Invaginación intestinal en el niño, respuesta al tratamiento médico / Intestinal intussusception in children and response to medical treatment

INTRODUCCIÓN: la invaginación intestinal idiopática es la causa más frecuente de abdomen agudo en el lactante y en el transicional. El tratamiento de elección es el médico, siempre que cumpla los criterios de inclusión, por ser menos invasivo, presentar menos complicaciones, menor costo y más efectivo, al compararlo con el tratamiento quirúrgico. OBJETIVO: evaluar la efectividad del tratamiento médico en niños con invaginación intestinal. MÉTODOS: se realizó un estudio descriptivo, longitudinal y retrospectivo de 55 pacientes con el diagnóstico de invaginación intestinal idiopática con criterios de tratamiento médico, que ingresaron en el servicio de Cirugía Pediátrica del Hospital Pediátrico Universitario Centro Habana, en el período de enero de 2000 a diciembre de 2012. Los métodos de reducción empleados fueron mediante neumocolon y el colon por enema baritado. Se utilizó el test de chi cuadrado para el análisis. RESULTADOS: el tratamiento con enema de bario predominó ligeramente sobre el neumocolon (28/27) para 50,9 % y 49,1 % respectivamente. Su efectividad fue mayor para el neumocolon (77,8 %), en comparación con el enema de bario (57,1 %) (RR= 1,38, p> 0,05). La efectividad de estos procederes está en relación con el tiempo de evolución; a menor tiempo, mejores resultados. CONCLUSIONES: no se encontró una variación significativa en los resultados en los 2 procederes médicos propuestos, aunque fue más efectivo el neumocolon que el enema de bario.

INTRODUCTION: idiopathic intestinal intussusceptions are the most frequent cause of acute abdomen in the breastfed baby and in the transitional infant. The medical treatment is the choice provided that the inclusion criteria are met since it is less invasive, costly and complicated but more effective than the surgical treatment. OBJECTIVE: to evaluate the effectiveness of the medical treatment in children with intestinal intussusception. diagnosed with idiopathic intestinal intussusceptions and met the medical treatment criteria met; they had been admitted to the pediatric surgical service of Centro Habana university pediatric hospital in the period of January 2000 through December 2012. The used methods were pneumocolon and barium enema colon. Chi-square test was used for the analysis. RESULTS: the barium enema treatment slightly prevailed over pneumocolon (28 vs. 27) for 50.9 % and 49.1 %, respectively. The pneumocolon effectiveness (77.8 %) was higher than the barium enema (57.1 %) (RR= 1.38, p> 0.05). The effectiveness of both procedures depends on the time of progression of disease, which means that best results go to less time of progression. CONCLUSIONS: no significant variations were found in the results of the two suggested medical procedures, although pneumocolon was more effective than barium enema.

Invaginación intestinal: aspectos epidemiológicos y clínicos: centro hospitalario Pereira Rossell 2006-2010 / Intussusception: epidemiological and clinical aspects: centro hospitalario Pereira Rossell 2006-2010

Introducción: la invaginación intestinal es la primera causa de oclusión intestinal en niños pequeños. El diagnóstico exige alto grado de sospecha. El tratamiento de elección es la reducción guiada por imagen con un porcentaje de éxito elevado.Objetivo: describir las características clínicas, el tratamiento y la evolución de los niños hospitalizados por invaginación intestinal en el Servicio de Cirugía Pediátrica del Hospital Pereira Rossell en el período 2006-2010.Material y métodos: se incluyeron todos los niños hospitalizados con invaginación intestinal en el período 1/1/2006–31/12/2010. Se analizó: edad, sexo, procedencia, manifestaciones clínicas, métodos diagnósticos, tratamiento y evolución (complicaciones, ingreso cuidados intensivos (CTI), estadía hospitalaria). Para el procesamiento de datos se utilizó Epi Info 2008 versión 3.5.1.Resultados: se incluyeron 64 episodios de invaginación intestinal, 85,9% menores de 2 años. Dolor abdominal, vómitos y enterorragia se presentaron en el 50% de los casos. Se intentó la desinvaginación guiada por imagen en 76%; fue exitosa en 61%. Se realizó cirugía en 34 pacientes (53%), por fracaso de la desinvaginación por imagen en 19. La estadía hospitalaria, la necesidad de ingreso a CTI y la presencia de complicaciones fueron significativamente mayores en los niños sometidos a cirugía...

