Treatment Of Intestinal Intussusception Research Articles

Інвагінація кишечника в дітей: навчання та практика

Intestinal invagination is a mixed form of intestinal obstruction that occurs when one section of the intestine is telescopically immersed in the lumen of another and occurs mainly at the age of 3 months to 1 year, which is 90%, and mortality, according to the literature, ranges from 6 to 14.5%. Despite a sufficient number of scientific and clinical publications on the pages of medical journals regarding the diagnosis and treatment of intestinal intussusception, there are no fake simulators in the training of students and interns, which determines the relevance of this publication. Purpose - to improve the results of diagnosis and treatment of children with intestinal intussusception by analyzing domestic developments and visually studying the mechanism of its development with the help of a simulator both for the purpose of diagnosis and treatment - conservative disinvagination. Results. In today’s conditions, general practitioners and pediatricians are not trained to diagnose intussusception in children, that is, they do not have simple methods of examination. Hospitals usually do not have the equipment to examine and diagnose acute intussusception. In order to eliminate the gaps at the Department of Pediatric Surgery of the Bukovinian State Medical University, a dummy-simulator of intestinal intussusception «Garant» was developed and introduced into the educational process. Training on a simulator allows you to master the practical skills of diagnostics in the conditions of an X-ray room and conservative disinvagination followed by X-ray control. In turn, the development of skills by primary care physicians and pediatric surgeons in diagnosis and treatment will primarily improve the understanding of the onset of the disease and treatment methods. Conclusions. With certain and significant developments regarding the diagnosis and treatment of intestinal intussusception in children, the problem has not been solved, since some children seek help at the wrong time, and as a result of complications - necrosis, peritonitis with organ and multiple organ failure. The use of a scoring system for assessing the stage of invagination makes it possible to systematize the main prognostic indicators of sonographic and dopplerographic studies in order to determine an adequate method of treatment. Practicing the skills of diagnosis and treatment on the self-developed dummy «Garant» allows you to clearly understand the essence and purpose of the measures taken to establish and confirm the diagnosis of intestinal intussusception, evaluate the possibilities of various methods of conservative and surgical treatment and indications for them. No conflict of interests was declared by the authors.

Intussusception of the bowel in adults: two different cases.

Intussusception in adults is considered an unusual condition accounting for 5% of all cases of intussusceptions and almost 1%-5% of all cases of bowel obstruction. We present two cases of patients with a complaint of abdominal discomfort and concomitant vomiting who are 43 and 44 years old. Ileocecal intussusception was diagnosed by computed tomography. One patient underwent open whereas the other underwent laparoscopic right hemicolectomy and ileotransversostomy. A histopathological study revealed lipoma in the first case and adenocarcinoma in the second. We described the diagnosis and treatment of intestinal intussusception in adults.

A 30-Year Experience in Treatment of Intestinal Intussusception in Children by Own Technique

The issues on objectification and selection of indications for conservative treatment of intestinal intussusception in children remain to be disputable.Materials and methods. The experience of treating 249 pediatric patients (172 boys and 77 girls) with intestinal intussusception at the age of 2 months - 13 years was analyzed. There were 265 cases of intestinal intussusception including 16 cases of the recurrence in 11 children. Conservative treatment was performed in 178 (71.5%) children, 71 (28.5%) children were operated on. To make the analysis, children were divided into 3 groups according to three ten-year periods.Results and discussion. The statistical analysis demonstrated the decrease in the number of patients with the increase in the number of children over 1 year of age over the past decade. The 1st decade was characterized by the introduction and experimental substantiation of flow-through pneumatic insufflation developed by the author with following refusal of X-Ray control. The methods of objectification of the criteria for non-surgical reduction of intussusception using flow-through pneumatic insufflation were developed experimentally. In the 2nd decade the algorithm for treatment of intestinal intussusception was developed; the indications for non-surgical reduction of intussusception were extended. 5 (22.7%) children out of 22 with disease duration of more than 24 hours and 6 (46.2%) children out of 13 over 1 year of age underwent non-surgical reduction of intussusception. In the 3rd decade the indications for non-surgical reduction of intussusception were extended. 11 (57.9%) children out of 19 with disease duration of more than 24 hours and 20 (74.1%) children out of 27 over 1 year of age underwent non-surgical reduction of intussusception. Only in 4 (28.5%) children out of 14 over 1 year of age who were operated on, we found out anatomical cause of the condition. We have analized the experience in treating 11 children with 16 recurrences of intestinal intussusception. In 7 cases non-surgical reduction was performed, 4 children were operated on. During surgeries there were observed no anatomical causes or predispositions to intussusception. Lethal outcomes were not registered.Conclusions. Thus, flow-through pneumatic insufflation is an effective and objective technique of non-surgical reduction of intestinal intussusception in infants. Non-surgical reduction of intestinal intussusception can be performed in the majority of patients without the signs of peritonitis. The duration of the condition, age of patients and the presence of recurrence should not be considered as absolute criteria in choosing treatment tactics in intestinal intussusception.

