMOTE SETTINGS DURING OVERSEAS DEPLOYMENT

Intussusception is a major cause of acute intestinal obstruction in children. Idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years. This paper reports three cases of infant intussusception, including one Ileo-ceaco-colic intussusception in an 8-month-old baby boy (an uncommon condition in small infants) treated at the peripheral hospital during deployment in remote settings. This case series highlights diverse signs and symptoms of intussusception, and very few cases present with a typical triad of intussusception (abdominal pain, vomiting, and red currant jelly stool). Strong clinical suspicion is required for the diagnosis of intussusception, especially in a remote peripheral setting where diagnostic facilities are scarce. Furthermore, the surgeon should be ready for a surprise challenge after opening Pandora’s box. Delay in diagnosis may result in complications such as perforation, necrosis, and death. An important lesson learned from these three different cases is that the postoperative behavior of surgically reduced intussusception differs from case by case, and we have to be careful and alert during the postoperative period.

Outcome of ultrasound guided reduction of intussusception in children by saline enema

Background: Intussuception is a common cause of acute intestinal obstruction in children and contributor of morbidity and mortality in children. The purpose of this study was to evaluate efficacy of hydrostatic reduction of intussusception over operative reduction using normal saline enema in children and to identify procedure related complications.Methods: All patients presenting to us with features of intussusception clinically and confirmed by ultrasonography between June 2015 to November 2017 were included in study. Depending on haemodynamic stability of patient and surgeon’s preference, patients were subjected to trial of hydrostatic reduction by normal saline enema or operative procedure. Patients with failure or partial reduction were taken for surgery.Results: The mean age was 21.07 months with a male preponderance. Of 53 patients attending the institute, 32 were given a trial of hydrostatic reduction which was successful in 28. Thus success rate was 87.5%. 1 patient succumbed resulting in 1.4% mortality rate after the procedure. It was observed that longer duration of symptoms reduced chances of reduction. 88%patients with successful hydrostatic reduction were discharged within 4 days of admission.Conclusions: We conclude that ultrasound guided saline enema is simple ,safe and effective method of treating intussusception in children with low rate of complications and can be strongly recommended as first line of treatment of intussusception in select group of paediatric patient, especially those reporting early to the hospital.

TREATMENT OF ADULT INTUSSUSCEPTION WITH NON-OPERATIVE MANAGEMENT: A CASE REPORT

Intussusceptions, defined as insertion of proximal part of intestine into distal one, it is the second most common acute abdomen pathology after appendicitis. Acute intussusception is one of the common causes of acute intestinal obstruction in children, but on seldom occasions associated with leading points to the intussusceptions. The symptoms are the result of intussusception, like intestinal obstruction, volvulus due to subserosa lipoma and hemorrhage due to ulcerations of the overlying mucosa caused by direct pressure from the lipoma or the intussusception itself. Intussusception in adults is very rare. Most intussusception cases must be treated surgically. In patients who present with a vague history and constellation of abdominal symptoms pointing towards obstruction and are found to have a short segment intussusception, it is a valid option to apply a conservative approach with caution. Based on the available literature, CT scan evaluation seems to have both diagnostic and prognostic value, as it provides enough evidence with regards to signs indicating the need for surgery. Herewith, we describe a rare case of intussusception in Indonesian adult which was successfully treated non-surgically

Comparison of two examination methods in the diagnosis of acute intestinal obstruction in children