Introduction:intussusception is the most commoncause of bowel obstruction in young children. Itsdiagnosis requires high level of suspicion. Theprimary treatment is image guided reduction with ahigh success rate.Objective:to describe the clinical characteristics,treatment and evolution of all children with intussuception admitted to the Pediatric SurgeryService of the Hospital Pereira Rossell from 2006 to2010.Methods:all children with intussuception admitedbetween 1/1/2006 and 31/12/2010 were included.The items registered were: age, sex, provenance,clinical manifestations, diagnostic methods,treatment and evolution (complications, admission to intensive care unit, duration of hospitalization). Datawas analysed with Epi Info 2008 3.5.1.Results:64 intussuception cases were registered,85,9% of them younger than 2 years. Abdominal pain, vomiting and enterorrhagia occured in 50% of the cases. Attempt of image guided reduction was made in 76%; with a success rate of 61%. Surgical reduction was made in 34 pacientes (53%), 19 of them as a result of nonsurgical reduction failure.Duration of hospitalization, admission to intensive care unit and duration of hospitalization were significantly higher in children who receive surgical treatment.

Ileo-colic intussusception; is hydrostatic reduction worth considering till late?

To evaluate the success rate of hydrostatic reduction of intussusception and incidence of complications in late presenting cases. Prospective study. Study was carried out in Armed Forces Institute of Radiology and Imaging Rawalpindi and different Combine Military Hospitals during last 5 years. All the children up to 2 years age with diagnosis of ileo-colic intussusception and 3 days or less history of onset of symptoms were included in the study. Patients with signs of perforation, suspicion of lead point or long intussusceptum protruding through rectum were excluded. After plain film evaluation, thin barium was instilled through Foleys catheter under fluoroscopic guidance. Rule of 3 was followed and reduction was considered successful when contrast refluxed into terminal ileal segment. Follow up plain x-ray and ultrasound was done after 48 hours to rule out recurrence. Hydrostatic reduction was successful in 18 out of 21 patients collected during last five years. Reduction was incomplete in one case while perforation was observed in 2 cases. These complications were observed in the largest group [52%] of patients reporting on 3rd day of onset of symptoms. A significant number [38%] of patients reached the hospital within 48 hours. Only 2 [10%] patients presented in first 24 hrs but uneventful reduction was possible in later two groups. Careful hydrostatic reduction in cases of ileo-colic intussusception reporting within 72 hrs will reduce hospital stay and patient morbidity in most of the cases

Invaginación intestinal recurrente secundaria a apéndice cecal invaginado: caso clínico / Recurrent intussusception secondary to invaginated cecal appendix. Case report

Introducción: La invaginación intestinal es una patología de causa idiopática en el 95 por ciento de los casos, encontrándose en el 5 por ciento restante algún factor desencadenante que la justifique. Las recurrencias se presentan en un 7 a 12 por ciento de los casos y se asocian a múltiples causas. El objetivo de este trabajo es presentar el caso de un paciente con invaginación intestinal recurrente y analizar la causa de la recurrencia. Caso clínico: Paciente de 1 año y 4 meses de edad, sexo masculino, con antecedente de primer episodio de Invaginación intestinal operado a los 4 meses de edad. Presenta segundo episodio de invaginación a los 9 meses de edad, la cual se trató con desinvaginación neumática y a los 16 meses de edad presentó su tercer episodio, manejandose con desinvaginación hidrostática. Ocho horas post procedimiento el paciente presentó nueva invaginación; se realizó reducción manual quirúrgica. Se encontró una invaginación ileocólica con un remanente apendicular intracecal actuando como cabeza invaginante. Se reseco remanente y se envió a biopsia. Conclusiones: La invaginación intestinal recurrente se asocia a factores anatómicos desencadenantes, por lo cual al presentar recurrencias se debe tener en consideración una posible causa orgánica, ante lo cual se recomienda el tratamiento quirúrgico.

