GASTROINTESTINAL SYSTEM BLOCK

CASE 4B

Ronald Chrisbianto Gani 405090223 Faculty of Medicine 2009 Tarumanagara University

INTUSSUSCEPTION

INTUSSUSCEPTION
A portion of the alimentary tract is telescoped into a adjacent segment. Unknown cause Most common cause of intestinal obstruction between 3mo 6yr age 60% pts is <1yr, 80% pts is <2year Male : female = 4 : 1 Peak in spring and autumn Correlation with adenovirus is noted No association between wild human rotavirus and intussusception In 2-8% patients, recognizeable lead points are found, such as meckel diverticulum, intestinal polyp, neurofibroma, intestinal duplication, hemangioma, and malignant condition
Nelson Textbook of Pediatrics 18th ed

PATHOLOGY
Most often ileocolic, less commonly cecocolic, rarely exclusively ileal Upper portion bowel : intussusceptum Lower portion bowel : intussuscipiens Bleeding of mucosa causes bloody and mucous stool Must be distinguished from prolapse
Nelson Textbook of Pediatrics 18th ed

CLINICAL MANIFESTATION
Sudden onset, severe paroxysmal colicky pain accompanied by straining efforts with leg and knees flexed and loud cries The infant will progressively become lethargic Eventually, shocklike state with fever can develop Pulse weak and thready, respiration shallow and grunting. Vomiting, in later phase, its bile stained Blood passed for 1st 12hrs, 60% currant jelly stool Tender sausage-shaped mass, ill defined, most ofen in right upper quadrant. 30% pts dont have this palpable mass Precense of blood in finger after rectal exam Advancing intestine prolapses through anus
Nelson Textbook of Pediatrics 18th ed

DIAGNOSIS
Ultrasound, tubular mass in longitudinal view and doughnut or target appearance in transverse view Plain abdominal radiograph, shows density in the area

Nelson Textbook of Pediatrics 18th ed

INTUSSUSCEPTION

Nelson Textbook of Pediatrics 18th ed

DIFFERENTIAL DIAGNOSIS
Difficult to diagnose in a child who already has a gastroenteritis Distinguished from enterocolitis which is less pain and less regular, has a diarrhea, and the infant recognizeably ill between pain Bleeding from meckel diverticulum is painless

Nelson Textbook of Pediatrics 18th ed

TREATMENT
Emergency procedure and performed immediately after diagnosis In patients with prolonged intussusception with signs of shock, peritoneal irrititaion, intestinal perforation, or pneumatosis intestinalis, reduction should not be attempted

Nelson Textbook of Pediatrics 18th ed

PROGNOSIS
Untreated = fatal Reccurence rate is ~10% After surgical reduction 2-5% Corticosteroid reduces the frequency of recurrent intussusception

Nelson Textbook of Pediatrics 18th ed