Objective To compare the value of 64-slice spiral CT and digital radiography(DR)in the diagnosis of acute intestinal obstruction in children. Methods Eighty-one children with suspected acute intestinal obstruction were selected. All patients were given DR and CT examinations. The diagnostic accuracy rates of the two examination methods were analyzed by taking surgery or follow-up results as golden standards. Results Among the 81 children patients, there were 58 cases with intestinal obstruction, with a sensitivity of 91.38% in CT and 87.93% in DR, a specificity of 86.96% and 82.61%, respectively, the accuracy rate of 90.12% and 86.42%, respectively, and the consistency Kappa value of 0.763 and 0.679, respectively. McNemar test results showed no significant difference between the two groups(P>0.05). Among 58 children patients with intestinal obstruction, there were 19 cases with adhesive obstruction, 16 cases with intussusception, 11 cases with congenital intestinal obstruction, 5 cases with incarcerated hernia, 3 cases with necrotic enteritis and 4 cases with volvulus, and the accuracy rates of CT and DR for etiology of intestinal obstruction were 91.38% and 75.86%, respectively(P<0.05). Among 58 children patients with intestinal obstruction, there were 48 cases(82.76%)with low intestinal obstruction, 6 cases(10.34%)with high intestinal obstruction and 4 cases(6.90%)with colon obstruction, with the accuracy rates of CT and DR for the obstruction site examination were 94.83% and 82.76%, respectively(P<0.05). Conclusion The accuracy rate of CT in diagnosis of intestinal obstruction is comparable to that of DR, but CT has obvious advantages over DR in the etiology and sites of obstruction.

Mesenteric cyst(s) presenting as acute intestinal obstruction in children: Three cases and literature review.

Background and objectivesMesenteric cysts are rare in paediatric age group and usually present as asymptomatic abdominal lumps. Acute presentations are uncommon and their preoperative diagnosis is difficult.Design and settingsThis is a retrospective observational study describing three children with mesenteric cysts who presented with symptoms and signs of acute intestinal obstruction.Patients and methodsThree children with mesenteric cysts who presented with acute abdomen are described as per their age, presenting symptoms and signs, investigations, management, and outcome.ResultsThe three children presented in emergency with symptoms and signs of acute intestinal obstruction. On exploration, all had mesenteric cyst and were managed by deroofing, marsupilisation and excision. All patients recovered uneventfully.ConclusionsPresentation of mesenteric cyst as acute obstruction in paediatric age group is rare and preoperative diagnosis is difficult. The larger cysts are more likely to have an acute presentation.

Acute Intestinal Obstruction in Children: Experience in a Tertiary Care Hospital

Acute Intestinal Obstruction is one of the commonest surgical emergencies in children. These cases are invariably operated upon by general surgeons as pediatric surgeons are very few in Nepal. Outcome to a great extent depends on prompt clinical diagnosis and treatment. This is prospective study of 51 cases of intestinal obstruction admitted, operated and treated at Manipal Teaching Hospital, a tertiary care hospital in the Western Region of Nepal from January 2011 to September 2015. Aim of the study was to observe the pattern of intestinal obstruction in children and the treatment outcome in the hands of general surgeons. Number of cases in the cohort was 51. Out of that 50 cases were operated upon and 1 case was managed conservatively. Age of the patients’ ranged from 1 day to15 years (median age 9 months); There were 33 males and 18 females with a ratio of 1.8:1. Causes of intestinal obstruction were Intussusceptions (33), Meckel’s diverticulum (6), obstructed /strangulated hernia(4), imperforate anus(2), Hirschprung’s disease(2), Meconium ileus (1), Ladd’s band with malrotation of mid gut (1),annular pancreas(1) and Adhesions (1) Base line investigations of CBC, BT, CT, PT and serum electrolytes were done in all the cases. Plain x-ray abdomen erect and supine, ultrasonography (USG) and computed tomography (CT) scan were done in most of the cases and. Contrast study using Diatrizoate Meglumine (Gastrografin) was done wherever necessary. There were 3 mortalities and 2 cases had postoperative complications. Average post operative Hospital stay was 6 days. Early diagnosis and surgical intervention gives favorable outcome, delay increases morbidity and mortality. All these cases were taken up by general surgeons and the results were encouraging and good.

