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1.
Khirurgiia (Mosk) ; (3): 67-73, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271740

RESUMO

OBJECTIVE: To analyze acute complications of stromal gastrointestinal tumors and determine diagnosis and optimal treatment of these patients. MATERIAL AND METHODS: There were 33 patients with acute complications of GIST aged 40-74 years. RESULTS: Acute complications were presented by gastrointestinal and (or) intratumoral (interstitial) bleeding (n=31). Hemorrhage was combined with stomach perforation in 1 case, intussusception and obstruction of the duodenum in 1 patient, small bowel obstruction in 2 patients. All findings were confirmed by the marker CD 117 (+). One patient died in long-term period after R0-resection and chemotherapy. Targeted therapy was used in 2 patients. CONCLUSION: Clinical examples indicate the progress in diagnosis and treatment of GIST due to development of instrumental imaging techniques, histological and histochemical verification of the process.


Assuntos
Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/terapia , Adulto , Idoso , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Tumores do Estroma Gastrointestinal/diagnóstico , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Intestino Delgado , Intussuscepção/etiologia , Intussuscepção/terapia , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas c-kit/análise
2.
Am Surg ; 86(2): 79-82, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32106907

RESUMO

Mark M. Ravitch is a surgeon worth acknowledging. He is credited for revolutionizing pediatric surgery as a subspecialty, mastering chest wall deformities and introducing the surgical stapler to the United States, to name a few. Above all, he was a notable leader, teacher, and author. This historical vingette is a brief snapshot of his biography and various achievements.


Assuntos
Grampeadores Cirúrgicos/história , Cirurgia Torácica/história , Bancos de Sangue/história , História do Século XX , Intussuscepção/história , Intussuscepção/terapia
3.
Medicine (Baltimore) ; 99(5): e18956, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000420

RESUMO

Intussusception is common emergency condition in children. Pneumatic or hydrostatic reduction (HR) is considered the first-choice management strategy in cases lacking indications for surgical intervention. Generally, sedatives are not used in children undergoing interventional radiology procedures. Surgical management is associated with long hospitalization durations and high costs, unlike nonsurgical reduction. To avoid surgery, reduction procedures are repeated despite initial treatment failure. However, in cases involving repeated failures, children should be referred for surgery.To ensure good response to reduction, we planned HR under sedation during the third reduction attempt. Sedative reduction (SR) was performed with the administration of ketamine, midazolam, and atropine. All patients with contraindications against HR underwent laparoscopic reduction (LR) without HR.During 3 years, SR was performed in 43 patients, and in 28 (65.1%), the treatment was successful. Among the 15 patients in whom the procedure failed, 14 underwent LR without intestinal resection. There was no significant risk factor contributing to failed reduction under sedation.During the second or third HR attempt, successful reduction may be ensured with the SR procedure with intravenous ketamine, midazolam, and atropine; this procedure may further reduce surgery rates in pediatric intussusception.


Assuntos
Hipnóticos e Sedativos/uso terapêutico , Intussuscepção/terapia , Administração Intravenosa , Atropina/uso terapêutico , Pré-Escolar , Feminino , Humanos , Lactente , Ketamina/uso terapêutico , Laparoscopia , Masculino , Midazolam/uso terapêutico , Retratamento , Estudos Retrospectivos , Resultado do Tratamento
5.
J Surg Res ; 244: 122-129, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31284141

