DOI: https://doi.org/10.22141/2224-0551.5.73.2016.78320

Diagnosis and Treatment of Intussusception in Children

O.V. Spakhi, O.V. Lyaturynska, A.P. Paholchuk

Abstract


Intussusception is the most common form of acquired gastrointestinal obstruction in children. The aim is to study the features of clinical course and treatment strategy for intussusception in children and to analyze limitations of diagnostic, clinical and special research methods. Materials and methods of the study. The analysis of treatment outcomes has been carried out in 272 children in pediatric surgery clinic from 2004 to 2015. We have developed the objective criteria for evaluation of intussusception stages that correlate with the degree of endotoxemia, changes in respiratory function and circulation, the disorders of gut motility, as well as ultrasound of the abdominal organs. Results and discussion. Patients with intussusception stage I (233 children) had no signs of endotoxemia or they were non-significant. In 10 children we performed surgery, in 4 cases — laporoscopically. Of the 32 patients with stage II, in 8 cases the intussusception was straightened conservatively on the first try. We don’t make a second attempt in children with intussusception stage II. Surgical straightening was perfomed in 24 patients. Intussusception stage III in children (7 patients) had signs of third degree endotoxemia. All patients of the third stage of intussusception underwent median laparotomy. In 5 cases we have detected intussusceptum necrosis, and these children were made bowel resection followed by the imposition of final ileostomy and intubation of the small intestine. In the rest (2) of patients, we managed to straighten the intussusceptum, and the gut was recognized as vital. Imposing primary anastomosis after the bowel resection in peritonitis we consider unacceptable. Conclusions. 1. Comprehensive survey of children using laboratory and instrumental methods became the basis for the allocation of 3 stages of intussusception, which correlated with the degree of endotoxemia and impaired bowel functions: stage I — compensated; stage II — subcompensated; stage III — decompensated. 2. An objective assessment of intussusception stages allows us to differentiate the extent of measures on the stages of treatment depending on the stage of the disease, which greatly simplifies solving tactical problems faced by the surgeon and anesthesiologist before, during and after reduction of intussusception.


Keywords


intussusception; intestine; endotoxemia; laparotomy; children

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