Hydrostatic Reduction of Intussusception under Ultrasound Guidance: An Initial Experience in a Developing Country

Intussusception is one of the most common causes of acute intestinal obstruction in children. Hydrostatic reduction with barium enema is the widely accepted and preferredmode of treatment of uncomplicated intussuception. The aim of this study was to report our initial experiencewith hydrostatic reduction of intussusception. We present our initial experience in which 8 patients had ultrasound guided hydrostatic reduction of intussusception over a period of 2 years. All patients that presentedwithin 48hours of onset of symptoms were recruited into the study. Clinical diagnosis of intussusceptions was made in all of them while abdominal ultrasoundwas used to confirm the diagnosis. Half of the patients presented after 24 hours of onset of symptoms. Five patients (62.5%) had a successful reduction of their intussusception while three patients (37.5%) had incomplete reduction which was completed by surgery. There was only one (12.5%) recurrence and there was no peritonitis. Ultrasound guided hydrostatic reduction of intussusceptions in this environment is possible when patients present early with low risk of complication and low recurrence rate. Keywords : Intussusception, ultrasound guided, hydrostatic reduction, recurrence. African Journal of Paediatric Surgery Vol. 4 (2) 2007: pp. 68-71

Acute Intussusception in childhood : Aspects of epidemiologic, Clinical Features and Management at Children′s Hospital, Donka, Guinea Conakry

Background: Intussusception is a common cause of acute intestinal obstruction in children. This study reports our experience in the management of childhood intussusception at children's hospital, Donka, in Conakary. Patients and Methods: This was a retrospective study of children treated for intussusception at children's hospital, Donka, in Conakary from January 1993 to June 2003. Results: There were 37 children in this study (M:F= 1.3: 1). Intussusception accounted for 4.60% of all abdominal emergencies in the paediatric surgery arm of the children hospital Donka in Conakry within the period. There was 56.76% male preponderance. Majority (86.48%) presented late, resulting in delayed intervention. Fifteen out of the 37 children presented after one week of onset of illness. All the patients presented with abdominal pain. Abdominal mass was palpable in 12 (32.4%) patients while four (10.8%) patients presented with prolapsed intussusception through the rectum. Majority of the intussusceptions in this study were of idiopathic origin. Seventy three percent (27) of the intussusceptions were of ileo-caeco-colic type. The average length of the intussuscepiens was estimated at 20 cm. The mortality rate was high (35.13%); the mortality was higher before the age of one year. Conclusion: Children with intussusception presented late in our hospital, with a high mortality rate especially in infants. Ignorance and poverty may be contributory factors. Keywords : Intussusception, children, classification, mortality African Journal of Paediatric Surgery Vol. 3 (1) 2006: pp. 1-3

Paediatric acute intestinal obstruction in Central India.

67 cases of acute intestinal obstruction in children were analysed. Intussusception (31.3%), external hernia (23.8%) and imperforated anus (16.4%) were the main causes of obstruction in more than 70 per cent of the cases. There are significant differences in the pattern of paediatric intestinal obstruction in developing countries, as compared with that in other parts of the world. The overall morbidity and mortality in this series was 26.8% and 23.8% per cent, and the neonatal mortality was 43.5%.

The diagnosis and treatment of acute diseases of the abdomen in children

There are some acute surgical conditions frequently encountered in children which are rare in adults. Acute diseases common to both childhood and adult life may manifest themselves differently in the young and require different forms of treatment. In children, it is not unusual for pathological lesions situated in distant parts of the body first to produce referred symptoms in the abdomen. A different technic should be employed when examining young individuals. Success in diagnosis depends upon the ability of the physician to manage the patient. There is no age limit for appendicitis. The disease in the young is notorious for the rapidity with which it progresses. Prompt diagnosis and removal of the organ before perforation occurs assures recovery. Even when rupture has taken place, eradication of the source of infection offers the best hope of a favorable outcome. The causes of acute intestinal obstruction in children are not always the same as those found in older patients. Young individuals are unable to tolerate the shock, dehydration and toxemia which accompany the condition. The mortality is high unless immediate relief is obtained. Intussusception is the most common surgical emergency encountered in infants under two years of age. Reduction constitutes the only safe method of treatment which assures a good chance of recovery. As this is possible only during the early stages of the disease, prompt diagnosis and immediate surgical intervention are necessary to save the child's life. The urachal remnant and Meckel's diverticulum are uncommon sources of acute abdominal disease. Nevertheless, these structures, as well as abdominal tumors and lesions of the biliary system must be kept in mind when dealing with acute abdominal disease in children.