RESUMO

BACKGROUND: The objective of this study was to evaluate clinical outcomes, costs, and clinician and parent satisfaction after implementation of a protocol to discharge patients from the emergency department (ED) after successful reduction of uncomplicated ileocolic intussusception. MATERIALS AND METHODS: In March 2017, an intussusception management protocol was implemented for children presenting with ultrasound findings of ileocolic intussusception. Those meeting inclusion criteria were observed after successful radiological reduction in the ED and discharged after 6 h with resolution of symptoms. Retrospective chart review was completed for cases before and after protocol implementation for clinical outcomes and costs. Clinicians and parents were surveyed to assess overall satisfaction. RESULTS: Charts were reviewed before (42 encounters, 37 patients) and after (30 encounters, 23 patients) protocol implementation. After implementation, admission rates decreased from 95% (40/42) to 23% (7/30; P < 0.001) and antibiotic use was eliminated (91% to 0%, P < 0.001). There was no difference in recurrence rates (17% versus 23%, P = 0.44). Median total length of stay decreased from 18.87 to 9.52 h (P < 0.001), whereas median ED length of stay increased from 4.37 to 9.87 h (P < 0.001). In addition, there was an overall hospital cost saving of over $2000 ($9595 ± 3424 to $7465 ± 3723; P = 0.009) per encounter. Clinicians and parents were overall satisfied with the protocol and parents showed no changes in patient satisfaction with protocol implementation. CONCLUSIONS: An intussusception protocol can facilitate early discharge from the ED and improve patient care without increased risk of recurrence. Additional benefits include decreased hospital- and patient-related costs, elimination of antibiotic use, and parent as well as clinician satisfaction.


Assuntos
Protocolos Clínicos/normas , Implementação de Plano de Saúde , Doenças do Íleo/terapia , Intussuscepção/terapia , Satisfação Pessoal , Pré-Escolar , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Enema , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Doenças do Íleo/economia , Lactente , Recém-Nascido , Intussuscepção/economia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Alta do Paciente/normas , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Estudos Retrospectivos , Prevenção Secundária/economia , Prevenção Secundária/organização & administração , Prevenção Secundária/normas , Inquéritos e Questionários/estatística & dados numéricos
6.
Arab J Gastroenterol ; 20(2): 69-73, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31155426

RESUMO

BACKGROUND AND STUDY AIMS: Intussusception is a life-threatening illness, with incompletely understood aetiology, although some predisposing factors are known. Intussusception frequently occurs in well-nourished chubby infants. We aimed to determine whether patients presenting with intussusception have a high prevalence of obesity. PATIENTS AND METHODS: This cross sectional study was conducted in 100 infants presenting with intussusception aged ≤2 years at the Paediatric Surgery Department. Anthropometric measures, history of recent upper respiratory tract infection, timing and type of intervention were recorded. A near median split divided the population into younger (aged < 8 months, N = 47) and older (8-24 months, N = 53) groups. Obesity was defined as having a body weight for length ≥ 97.7th centile on WHO growth charts. RESULTS: The study comprised 58 boys and 42 girls, 31% of whom had upper respiratory infection in the preceding month. Obesity was present in 18% of patients, based on WHO growth charts. There was a trend towards higher percentage of obese infants within the younger (25%) compared to older age groups (12%, P = 0.085), but no gender difference. Obesity did not influence the rate of success of hydrostatic reduction. Based on Egypt-specific growth charts, the percentage of infants with a weight-for-age centile ≥ 85th was 42%, of whom 7% were ≥ 97.7th centile. The corresponding percentages for the weight-for-length were 29% and 15% of patients respectively. CONCLUSION: There is a high prevalence of obesity in infants presenting with intussusception, particularly under 8 months of age. The mechanistic link between obesity and the pathogenesis of intussusception deserves investigation.


Assuntos
Intussuscepção/epidemiologia , Obesidade/epidemiologia , Fatores Etários , Estatura , Peso Corporal , Comorbidade , Estudos Transversais , Egito/epidemiologia , Feminino , Gráficos de Crescimento , Humanos , Lactente , Intussuscepção/terapia , Masculino , Prevalência
7.
Pediatr Surg Int ; 35(8): 879-885, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31139892