Introduction: Intussusception is an idiopathic pathology that accounts for 95 percent of cases found; the remaining 5 percent is caused by some triggering events. Recurrences occur in 7 to 12 percent of cases and are associated with multiple causes. The aim of this research is to present the case of a patient with recurrent intussusception and analyze the cause of the recurrence. Case report: The patient was a 16 month-old male infant with a history of first episode of intussusception surgery at 4 months old. His second intussusception episode took place at 9 months of age, which was treated with pneumatic reduction process; at 16 months of age he presented his third episode, which was treated with hydrostatic reduction process. 8 hours post procedure, the patient had a new intussusception condition and surgical manual reduction was performed. Ileocolic intussusception was found with an appendiceal intrathecal remnant acting as the invaginating head. Remnant was removed and sent for biopsy. Conclusions: Recurrent intussusception is associated with triggering anatomical factors; therefore, in the case of recurrences, a possible organic cause should be considered and surgical treatment is recommended.

Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome / Tratamento de pacientes com retocele, múltiplas disfunções e síndrome da evacuação obstruída

CONTEXT: Management of patients with obstructed defecation syndrome is still controversial. OBJECTIVE: To analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. METHODS: The study included 103 females aged 26-84 years with obstructed defecation, grade-II/III rectocele and multiple dysfunctions on echodefecography. Patients were distributed into three treatment groups and constipation scores were assigned. Group I: 34 (33%) patients with significant improvement of symptoms through clinical management only. Group II: 14 (14%) with improvement through clinical treatment plus biofeedback. Group III: 55 (53%) referred to surgery due to treatment failure. RESULTS: Group I: 20 (59%) patients had grade-II rectocele, 14 (41%) grade-III. Obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). The average constipation score decreased significantly from 11 to 5. Group II: 11 (79%) grade-II rectocele, 3 (21%) grade-III, associated with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). There was significant decrease in constipation score from 13 to 6. Group III: 8 (15%) grade-II rectocele, 47 (85%) grade-III, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). The constipation score remained unchanged despite clinical treatment and biofeedback. Twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. The remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. CONCLUSIONS: Approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. Surgical repair was mainly required in patients with grade-III rectocele whose constipation scores remained high despite all efforts.

CONTEXTO: O tratamento dos pacientes com evacuação obstruída permanece controverso. OBJETIVO: Analisar a eficácia do tratamento clínico, tratamento clínico seguido por biofeedback e tratamento cirúrgico em pacientes com retocele e disfunções do compartimento posterior do assoalho pélvico avaliados com ultrassom tridimensional dinâmico-ecodefecografia. MÉTODO: O estudo incluiu 103 mulheres, em idade entre 26-84 anos, com diagnóstico de evacuação obstruída, retocele grau II/III e disfunções múltiplas na ecodefecografia. Pacientes foram distribuídos em três grupos e registrados os escores de constipação. Grupo I: 34 (33%) pacientes com melhora significante dos sintomas apenas com tratamento clínico. Grupo II: 14 (14%) com melhora ao tratamento clínico e biofeedback. Grupo III: 55 (53%) encaminhadas para cirurgia, sem resposta ao tratamento clínico. RESULTADOS: Grupo I: 20 (59%) pacientes com retocele grau II, 14 (41%) grau III associada a intussuscepção (41%), prolapso mucoso (41%), anismus (29%), enterocele (9%) ou duas disfunções (23%). O escore de constipação reduziu-se significantemente em média de 11 para 5. Grupo II: 11 (79%) retocele grau II, 3 (21%) grau III, associado a intussuscepção (7%), prolapso mucoso (43%), anismus 71% ou duas disfunções (29%). O escore de constipação reduziu-se com significância estatística em média de 13 para 6. Grupo III: 8 (15%) retocele grau II, 47 (85%) grau III, associado a intussuscepção (42%), prolapso mucoso (40%), ou disfunções (32%). O escore de constipação não se alterou, apesar do tratamento clínico e biofeedback. Vinte e três foram encaminhados para cirurgia resultando em redução significante do escore de constipação de 16 para 4. Dos 32 restantes, 22 optaram por não realizar cirurgia, 6 apresentavam pressões anais reduzidas e 4 com trânsito lento. CONCLUSÃO: Aproximadamente 50% dos pacientes com evacuação obstruída, retocele ou disfunções múltiplas apresentaram resposta satisfatória ao tratamento clínico e/ou ao biofeedback. Tratamento cirúrgico foi necessário principalmente em pacientes com retocele grau III em que o escore permaneceu inalterado apesar do tratamento clínico e biofeedback.