Experience of Diagnosis and Treatment of Intussusception in Children

The objective of the research was to establish the causes of complications of intestinal intussusception in children as well as to determine the optimal diagnostic and treatment strategy.Materials and methods. The analysis of medical records and examinations of 100 children with intestinal intussusception at the age of 1 month to 17 years who were treated at the clinic of pediatric surgery of the Ivano-Frankivsk National Medical University was made. Ileocecal intussusception was diagnosed in 77 children; 13 patients had small intestinal intussusception; there were no patients with colonic intussusception; in 10 patients the localization of intussusception was not established. Treatment of intestinal intussusception was performed urgently immediately after the diagnosis. High priority was given to conservative treatment (74 patients); it was effective in 64 (86.5%) patients. The remaining 36 patients underwent surgery, 9 (25%) of them underwent a laparoscopic disinvagination. In 27 cases open surgery – disinvagination – was used.Results and discussion. The typical age (4-12 months) was observed in 50% of patients only, however, 38% of patients were over 1 year of age, and 20% of children were older than 3 years. All children with intestinal intussusception recovered. The complications of intestinal intussusception were observed in 7 patients, most of them were admitted to the clinic 24 hours after the onset of the disease. Re-laparotomy was used in three cases; two patients underwent elective (programmed re-laparotomy) and one patient underwent urgent re-laparotomy due to the presence of signs of peritonitis. Recurrent intussusception was observed in 5 patients; 4 patients developed this condition after conservative disinvagination, one child - after surgery.Conclusions. The complications of intussusception in children are usually associated with untimely diagnosis and treatment.Diagnostic laparoscopy is a highly informative method of diagnosis in the absence of typical symptoms of intussusception being also an effective minimally invasive treatment.When selecting the method of intussusception treatment you should be guided by the duration of rectal bleeding and Doppler data being the most important criteria for determining the degree of the impairment of hemomicrocirculation in the invaginated intestine.Conservative disinvagination is the priority method of treating intussusception.

Combination of different types of intestinal intussusception trauma in children

The issues of diagnosis and treatment of intestinal intussusception in children are still one of the most urgent in pediatric surgery. Often, intestinal intussusception is combined with various types of injuries.

Adult respiratory distress syndrome in an adolescent with diabetic ketoacidosis

7. Kitamura T. A clinical evaluation of pneumatic reduction for intussusception in infancy and chiidhood. J Jpn Surg Soc 1971 ;72:725-47. 8. She YX. Treatment of intestinal intussusception with particular emphasis on reduction by colonic insufflation: report of 5110 cases. Chir Pediatr 1982;23:373-8; 9. Fiorito ES, Cuestas LAR. Diagnosis and treatment of acute intestinal intussusception with controlled insufflation of air. Pediatrics 1959;24:241-4. 10. Pollet JE. Intussusception: a study of its surgical management. Br J Surg 1980;67:213-5. 11. Grieg D. On insutttation as a remedy in intussusception. Edinburgh Med J 1865;10:306.

Treatment of intestinal intussusception: Reduction by colonic insufflation (Report of 5110 cases): She Ya-Xiong. Chir Pediatr 23:373–378, 1982

Treatment of intestinal intussusception: Reduction by colonic insufflation (Report of 5110 cases): She Ya-Xiong. Chir Pediatr 23:373–378, 1982

Errors in the diagnosis and treatment of intestinal intussusception in children

The analysis of errors in the diagnosis and treatment of 49 children with intestinal intussusception is carried out according to the case histories. The most common causes of diagnostic errors are incorrect assessment of bloody discharge from the rectum, insufficiently careful examination of the patient, poor use of additional research methods, neglect of preoperative preparation in a serious condition of the child, inappropriate choice of anesthesia method and improper postoperative management of patients.

DIAGNOSIS AND TREATMENT OF ACUTE INTESTINAL INTUSSUSCEPTION WITH CONTROLLED INSUFFLATION OF AIR

Use of a new method for diagnosis and treatment of intestinal intussusception is described, termed "controlled insufflation." It consists of insufflation of the colon with air under fluoroscopic and manometric control. A simple attachment avoids higher intestinal pressures than desired. The apparatus, procedure, advantages and therapeutic results are briefly presented. Full reduction was achieved in 94% of 86 cases of intussusception.