RESUMO

BACKGROUND: Most cases of intussusception in children are idiopathic. Rarely, a malignant disease such as intestinal lymphoma may cause intussusception. Due to dramatic changes of expected outcome with chemotherapy regime alone, the surgical management of patients with intestinal lymphoma presenting with intussusception has to be reevaluated. METHODS: Retrospective chart review from May 2011 to February 2017. We included all patients with intestinal lymphoma presenting with intussusception. RESULTS: We found five patients with a mean age of 6.4 years (range 3-16). The most common presenting symptom was abdominal pain for several weeks which had acutely worsened. In all but one patient an ultrasound before pneumatic or hydrostatic reduction showed a finding suspicious of a pathological lead-point. Pneumatic or hydrostatic reduction was attempted in all patients, no complications were noted. In one patient reduction was not successful. Recurrence after reduction occurred in two patients. Two patients needed surgery, three had a percutaneous ultrasound-guided biopsy for diagnostic purposes. All patients had aggressive mature B cell non-Hodgkin lymphoma. CONCLUSION: A high index of suspicion for the presence of a pathological lead-point in children older than 4 years and children with recurrent intussusception is necessary in patients presenting with intussusception. Malignant, highly aggressive B cell non-Hodgkin lymphoma, although rare, must actively be searched for. Pneumatic or hydrostatic reduction should remain the first line treatment in most cases.


Assuntos
Neoplasias do Íleo/complicações , Intussuscepção/etiologia , Laparotomia/métodos , Linfoma/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Pressão Hidrostática , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/cirurgia , Biópsia Guiada por Imagem , Intussuscepção/diagnóstico , Intussuscepção/terapia , Linfoma/diagnóstico , Linfoma/cirurgia , Masculino , Estudos Retrospectivos , Ultrassonografia
8.
Indian Pediatr ; 56(1): 29-32, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30806357

RESUMO

OBJECTIVE: To analyze the association between the clinical presentation, clinical course, management and outcome in intussusception with emphasis on safety of saline hydrostatic reduction. METHODS: This retrospective study included 375 patients of intussusception diagnosed between March 2007 to February 2017. Symptoms at presentation, mode of reduction of intussusception and associated complications were recorded. RESULTS: 336 (89.6%) patients were aged below 3 years. Classical triad of abdominal pain, vomiting and red stools was present in 111 (29.6%) patients. While 64 (17.1 %) patients had spontaneous resolution, hydrostatic reduction and surgery cured 283 (75.5 %) and 28 (7.4 %) patients, respectively; overall recurrence rate was 13.1%. Among the patients who underwent operative reduction, blood in stools was present in 15 (53.6%) patients. CONCLUSIONS: Hydrostatic reduction of intussusception is effective irrespective of duration of symptoms and number of recurrences.


Assuntos
Intussuscepção , Dor Abdominal , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Lactente , Intussuscepção/diagnóstico , Intussuscepção/epidemiologia , Intussuscepção/terapia , Masculino , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Vômito
11.
Medicine (Baltimore) ; 98(1): e13826, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30608396

RESUMO

The aim of this current study was to explore the risk factors associated with failure of hydrostatic reduction of intussusception in pediatric patients.Patients with intussusception treated with hydrostatic reduction from January 2010 to December 2016 were retrospectively analyzed. Candidates for inclusion in the study were children from 0 to 18 who were diagnosed with intussusception and treated with hydrostatic reduction. We excluded the patients who had contraindications for hydrostatic reduction, which included peritonitis, perforation signs, and non-responsive shock that required surgery. The data collected included: demographic data (sex, age, and bodyweight), symptoms (vomiting, abdominal pain, rectal bleeding, diarrhea, distention, constipation, and duration of symptoms), signs (temperature, palpable mass, and location of the mass), and other investigations (white blood cell counts, neutrophils, electrolytes, and ultrasound findings).The risk factors for failure of hydrostatic reduction of intussusception were analyzed using the univariable analysis and the multivariable analysis. In the univariable model, the significant risk factors for failure of hydrostatic reduction of intussusception analyzed were age, bodyweight, duration of symptoms, rectal bleeding, constipation, palpable abdominal mass, poor prognosis signs on ultrasound scans and location of mass (the P value for each parameter are stated in ). After the multivariable analysis was done, we found that the significant risk factors for failure of hydrostatic reduction of intussusception were an age of under 1-year-old (OR = 3.915, P = .027), duration of symptoms more than or equal to 48 h (OR = 0.056, P < .001), rectal bleeding (OR = 0.283, P = .003), constipation (OR = 0.086, P < .001), palpable abdominal mass (OR = 0.370, P = .010), and location of mass (left over right side) (OR = 13.782, P < .001).(Table is included in full-text article.)Our study found that an age of under 1-year-old, a duration of symptoms of more than or equal to 48 h, rectal bleeding, constipation, palpable abdominal mass and location of mass (left over right side) were risk factors for the failure of hydrostatic reduction of intussusception.