Reducción hidrostática de invaginación intestinal: a propósito de un caso / Hydrostatic reduction of intussusception: a case report

Se presenta el caso de un lactante masculino de 6 meses de edad, que acude a consulta de cuerpo de guardia, en el Hospital Provincial Docente Dr Antonio Luaces Iraola de Ciego de Ávila, con vómitos y diarreas con estrías de sangre. Se realizaron estudios ecográficos pertinentes y se arribó al diagnóstico de invaginación intestinal. Se realizó evaluación conjunta con el servicio de cirugía pediátrica y se aplicó el proceder de reducción hidrostática con solución salina y control ecográfico, con lo que se logró la reducción total del segmento intestinal afectado y se evitó la intervención quirúrgica.

A case of a male infant of 6 months of age is presented, that goes to consultation of emergency service, in the Provincial Teaching Hospital in Ciego de Avila with vomiting and diarrhea streaked of blood. Relevant ultrasonography studies were carried out and it arrived to diagnosis of intussusception. Joint assessment was conducted with the pediatric surgery department, and hydrostatic reduction applies with saline solution and ultrasonographic guidance, achieving a total reduction of the affected bowel segment, thus avoiding surgery.

Barium enema reduction of intussusception in a developing country / Reducción de la intususcepción mediante enema de bario en un país en vías de desarrollo

OBJECTIVE: To determine the current success rate of barium enema reduction of intussusception and to investigate the factors affecting successful reduction. DESIGN AND METHODS: All patients admitted to the Eric Williams Medical Sciences Complex during the 8-year period from January 1, 2000 to December 31, 2007 with a diagnosis of intussusception were included. Patients' demographics, date and time of admission, clinical features, success of barium reduction, surgical findings and length of stay were recorded. The SPSS 12.0 programme was used for data analysis. RESULTS: There were 65 cases of intussusception. Vomiting and rectal bleeding were the most common presenting symptoms (55, 85% / 49, 75%). Fifty-eight patients underwent barium enema reduction with 41.4% (24/58) having successful reduction. Factors which significantly increased the success rate included males older than 12 months, non-opioid analgesia or no analgesia and an admission to enema reduction time of less than 6 hours. CONCLUSION: The successful reduction rate is relatively low (41%). A higher index of suspicion is needed in order to make a timely diagnosis and institute appropriate treatment quickly.

