Intussception Flashcards
Resuscitation
Initiate-
Aggressive fluid resuscitation using - and - if indicated
-placement and drainage
Urethral catherization
-antibiotice including -cover
IV access
Crystalloids and blood transfusion
NG tube
Broad spectrum ,anaerobic
Nonoperative treatment
Hydrostatic reduction
Pneumatic reduction
BOTH
USS guided
Flouroscopy Guided
Hydrostatic reduction uses
Saline
Barium
Gastrograffin
Hydrostatic reduction
Method
1)done under _
2)dilute barium/warm saline not cm above patient
3)Rule of 3’s _ , and _
Sedation
>100cm
Height(can at height of 3feet above patient),duration(about 3mins) and attempts (3attempts)
Success rate(65-85%) of hydrostatic reduction
Intussceptum moves - through - junction
Endpoint should be_ in _ with disappearance of target sign
Patients symptoms resolve
Backward,ileocecal
Free flowing fluid,terminal illeum
Hydrostatic reduction
Complications rate
Perforation in 1-2%
Recurrence in 8-20%
Pneumatic Reduction
Method:
Tight anal seal
Air insufflation limited to maximum _pressure of -mmhg(younger),-mmhg (older)
Rule of 3’s
Resting pressure
80mmhg
120mmhg
Success rate (75-90%)
must observe air in terminal illeum
Less recurrence(5-10%)
Low perforation rate(1%)
Non operative reduction
Contraindications
Absolute inflammation
-_ signs of inflammation
-suspected perforation
Relative contraindication
Symptoms >-hrs
Rectal bleeding
Poor prognostic indicators
Peritoneal signs
24-48hrd
Factors associated with failure
Symptoms>48hts
Rectal bleeding
Small bowel obs radiographically
Ileocolic or small bowel types
Presence of mechanical lead point
Age <3months
Operative management
Indications
-Non operative treatment failed
Successful non op treatment but residual -
Signs of -
Presence of a pathologic lead point
Radiographic evidence of -
-Non operative treatment failed
Successful non op treatment but residual luminal filling defect
Signs of peritonitis
Presence of a pathologic lead point
Radiographic evidence of pneumoperitoneum
Recurrent intussception
May follow either treatment in -
% in 24hrs,% in 6monthsb
Generally non op treatment is adopted
Operative treatment adopted if
1)patient has -episodes,ff previous Mon op management
2)1st recurrence in a child -yrs with previous non op management
3)pathological lead point suspected
2-20%casesv
20%
70
>1
2yrs
Post op intussception
Maybe be mistaken for -
Occurs usually within -
Op reduction is effective
Post op adhesive OBS
A month of initial procedure
Complications
Dehydration
Aspiration from emesis
Bowel perforation with peritonitis
Shock
Septicemia
Anastomotic leak
Short bowel syndrome
Recurrence
Prognosis
100% fatality with no treatment
Excellent if diagnosed early