Assuntos
Enema/métodos , Pressão Hidrostática , Enteropatias/terapia , Intussuscepção/terapia , Fatores Etários , Constipação Intestinal/etiologia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Lactente , Enteropatias/complicações , Intussuscepção/complicações , Masculino , Doenças Retais/etiologia , Estudos Retrospectivos , Fatores de Risco , Gastropatias/etiologia , Fatores de Tempo , Falha de Tratamento
12.
Pediatr Radiol ; 49(1): 76-81, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30232533

RESUMO

BACKGROUND: Ileocolic intussusception occurs when the terminal ileum "telescopes" into the colon. We observed that ileocolic intussusception lengths are similar regardless of location in the colon. OBJECTIVE: To examine the uniformity of ileocolic intussusception length and its relationship to colon location, symptom duration and reducibility. MATERIALS AND METHODS: We retrospectively reviewed ultrasound-diagnosed pediatric ileocolic intussusceptions initially treated with pneumatic reduction at the Mayo Clinic or Texas Children's Hospital. We recorded demographic, imaging and surgical findings including age, gender, symptom duration, location of the ileocolic intussusception, reducibility with air enema and, if fluoroscopically irreducible, surgical findings. RESULTS: We identified 119 ileocolic intussusceptions (64% boys), with 81% in the right colon. There was no significant relationship between ileocolic intussusception length and colon location (P=0.15), nor ileocolic intussusception length and symptom duration (P=0.36). Ileocolic intussusceptions were more distal with increasing symptom duration (P=0.016). Successful reductions were unrelated to symptom duration (P=0.84) but were more likely with proximal versus distal locations (P=0.02). CONCLUSION: Ileocolic intussusception lengths are relatively uniform regardless of location along the course of the colon where they present. Our findings suggest that most of the apparent distal propagation of ileocolic intussusceptions is not caused by increasing telescoping of small bowel across the ileocecal valve but rather by foreshortening of the right colon. This implies poor cecal fixation and confirms fluoroscopic and surgical observations of cecal displacement from the right lower quadrant with ileocolic intussusceptions. The movement of the leading edge of the ileocolic intussusception during reduction is first due to "relocating" the cecum into the right lower quadrant after which the reduction of small bowel back across the ileocecal valve then occurs.


Assuntos
Doenças do Colo/diagnóstico por imagem , Doenças do Íleo/diagnóstico por imagem , Intussuscepção/diagnóstico por imagem , Ultrassonografia/métodos , Doenças do Colo/terapia , Feminino , Humanos , Doenças do Íleo/terapia , Lactente , Intussuscepção/terapia , Masculino , Estudos Retrospectivos , Resultado do Tratamento
13.
J Pediatr Surg ; 54(8): 1609-1612, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30309734

RESUMO

PURPOSE: Pediatric intussusception's first line treatment consists of fluoroscopic guided air enema reduction. Postprocedure, these patients are usually admitted overnight for observation. The purpose of our study was to document the results of emergency department (ED) observation and discharge protocol after successful reduction of ileocolic intussusception. METHODS: A prospective observational study was conducted after implementation of an ED protocol for ileocolic intussusception from 10/2014 to 7/2017 and compared these patients to a historical cohort immediately prior to protocol initiation (10/2011-9/2014). Data collected included demographics, total time in the ED and hospital, enema reduction, recurrence, and requirement for operative intervention. Results reported as means with standard deviation and medians reported with interquartile ranges (IQR). RESULTS: 115 patients were treated with the prospective protocol and were compared to a 90 patient historical cohort. Reduction was successful in 84%-89% of cases. Median hospital time after enema was shorter in the protocol group [4.8 h (4.25, 14.97) versus 19.7 h (13.9, 33.45), p < 0.01]. Only 33% of patients were admitted following the protocol; the most common admission reason was persistent abdominal discomfort. CONCLUSION: ED observation and discharge after successful air enema reduction in children with ileocolic intussusception are safe, facilitate early discharge, and reduce hospital resource utilization. LEVEL OF EVIDENCE: III.