OBJETIVO: Determinar la tasa de éxito actual de reducción de la intususcepción por edema de bario e investigar los factores que afectan la reducción exitosa. PLAN Y MÉTODOS: Todos los pacientes ingresados en el Complejo de Ciencias Médicas Eric Williams por el período de 8 años que va del 1ero de enero de 2000 al 31 de diciembre de 2007 con diagnóstico de intususcepción, fueron incluidos. Se registró toda la información relacionada con los datos demográficos de los pacientes, fecha y tiempo de ingreso, características clínicas, éxito de la reducción por bario, resultados quirúrgicos, y duración de la hospitalización. Se usó el programa SPSS 12.0 para el análisis de los datos. RESULTADOS: Se produjeron 65 casos de intususcepción. Los vómitos y el sangramiento rectal fueron los síntomas presentes más comunes (55, 85%/49, 75%). A cincuenta y ocho pacientes se les practicó la reducción por enema de bario, logrando 41.4% (24/58) una reducción exitosa. Los factores que aumentaron la tasa de éxito de manera significativa fueron los varones con más de 12 meses, la analgesia no-opioide o ninguna analgesia, y un tiempo de ingreso para la reducción por enema, de menos de 6 horas. CONCLUSIÓN: La tasa de reducción exitosa es relativamente baja (41%). Se requiere un índice más alto de sospecha para hacer un diagnóstico oportuno e iniciar un tratamiento apropiado rápidamente.

Conducta imagenológica ante la invaginación intestinal en la edad pediátrica: revisión bibliográfica / Imagenological behaviour in view of intestinal invagination in paediatric age: a bibliographic review

La invaginación intestinal es la causa de obstrucción intestinal más frecuente en niños. Aunque su cuadro clínico es un complejo sintomático fácilmente reconocible, en ocasiones existen errores diagnósticos relacionados con la interpretación inicial de algunos síntomas. En los últimos años los medios diagnósticos han jugado un papel importante en el diagnóstico temprano de esta enfermedad y es una elección terapéutica con alto porcentaje de certeza con crecientes resultados novedosos.

The intestinal invagination is the cause of more frequent intestinal obstruction in children. Although its clinical picture is easily recognizable as a symptomatic complex, there are sometimes diagnostic errors related to the initial interpretation of some symptoms. In the last years the diagnostic tools have played an important role in the early diagnosis of this disease and they are a therapeutic election with high percentage of certainty and increasing innovative results.

Caracterización de una población pediátrica con invaginación intestinal diagnósticada en un hospital de referencia durante un periodo de 8 años / Description of a group of children with intestinal intussusception diagnosed in a reference hospital during a period of 8 years

Objetivo: El objetivo general del estudio fue describir todos los casos documentados de invaginación intestinal en niños menores de 24 meses en el HNN durante el periodo 2001-2008. Métodos: estudio retrospectivo y descriptivo, basado en la información de expedientes clínicos y del Servicio de Estadística, de todos los egresos hospitalarios con el diagnóstico de invaginación intestinal en niños menores de 24 meses durante el periodo: enero 2001 a diciembre 2008. Resultados: durante este periodo de estudio la media de la tasa de incidencia de invaginación intestinal en el HNNH fue de 31 por cada 100000 nacidos vivos. La distribución de pacientes por sexo y grupo de edad fue: 57.7 por ciento hombres y 42.3 por ciento mujeres, p:0.003. El 85.2 por ciento de los episodios de invaginación intestinal ocurrió en niños menores de 12 meses, 14.8 por ciento de 12 a 24 meses, 27/182 pacientes. La edad media de presentación fue de 7.7 meses. 103 pacientes requirieron ser llevados a sala de operaciones para desinvaginación por taxis, de los cuales el 79.61 por ciento, 82, tuvieron un colon por enema fallido. La perforación intestinal fue la complicación más frecuente en un 12.6 por ciento de los casos, 13. Se realizó resección intestinal en 16 casos, 15.50 por ciento. Conclusiones: este estudio brinda información sobre la epidemiología de la invaginación intestinal en Costa Rica siendo éste un estudio base para futuras investigaciones asociadas a la introducción de las vacunas del rotavirus en el esquema de vacunación del país.

