Monday, August 28, 2017

Pediatric Surgery Intussusception

Intussusception
Definition
In case of entry of the ileum with its mesentery into the colon intussusception resulting in a mechanical bowel obstruction.
Objectives
   To open the abdomen to inspect the bowel
   To reduce the intussusception and relieve obstruction
   To resect and anastomose, if the bowel has become gangrenous.
Position
Supine.
Anesthesia
General with endotracheal intubation.
Procedure
   1.  Right transverse upper abdominal 7-8 cm long incision.
   2.  Avoid the subcutaneous tissues and muscles.
   3.  Open the peritoneal cavity.
   4.  Identify the intussusception mass.
   5.  Suck out the peritoneal fluid, if any.
   6.  Reduce the intussusception by “milking” from distal to proximal side, without injury to the bowel.
   7.  Resect and anastomoses the bowel, if it fails to reduce completely or found gangrenous.
   8.  Check for free flow of intestinal contents.
   9.  Check for any associated lesion, i.e. lymphoma Meckles diverticulum.
10.  Close the abdominal wound in layers.
Instruments
General pediatric set.
Sutures
   Catgut       2/0, 3/0, 4/0
   Silk             3/0, 4/0

   Nylon         4/0


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