Assuntos
Doenças do Íleo , Intussuscepção , Criança , Serviço Hospitalar de Emergência , Enema/efeitos adversos , Enema/métodos , Fluoroscopia , Hospitalização/estatística & dados numéricos , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/terapia , Intussuscepção/diagnóstico por imagem , Intussuscepção/terapia , Alta do Paciente , Estudos Prospectivos
14.
Eur J Pediatr Surg ; 29(1): 7-13, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30130824

RESUMO

INTRODUCTION: Recent literature advocates outpatient emergency department (ED) management of intussusception citing low recurrence rates and postreduction events after uncomplicated ileocolic reduction. However, few studies include both inpatient and outpatient cohorts. We performed a systematic review and meta-analysis to compare recurrence rates and length of hospital stay between the groups. MATERIALS AND METHODS: Studies published in English up to January 2018 were searched from Medline, Embase, Google Scholar, and Cochrane databases, using a combination of the terms 'intussusception,' 'reduction,' and 'management'. A meta-analysis of studies comparing outcomes after successful intussusception reduction in children between inpatients and ED patients was performed. RESULTS: No randomized controlled trials (RCT) were found. Nine observational studies (eight retrospective and one prospective) were included, comprising 546 inpatients and 776 ED cases. There was no statistical difference in overall recurrence rate between inpatients (8.8%) and ED (10.1%) (pooled odds ratio [OR] = 1.09; 95% confidence interval [CI] 0.74-1.62; P = 0.66; I 2 = 0). Five studies reported early recurrence (<48 hours) with no difference (pooled OR = 1.27; 95% CI 0.46-3.48; P = 0.65; I 2 = 0). Five studies reported postdischarge recurrence rate with no difference (pooled OR = 1.57; 95% CI 0.71-3.48; P = 0.27; I 2 = 34%). Five studies reported recurrence requiring surgery with no difference (pooled OR = 0.99; 95% CI 0.32-3.06; P = 0.99; I 2 = 0). Methods of reduction were air, barium, or other contrast enema. CONCLUSION: Management of intussusception in the ED after uncomplicated reduction appears acceptable. However, evidence levels are low, and RCT should be performed to adequately evaluate the safety of outpatient management of pediatric intussusception.


Assuntos
Serviço Hospitalar de Emergência , Hospitalização , Doenças do Íleo/terapia , Intussuscepção/terapia , Ar , Enema Opaco , Criança , Meios de Contraste , Enema/métodos , Humanos , Doenças do Íleo/cirurgia , Intussuscepção/cirurgia , Tempo de Internação , Recidiva
15.
Emerg Radiol ; 26(1): 1-4, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30143943

RESUMO

PURPOSES: Early recurrent ileocolic intussusception (RICI) is a rare event. We aimed to estimate the rate of RICI and identify predisposing factors for early recurrence for children treated in a tertiary-care academic medical center. METHODS: Consecutive children who were diagnosed with ileocolic intussusception (ICI) during the years 2005-2015 and had successful enema reduction were included. Demographic, clinical, imaging, and laboratory data were recorded for analysis. Ultrasound and fluoroscopy images were reviewed. Early RICI was defined as recurrence within 48 h. RESULTS: Two hundred forty-five episodes of intussusception in 210 patients, ages 2 to 77 months (mean 12.7), were included. Six patients (2.45%) had a RICI between 7 and 28 h (mean 17 h) after initial successful reduction. A total of 5/6 recurrences (83.3%) were in winter months. In the group without early recurrence, only 19.6% of the cases presented during the winter (p = 0.001). Mean age in the early recurrence group was 23 months compared to 12.4 months children with no early recurrence (p = 0.016). All other analyzed parameters were comparable for the groups. CONCLUSION: Early RICI is a relatively rare event that may not justify routine admission and long observation. The approach should be individual, based on the clinical picture.