Invaginación intestinal en un adolescente / Intestinal invagination in an adolescent

Se presenta el caso clínico de un paciente de 17 años que acudió a consulta con síntomas de apendicitis aguda, confirmada por los medios de diagnóstico; sin embargo, durante la operación se encontró una invaginación íleo-ileal con daño vascular irreversible, que necesitó una enterectomía del segmento afectado, así como enteroanastomosis terminoterminal. El joven evolucionó satisfactoriamente y egresó a los 6 días. Se revisaron aspectos clinicoquirúrgicos de interés práctico, para el mejor diagnóstico y tratamiento de esta infrecuente causa de abdomen agudo en el adulto.

The clinical case of a 17 year-old patient that made a visit with symptoms of acute appendicitis is presented, confirmed by diagnostic means; however, during the operation, an ileus-ileal invagination with irreversible vascular damage that needed an enterectomy of the affected segment was found, as well as an end-to-end enteroanastomosis. The patient had a satisfactory clinical course and was discharged 6 days later. Clinical and surgical aspects of practical interest were reviewed, for the better diagnosis and treatment of this uncommon cause of acute abdomen in the adult.

How do different presenting and therapeutic modalities change the outcome in intussusception.

OBJECTIVE: To evaluate if a correlation exists between the clinical and radiologic characteristics at presentation; and the success of conservative management, morbidity and outcome of patients with intussusception. METHODS: All patients (total 179) treated for intussusception in our unit between 1993 and 2003, were retrospectively reviewed to find out the effects of physical examination (general appearence, consciousness, body temperature, abdominal distention and tenderness, blood on rectal examination), laborat (leukocyte count) and radiologic (air-fluid level on X-ray, free abdominal fluid on ultrasonography) findings on selection of first step therapeutic modality, conservative management (reduction with barium or air) success rate and surgical complication (serosal defect, intestinal perforation) rate. Additionally, the patients were subdivided into three subgroups as group A (patients for whom surgical management was performed primarily), group B (the ones who were operated after failure of reduction attempt with barium or air), group C (patients who had successful conservative reduction). These groups were compared within each other with regard to duration of nasogastric suction, antibiotic therapy; onset of oral feeding and duration of hospitalization. The chi-square, Kruskal-Wallis and ANOVA tests were used for the statistical analysis and p value less than 0.05 was considered to be significant. RESULTS: Incidence of selecting conservative treatment primarily was lower in patients with moderate general appearence (p=0.02) and with free fluid on ultrasonography (p=0.007). Success rate of conservative treatment was lower in patients with moderate general appearence (p=0.000), lethargy (p=0.011), blood on rectal examination (p=0.004), air-fluid level on X-ray (p=0.039), free fluid on ultrasonography (p=0.001). Surgical complication rate was higher in patients with moderate general appearence (p=0.000), lethargy (p=0.007), air-fluid level on X-ray (p=0.009). In group A; the duration of N/G suction, antibiotic therapy and hospitalization was longer; the onset of oral feeding was later than the other two groups (p=0.000). In group B; the duration of N/G suction, antibiotic therapy and hospitalization was longer; the onset of oral feeding was later than group C (p=0.000). CONCLUSION: Moderate general appearence, lethargy and air-fluid level on X-ray not only decrease the success rate of conservative management, but increase the surgical complication rate as well. Thus, these parameters deserve more importance in the management scheme. Reduction with conservative management is the most important factor which decreases the morbidity. Morbidity is lower in cases who are operated after failure of conservative management than the ones for whom surgery is performed primarily. Thus, conservative management should be tried for all patients unless there is a clear cut contraindication such as peritonitis and/or pneumoperitoneum.

