Case by prof Tariq Altokais, Professor and consultant of pediatric surgery King Saud university, Riyadh, Saudi Arabia

[size=20px]4 months old boy, healthy, brought by parents due abdominal pain and excessive crying for 1 day. Pain is intermittent, pulling his legs up during pain, associated with vomiting. Later he passed blood with stool. On physical examination, he is lethargic, abdomen is distended. US showed a classic target sign at Left iliac fossa.

What is your initial management?[/size]

Edited February 4, 20251 yr by Admin

[size=20px]After initial resuscitation and hydration, enema reduction was performed.

Intussusception at the sigmoid colon.[/size]

 

The contrast was not seen in the terminal ileum. So another enema reduction was tried after few hours.

 

[size=20px]Contrast seen at terminal ileum.

So Feeding started but baby developed vomiting after 8 hours. and Abdomen is distended more.[/size]

What will you do?

Edited February 4, 20251 yr by Admin

[size=20px]US was repeated and showed similar findings with target sign at the Left iliac fossa.

what next?[/size]

Laparoscopic exploration decided and Laparoscopic reduction done of the intussusception. The intussusceptum was at the level of descending colon. A Mickle’s diverticulum was the leading point. umbilical port site was extended, Mickle’s was resected.

Thanks

4 aylık bebekte lead point olmaksızın invaginasyon beklenen bir durum değildir. O nedenle baryumşa redüksiyon denemekten çok cerrahi tedavi tercih edilmelidir.

4 aylık bebekte kurşun noktası olmaksızın invajinasyon beklenen bir durum değildir. Bu nedenle baryumşa redüksiyon denemesinden çok cerrahi tedavi tercih edilmelidir.

Öncü nokta olmaksızın bağırsak tıkanıklığı, 4 aylık bir bebekte beklenmedik bir durumdur. Bu nedenle, baryum ile redüksiyon girişiminden ziyade cerrahi tedavi tercih edilmelidir.

An air or contrast enema is first-line treatment if there are no contraindications to nonoperative reduction.