Assuntos
Enema/métodos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/terapia , Intussuscepção/diagnóstico por imagem , Intussuscepção/terapia , Ar , Criança , Pré-Escolar , Fluoroscopia , Humanos , Incidência , Lactente , Recidiva , Fatores de Risco , Resultado do Tratamento , Ultrassonografia
16.
J Pediatr Surg ; 54(7): 1316-1323, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30503194

RESUMO

BACKGROUND: Variability in management of intussusception after enema reduction exists. Historically, inpatient observation was recommended; however, there is a lack of evidence-based guidelines for this practice. METHODS: A systematic review and meta-analysis evaluating outcomes between inpatient (IP) and outpatient (OP) management after enema reduction was performed. The following databases were searched: PubMed, EBSCOhost CINAHL, EMBASE, Web of Science, and Cochrane Database. Data from an institutional review were included in the meta-analysis. RESULTS: Ten studies of patients aged 0-18 years with intussusception who underwent successful enema reduction that reported outcomes of outpatient management were included. Overall recurrence rates were 6% for IP and 8% for OP (p = 0.20). Recurrences within 24 (IP: 1% vs OP: 0%, p = 0.90) and 48 h (IP: 1% vs OP: 2%, p = 0.11) were similar. There was no significant difference in the rate of return to the emergency department (IP: 6% vs OP: 14%, p = 0.11). Both groups had a similar rate of requiring an operation (IP: 2% vs OP: 1%, p = 0.84). CONCLUSIONS: Outpatient management of intussusception after enema reduction results in a shorter hospital stay with no difference in the rate of return to the emergency department, recurrence, need for operation, or mortality. The findings of the meta-analysis suggest that outpatient management may be safe and could reduce hospital resource utilization. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: III.


Assuntos
Enema/efeitos adversos , Doenças do Íleo/terapia , Intussuscepção/terapia , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Doenças do Íleo/fisiopatologia , Lactente , Recém-Nascido , Intussuscepção/etiologia , Intussuscepção/fisiopatologia , Masculino , Pacientes Ambulatoriais , Recidiva
17.
Pediatr Emerg Care ; 35(7): e133-e134, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29438126

RESUMO

Abdominal radiography and computed tomography scans are standard tests to diagnose pneumoperitoneum. With the growing availability of point-of-care ultrasound, pneumoperitoneum may be diagnosed in settings without easy access to radiography or computed tomography, such as in overcrowded emergency departments or resource-poor environments. The use of point-of-care ultrasound to diagnose or monitor pneumoperitoneum has been described in adult but not pediatric patients. We present a case of point-of-care ultrasound detection of pneumoperitoneum and monitoring for tension pneumoperitoneum, after failed air enema reduction for intussusception in an infant.


Assuntos
Enema/efeitos adversos , Doenças do Íleo/terapia , Intussuscepção/terapia , Pneumoperitônio/diagnóstico por imagem , Testes Imediatos , Ultrassonografia , Enema/métodos , Humanos , Lactente , Masculino , Pneumoperitônio/etiologia
18.
Pediatr Emerg Care ; 35(8): 533-538, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28146013

RESUMO

OBJECTIVES: The aim of this study was to evaluate the effects of a practice guideline of postreduction management of intussusception in children on the length of stay (LOS) from reduction in the pediatric emergency department (PED) and on the incidence of recurrence. METHODS: We developed a practice guideline of postreduction management of intussusception in the PED. The practice guideline involved feeding 2 hours after reduction and discharge 2 hours after successful feeding. The guideline was implemented on October 1, 2012. Retrospective quasi-experimental study was conducted for evaluation of the difference in LOS in the PED after reduction of intussusceptions, and the recurrence rate of intussusceptions between the preimplementation and postimplementation periods. Piecewise regression was performed to determine the differences between groups. RESULTS: In total, 45 and 52 patients were included in the preimplementation and postimplementation periods, respectively. The median LOS in the postimplementation period was significantly shorter than that in the preimplementation period (289 vs 532 minutes, respectively; P = 0.001). The slope of the LOS changed from 0.68 to -0.29. The slope decreased by 0.97 after practice guideline implementation. This difference was not statistically significant (P = 0.123), but it changed from a positive to negative gradient. The recurrence rate was not significantly different between the 2 periods (P = 0.605). CONCLUSIONS: Implementation of a practice guideline involving early feeding and discharge after reduction of intussusception resulted in a reduced LOS from reduction of intussusception in the PED and was not associated with recurrence of intussusception.