Intussuscepção íleo-cólica em adulto / Ileocolic intussusception in adult

A intussuscepção representa a invaginação de um segmento intestinal sobre outro que, apesar de relativamente comum entre as crianças, raramente acomete os adultos. Nestes, a invaginação intestinal apresenta uma causa bem definida na maioria dos casos e seu quadro clínico costuma ser bastante variável, contudo, poucos deles são diagnosticados no período pré-operatório. Um tratamento padrão ainda não pôde ser estabelecido e sua abordagem terapêutica deve ser individualizada, porém frequentemente resulta em ressecções dos segmentos intestinais envolvidos. Este artigo relata o tratamento cirúrgico de um caso de obstrução intestinal em mulher idosa, causada por intussuscepção íleo-cólica. O agente etiológico correspondia a um tumor polipóide em íleo terminal, para a qual a utilização de imuno-histoquímica foi necessária na realização de seu diagnóstico diferencial com GIST.

Whereas intussusception is relatively common in children, it is clinically rare in adults and requires a high index of suspicion. Controversy remains regarding the optimal management of this problem in the adult patient, but its treatment usually requires resection of the involved intestinal segment because of the frequency of neoplasms and bowel ischemia. This article reports one uncommon case of intestinal obstruction due to ileocolic intussusception in an older woman treated by surgical approach.

Reducción hidrostática de invaginación intestinal guiada por ultrasonido: una nueva opción / Us guided hydrostatic reduction of intssusception: a new option

lleocolic intussusception is an important cause of acute abdomen in infants. When there is no surgical indication, reduction under fluorosco-pic vision has been the main radiologic treatment performed in our country. Ultrasound examination is broadly used as a diagnostic method but reports on local experiences with ultrasound for guidance in intussusception reduction have not been recorded. A series of five cases of successful hydrostatic reduction performed under ultrasonographic control is presented and images of different stages of the reduction process are shown. Our aim is to promote a change in monitoring procedures so as to avoid the use of ionizing radiation.

La invaginación ileocólica es una causa importante de abdomen agudo en lactantes y su tratamiento de elección en nuestro medio es la reducción bajo visión fluoroscópica, cuando no existe indicación quirúrgica. El ultrasonido es utilizado como método de diagnóstico y su uso como guía para la reducción de la invaginación no ha sido comunicado en nuestro medio. Se presenta una pequeña serie de 5 casos de reducciones hidrostáticas exitosas efectuadas bajo control ultrasonográfico y se muestran imágenes de ultrasonido características de las diferentes etapas de la desinvaginación, con el objeto de estimular el cambio de método de monitorización en este procedimiento, evitando el uso de radiación ionizante.

Intussuscepção intestinal em adultos / Intussusception in adults

A intussuscepção intestinal em adultos é rara. Ao contrário do que ocorre na faixa pediátrica, é, na maioria das vezes, secundária a uma lesão definida com potencial significativo de malignidade. O objetivo deste estudo é avaliar retrospectivamente os aspectos diagnósticos e terapêuticos da intussuscepção intestinal em adultos. Foram estudados, retrospectivamente, os dados relativos às causas, à apresentação clínica, ao diagnóstico e ao manejo da doença em 16 pacientes, sendo 10 do sexo feminino (62 percent) e com média de idade de 49 anos (variação de 19-76 anos). Os principais achados clínicos foram: dor abdominal (100 percent), náuseas e vômitos (62,5 percent), massa palpável (62,5 percent), distensão abdominal (37,5 percent) e hemorragia digestiva baixa (31,25 percent). Sete pacientes (43,75 percent) apresentaram quadro agudo, sendo seis por obstrução intestinal (37,5 percent). O diagnóstico pré-operatório foi firmado em 8 pacientes (50 percent), através de exame clínico associado a ultra-sonografia, tomografia computadorizada, trânsito intestinal ou colonoscopia. Todos os pacientes foram submetidos a tratamento cirúrgico. Em cinco pacientes (31,25 percent) o segmento acometido foi o intestino delgado; em seis (37,5 percent) o íleo terminal e a valva ileocecal e em cinco (31,25 percent) havia acometimento colônico. Causa anatômica patológica foi identificada em 14 pacientes (87,5 percent), sendo que oito (50 percent) eram portadores de neoplasias malignas. Os procedimentos de ressecção realizados foram enterectomia (18,75 percent), hemicolectomia direita com anastomose primária (31,25 percent) ou ileostomia e fístula mucosa (12,5 percent), retossigmoidectomia a Hartmann (12,5 percent), retossigmoidectomia com anastomose primária (6,25 percent) e colectomia total com anastomose íleo-retal (6,25 percent). Dois pacientes (12,5 percent) foram tratados com redução sem ressecção. Complicações pós-operatórias ocorreram em 3 pacientes (seroma,...

