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Intussusception
Dec 06, 2022
Intussusception is a common condition with a dramatic but characteristic presentation. The acute onset of colicky abdominal pain and inconsolable crying in a hitherto thriving and playful infant can be extremely distressing for the parents and other caregivers.
Hydrostatic Reduction
A large majority of these intussusceptions are amenable to a reduction without the need for operative intervention. Furthermore, the option of open surgical treatment is poorly accepted by some of the parents. Non-operative reduction for intussusception should be offered as a first line of treatment for all children with idiopathic intussusception.
Non operative reductions are simple to perform and usually do not require sophisticated equipment. Pneumatic or hydrostatic reductions are generally performed under fluoroscopic guidance. Ultrasound guided hydrostatic reduction is frequently performed in centres where fluoroscopy is not available. The only drawback of an ultrasound guided reduction is the observer variability in assessing the completeness of reduction. The procedure can be safely performed either as an awake procedure in the radiology suite or under sedation in the operation theatre. Saline or air is pushed into the rectum and colon under controlled circumstances and low pressures until the intussusceptum is reduced and free flow of air or saline into the ileum is noted.
Laparoscopic Reduction
Intussusceptions are sometimes impacted and are not reducible in spite of adequate attempts at hydrostatic reductions using safe pressures. Then Laparoscopic visualization and assisted reduction of the intusssusceptum is done using 2 ports. The access is minimal and avoids a laparotomy which was conventionally required to manage this situation.
Laparotomy for Intussusception
Operative reduction should be reserved for patients with delayed presentation and signs of bowel revitalization, intussusceptions with documented pathological lead points or failure of attempts of non-operative reduction. Recurrence of idiopathic intussusception following non-operative reduction can be safely managed by repeated non-operative reductions. Only repeated recurrences in infants are offered open surgical reduction to rule out a pathological lead point and/or perform an ileoceopexy to help prevent further recurrences.
Rarely, the procedure maybe complicated by perforation of the intestine which is usually indicative of pre-existing devitalized bowel.
The surgeons in department (Banjara) manage around 50 cases in a year and most are managed through hydroscopic reduction.
Dr.HARISH JAYARAM
PEDIATRIC UROLOGIST & LAPAROSCOPIC SURGEON
Rainbow Children's Hospital, Banjara Hills, Hyderabad
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