|Case 16 :|
| A 7-year-old boy presents with a right iliac fossa lump. X-ray abdomen
(erect) showed acute small bowel obstruction. What is the diagnosis?
|__________SCROLL FOR ANSWER__________|
Intussusception is an invagination of a segment of intestine into adjacent bowel. Intussusception may be ileocecal (most common), ileoileocolic, ileoileal or colocolic. Pathological lead points that may cause intussusception include Meckel's diverticulum, inflamed appendix and polyps. Clinical symptoms are characterized by colicky abdominal pain and the child's drawing the legs into the abdomen.
The initial management of intussusception has changed and new methods are being continuously investigated to avoid radiation exposure and barium peritonitis. Kim et al first described hydrostatic reduction under US guidance in 1982.
The absolute contraindications
to hydrostatic reduction are: severe dehydration marked abdominal distension,
and clinical features of peritonitis or demonstration of free intraperitoneal
air on a plain abdominal radiograph. Relative contraindications are: History
longer than 48 hours, extremes of age - patient less than three months
of age or more than two years, dehydration more than five percent, small
bowel obstruction on plain radiographs, US demonstration of a thick irregular
rim of the target measuring more than 10 mm, absent Doppler signal on
a color Doppler signifying non-viable bowel.
Dr. Sanjeev Mani, Mumbai