Intussception

Question 1

Resuscitation
Initiate-
Aggressive fluid resuscitation using - and - if indicated
-placement and drainage
Urethral catherization
-antibiotice including -cover

Answer 1

IV access
Crystalloids and blood transfusion
NG tube
Broad spectrum ,anaerobic

Question 2

Nonoperative treatment

Answer 2

Hydrostatic reduction
Pneumatic reduction
BOTH
USS guided
Flouroscopy Guided

Question 3

Hydrostatic reduction uses

Answer 3

Saline
Barium
Gastrograffin

Question 4

Hydrostatic reduction
Method
1)done under _
2)dilute barium/warm saline not cm above patient
3)Rule of 3’s _ , and _

Answer 4

Sedation
>100cm
Height(can at height of 3feet above patient),duration(about 3mins) and attempts (3attempts)

Question 5

Success rate(65-85%) of hydrostatic reduction
Intussceptum moves - through - junction
Endpoint should be_ in _ with disappearance of target sign
Patients symptoms resolve

Answer 5

Backward,ileocecal
Free flowing fluid,terminal illeum

Question 6

Hydrostatic reduction
Complications rate

Answer 6

Perforation in 1-2%
Recurrence in 8-20%

Question 7

Pneumatic Reduction
Method:
Tight anal seal
Air insufflation limited to maximum _pressure of -mmhg(younger),-mmhg (older)
Rule of 3’s

Answer 7

Resting pressure
80mmhg
120mmhg

Question 8

Success rate (75-90%)

Answer 8

must observe air in terminal illeum
Less recurrence(5-10%)
Low perforation rate(1%)

Question 9

Non operative reduction
Contraindications
Absolute inflammation
-_ signs of inflammation
-suspected perforation

Relative contraindication
Symptoms >-hrs
Rectal bleeding
Poor prognostic indicators

Answer 9

Peritoneal signs
24-48hrd

Question 10

Factors associated with failure

Answer 10

Symptoms>48hts
Rectal bleeding
Small bowel obs radiographically
Ileocolic or small bowel types
Presence of mechanical lead point
Age <3months

Question 11

Operative management
Indications
-Non operative treatment failed
Successful non op treatment but residual -
Signs of -
Presence of a pathologic lead point
Radiographic evidence of -

Answer 11

-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

Question 12

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

Answer 12

2-20%casesv
20%
70
>1
2yrs

Question 13

Post op intussception
Maybe be mistaken for -
Occurs usually within -
Op reduction is effective

Answer 13

Post op adhesive OBS
A month of initial procedure

Question 14

Complications

Answer 14

Dehydration
Aspiration from emesis
Bowel perforation with peritonitis
Shock
Septicemia
Anastomotic leak
Short bowel syndrome
Recurrence

Question 15

Prognosis

Answer 15

100% fatality with no treatment
Excellent if diagnosed early

Question 16

Proximal portion

Answer 16

Intussceptum

Question 17

Distal/recieving bowel

Answer 17

Intussuscepiens

Question 18

Aetiology
Hint:VITAMINS ABCDEK

Answer 18

I-hypertrophy of Peyers patches due to RTI/gastroenteritis

Idiopathic-90% of cases
Pathological lead point from above 3yrs

Question 19

VITAMINS ABCDEK

Answer 19

Vascular-bleed or blocked
Infectious/inflammatory
Traumatic/toxic
Autoimmune/allergy
Metabolic
Iatrogenic/idiopathic
Neoplastic
Social-social reason

Alcohol
Behavioural
Congenital -all
Degenerative
Drug related
Endocrine/exocrine problems
Karotype/genetic disorders

Question 20

Classification of intus

Answer 20

Idiopathic/sec
Anatomical location:
Enterocolic :ileocolic ,ileo-ileocolic
Enteroenteric :jejunojenal
Colocolic :caecolic

Single /double
Anterograde/retrograde

Question 21

Pathophysiology
Edema and swelling of the -leads to -occlusion and - occlusion
Transmural necrosis of -,peritonitis and perforation
- leads to 3rd space loss,- and -
- results in sepsis,MODS and ultimately Death

Answer 21

Intusscepien
Luminal and mesenteric vascular
Intususceptum
Fluid sequestration
transmural bacterial migration.

Question 22

Classical triad

Answer 22

Intermittent abd pain,vomiting and bloody stool

Question 23

Clinical features
Early symptoms

Answer 23

1)paroxysmal and pain
2)separated by periods of apathy
3)Vomitting

Question 24

Late symptoms

Answer 24

1)Worsening vomitting becoming bilious
2)abd distention
3)initial normal stool ,then red currant jelly stool
4)dehydration(progressive)

Question 25

Physical examination Healthy looking child Palpable abd mass in early presentation Irritable,weak and lethargic Febrile pale and dehydrated or -(in late presentation) - sign Abd distention and features of peritonitis Rectal examination(- and -s)

Answer 25

Healthy looking child Palpable abd mass in early presentation Irritable,weak and lethargic Febrile pale and dehydrated or in shock(in late presentation) Dance sign Abd distention and features of peritonitis Rectal examination(blood mucoid stool,palpable mass)

Question 26

Prolapsed intus Vs rectal prolapse

Answer 26

Possiblity to freely insert index finger between anal wall and the prolapsed

Question 27

Epid Noticed to occur more at time of weaning especially in well nourished children Incidence is less than 30% in malnourished children 90% of cases are btw ages 3months -3yrs There is seasonal variation

Answer 27

Noticed to occur more at time of weaning especially in well nourished children Incidence is - in malnourished children 90% of cases are btw ages - to - There is seasonal variation

Question 28

Definitive surgery for intussception

Answer 28

Laparotomy through right extended upper transverse incision

Question 29

Viability must be assessed before intussusceptions reduction: If bowel is viable,-of intussusceptum from intussuscepiens for manual reduction If viability but manual reduction difficulty cause of edema then use -around intussusceptions for 10mins then manualy reduce If reduction impossible after above then - If viability questionable,saline soaked and towel is wrapped and oxygen delivery is increased to -for -mons from initial -% Then bowel is reassesed-viability achieved-manual reduction If no viability,reaction and anastomosis is done immediately

Answer 29

If bowel is viable,milk apex of intussusceptum from intussuscepiens for manual reduction If viability but manual reduction difficulty cause of edema then used saline soaked abd towel around intussusceptions for 10mins then manualy reduce If reduction impossible after above -bowel resection and anastomsis If viability questionable,saline soaked and towel is wrapped and oxygen delivery is increased to 100% for 10mins from initial 69% Then bowel is reassesed-viability achieved-manual reduction If no viability,reaction and anastomosis is done immediately