Rescue by pneumoenema under general anaesthesia of apparently non-reducible intestinal intussusception.

UNLABELLED: When an enema in the radiology unit is unsuccessful in treating intussusception, patients must undergo surgery. A further attempt at reduction under general anaesthesia in the operating room prior to laparotomy could avoid surgical intervention. A prospective study was carried out from 2002 to 2010 on paediatric patients with intestinal intussusception who underwent a deinvagination procedure in radiology with no anaesthesia. Unresolved cases were included in either group 3a (direct surgery) or group 3b (pneumoenema under general anaesthesia in the operating room), depending if the paediatric surgeon on duty wanted or not to participate in the study. Ninety-eight patients were included in the study. Six patients (group 1) were immediately operated after diagnosis because peritonitis was clinically suspected. Sixty-seven patients were successfully treated with an anaesthesia-free procedure in the radiology department (group 2). Of the 25 cases with initial treatment failure (group 3), 11 were assigned to group 3a (immediate laparotomy) and 14 to group 3b (pneumoenema with general anaesthesia). All patients in the 3b group were successfully treated by this procedure. There were no differences between the groups in terms of age, sex or evolution time. The average length of hospital stay and the number of repeated hospitalizations were significantly higher for group 3a. CONCLUSION: We consider that general anaesthesia increases effective reduction pressures and could avoid many surgeries in apparently non-reducible intestinal intussusceptions.

Lymphatic preservation in varicocele in the adolescent: does prior embolization limit spermatic dissection?

OBJECTIVE: One of the complications after complete section of the spermatic pedicle in the treatment of adolescent idiopathic varicocele is the formation of a scrotal lymphocele. This can be avoided by preserving lymphatic vessels using dye, but there is a risk that dissection may be complicated in patients who have previously undergone embolization. The aim of this study was to determine whether prior embolization limits spermatic dissection. MATERIAL AND METHOD: We used lymphography with dye (Patent Blue) prior to surgery in order to mark and preserve the lymph vessels during spermatic section. This was done by laparoscopy with a single umbilical port. RESULTS: We treated six patients aged 12.5-15 years (mean 13.12 years), two of whom had grade 2 varicoceles and four grade 3. Prior percutaneous embolization with metallic coils had been undertaken in all cases but had not been curative. Post-surgery controls were undertaken for a mean duration of 5 months without any lymphoceles appearing. No testicles were lost, nor did any other complication arise. CONCLUSION: The presence of embolization material in the spermatic veins and perivascular fibrosis does not complicate surgery, enabling the single port laparoscopic technique to be undertaken.