Assuntos
Intussuscepção/epidemiologia , Intussuscepção/terapia , Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Adolescente , Adulto , Criança , Serviço Hospitalar de Emergência , Feminino , Humanos , Incidência , Tempo de Internação/tendências , Masculino , Alta do Paciente/tendências , Guias de Prática Clínica como Assunto , Recidiva , Estudos Retrospectivos , Adulto Jovem
19.
J Int Med Res ; 47(2): 859-866, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30556437

RESUMO

OBJECTIVE: Intussusception is a common paediatric abdominal emergency in infants. The first-line treatment of choice in uncomplicated paediatric intussusception is enema reduction. The study aim was to provide an overview of the current national practice of enema reduction of paediatric intussusception in China. METHODS: A questionnaire on enema reduction of paediatric intussusception was sent to respondents (members of the Pediatric Anorectal Group, the Neonatal Group, the Society of Pediatric Surgery and the China Medical Association). RESULTS: Data from 128 questionnaires were analysed. Of these, 78.1% (100/128) reported the use of fluoroscopy, 17.2% (22/128) use of ultrasound monitoring, 78.9% (101/128) use of air and 17.9% (23/128) use of normal saline. A total of 78.9% (101/128) reported a success rate of 90%, 25.8% (33/128) reported that a paediatric surgeon managed the reduction, 18.8% (24/128) that a radiologist managed the reduction and 44.5% (57/128) that a paediatric surgeon and radiologist jointly managed the reduction. CONCLUSIONS: There is large variation in the techniques of enema reduction of intussusception in China. Fluoroscopy-guided air enema reduction is mainly used. Enema reduction of uncomplicated cases of paediatric intussusception in China lacks standardization of equipment and personnel involvement.


Assuntos
Enema/métodos , Intussuscepção/terapia , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Criança , China , Humanos , Prognóstico , Inquéritos e Questionários
20.
BMC Emerg Med ; 18(1): 46, 2018 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-30463518

RESUMO

BACKGROUND: The management of childhood intussusception in our sub-region is still via surgical intervention. Currently, the gold standard of treatment is non-operative reduction. We sought to assess the suitability of hydrostatic (saline) reduction of intussusception in children in our institution. MATERIALS AND METHODS: A prospective study was conducted between January 2016 and June 2017 in all children with ultrasound confirmed intussusception at a tertiary teaching hospital in Nigeria. All children excluding those with signs of peritonitis, bowel gangrene and intestinal prolapse were selected for ultrasound-guided hydrostatic reduction (USGHR). We allowed a maximum of three attempts at reduction. RESULTS: The age range was 3 months to 48 months with a mean of 10.8 ± 9.1 months. Forty percent (N = 18) presented after 24 h of onset of symptoms. The success rate of hydrostatic reduction with saline enema was 84.4% (N = 38). Two (4.4%) perforations occurred during the procedure. Three (7.5%) patients had recurrent intussusception within six months. The duration of symptoms greater than 24 h, age and sex of patients did not influence successful reduction p > 0.05. The duration of admission between those who had successful non-operative reduction and those who subsequently had operative reduction and or resection attained statistical significant difference, p = 0.001. There was no mortality. We achieved a 68% decrease in the operative reduction of intussusception using USGHR as the primary modality of treatment. CONCLUSION: Our study found out that USGHR is a suitable alternative for the treatment of childhood intussusception.


Assuntos
Enema/métodos , Intussuscepção/terapia , Solução Salina , Ultrassonografia , Pré-Escolar , Feminino , Hospitais de Ensino , Humanos , Lactente , Masculino , Nigéria , Estudos Prospectivos
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