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Intussusception in infants: an emergency in diagnosis and treatment
Insights
Intussusception in infants can cause bowel obstruction and necrosis. Prompt diagnosis and hydrostatic reduction are key, but delays often necessitate surgery, as shown in two case reports.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Intussusception is a significant cause of intestinal obstruction and bowel necrosis in infants.
- The ileocaecal junction is the most commonly affected site.
- Known etiological factors include Meckel's diverticulum and lymphoid hyperplasia.
Observation:
- Two cases of ileocaecal intussusception in infants are presented.
- One infant experienced delayed diagnosis leading to bowel necrosis and surgical intervention (terminal ileostomy).
- Another infant with timely diagnosis underwent successful, though challenging, hydrostatic reduction.
Findings:
- Delayed diagnosis of intussusception significantly increases the risk of complications like bowel necrosis.
- Hydrostatic reduction is the preferred initial treatment for intussusception.
- Factors such as dolichosigmoideum can complicate hydrostatic reduction.
Implications:
- Emphasizes the critical importance of early diagnosis and intervention in pediatric intussusception.
- Highlights the potential for successful non-operative management with prompt recognition.
- Underscores the need for surgical preparedness when reduction fails or is delayed.
Abstract:
Intussusception is an important cause of intestinal obstruction and bowel necrosis in infants under 2 years. Most frequently the ileocaecal junction is involved. Various aetiologic factors, such as Meckel's diverticulum and lymphoid hyperplasia have been identified. Hydrostatic reduction of the intussusception should be attempted, but delay in diagnosis frequently leads to surgical intervention, because of failing reduction. We report a case of a 4-month-old boy whose ileocaecal junction was intussuscepted into the rectum, and therefore could be palpated by rectal examination. Unsuccessful hydrostatic reduction and bowel necrosis because of delay in diagnosis, made surgical intervention necessary. A terminal ileostomy was performed. A second case report considers a 10-month-old boy whose ileocaecal junction was intussuscepted into the colon sigmoideum. Because there was no delay in diagnosis, this intussusception could be reduced hydrostatically. The procedure however was difficult because of a dolichosigmoideum. Recent literature is also reviewed.