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[Postoperative intestinal intussusception in children]
Insights
Postoperative intussusception (POI) is a rare complication following abdominal surgery in children. This report highlights risk factors and suggests epidural analgesia for better outcomes.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Postoperative intussusception (POI) is a recognized complication after abdominal surgery.
- Risk factors for POI in pediatric patients undergoing complex procedures are not fully elucidated.
Observation:
- Two pediatric cases of postoperative intussusception (POI) after extensive abdominal neuroblastoma surgery are presented.
- Both patients experienced small bowel obstruction postoperatively, requiring surgical reduction of ileo-ileal invagination.
Findings:
- Young age, preoperative chemotherapy, prolonged anesthesia, and extensive retroperitoneal dissection were identified as key risk factors.
- Opioid use for pain management may exacerbate POI by affecting intestinal motility.
Implications:
- POI, though uncommon, should be considered in pediatric patients with abdominal surgery history presenting with obstruction.
- Epidural analgesia with local anesthetics may be a safer alternative to opioids for postoperative pain management in high-risk patients.
Abstract:
Two cases of postoperative intussusception (POI) are reported. Both children, 13 and 6 months old, had long and difficult surgery for abdominal neuroblastoma after four courses of chemotherapy. Obstruction of the small intestine occurred on the fifth postoperative day, after feeding had been started again, in the first child, and on the third day in the second one. Surgery revealed a loose ileo-ileal invagination of 10 and 15 cm respectively, which was easily reduced. The postoperative course was uneventful in both cases. Although POI is a classical complication of abdominal surgery, it is often forgotten. In the cases described, the first surgical procedure combined most causative factors for POI: young age, preoperative chemotherapy, prolonged general anaesthesia, extensive retroperitoneal dissection close to components of the neurovegetative system. The use of opioids for postoperative analgesia may be an additional risk factor, as they alter intestinal motility. Epidural analgesia with local anaesthetics should be preferred in such cases.