Intestinal intussusception in adult patients is a rare entity. Differently from pediatric patients, this condition is often secondary to a defined lesion. A significant percentage of these lesions are malignant. Therefore, an optimal treatment is necessary to this condition. The aim of this study is to determine causes and management of adult intussusception. We carried out a retrospective review of adults patients with diagnosis of intussusception from 1997 to 2007 in our institution. Details concerning presentation, diagnosis, management, and pathology were analyzed. Sixteen patients with intestinal intussusception underwent laparotomy. There were 10 women with median age of 49 years (range, 19-76). Abdominal pain was the most common clinical finding. Seven patients (46.6 percent) presented with acute symptoms, six caused by intestinal obstruction. Diagnosis of gastrointestinal intussusception was correctly done preoperatively in 8 patients (50 percent). Five patients (31.25 percent) had the lead point of the intussusception in the small bowel, two in the jejunum and three in the ileum. Six patients (37.5 percent) had the lead point in the ileocecal valve resulting in ileocolic intussusception and five patients (31.25 percent) had colonic leading points. An anatomic or pathologic cause of the intussusception was identified in 14 patients (87.5 percent). In two patients (12.5 percent) the intussusception occurred in the postoperative period without associated lesions. Malignant neoplasms accounted for eight of sixteen patients (50 percent). All patients underwent operative management. The two patients who have postoperative intussusception of the small bowel underwent reduction with no resection. The others three patients with small bowel intussusception underwent to enterectomy. Right hemicolectomy was performed in five of the six patients with ileo-colonic intussusception. Retossigmidectomy was performed in one of the two patients...

Ultrasound guided hydrostatic reduction in the management of intussusception.

OBJECTIVE: A case series study was conducted for two years from 01 June 2002 to 01 June 2004 to study the efficiency of ultrasound guided hydrostatic reduction in the management of intussusception in children. METHODS: A total of 25 patients who underwent the procedure were evaluated. All the patients were diagnosed by High Resolution Ultrasonography (HRUSG). Continuous monitoring of the progress of reduction during the procedure was done by HRUSG. 500-1000 ml (average 600 ml) of normal saline was used. RESULTS: 24 out of 25 (96%) intussusceptions were successfully reduced. Average time taken was 15 minutes. All the patients were reviewed after 24 hrs for recurrence. None of them showed recurrence within 24 hrs. No complications were observed. CONCLUSION: The study concludes that ultrasound guided hydrostatic reduction is a safe, simple and effective method for treatment of intussusception in children.

Childhood intussusception

In a retrospective study, 38 patients with intussusception presenting to paediatric surgical emergency were studied. The objective was to review the management of childhood intussusception and identify factors that require attention for improved outcome. Out of 38 children 26 were males and 12 were females. Age ranged from 2 months to 10 years. Presenting features were mainly vomiting, abdominal pain/excessive crying, abdominal distension, passage of blood and mucus in the stool and a palpable abdominal mass. Duration of symptoms i.e., time period lapsing between the onset of symptoms and seeking the treatment was < 24hours in 21.3% cases, 24-72 hours in 3l.5% > 72 hours in 39.4% and > 1 week in 7.8% cases. Ileo-colic intussusception was found in 76% cases, colo- colic in 16 and ileo-ileal in 8% cases. Manual reduction was successful in 34% cases and resection of the gut had to be done in 66% cases. Delay in diagnosis was associated with increased morbidity and mortality. The authors recommend that prompt treatment is the key to reduce the morbidity and mortality