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Intestinal Obstruction II: Pathophysiology01:07

Intestinal Obstruction II: Pathophysiology

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Intestinal obstruction triggers a series of physiological responses, starting with gas and fluid accumulation in the bowel segment proximal to the obstruction, leading to distension. This distended intestine compresses the diaphragm, hindering lung expansion and potentially leading to reduced respiratory effort, atelectasis, and pneumonia.To overcome the blockage, the gut intensifies contractions, causing colicky abdominal pain, nausea, and vomiting, which reduces fluid and food intake and...
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Double small bowel intussusception complicating bilateral partial nephrectomies.

Fazal N Wahid1, Alpin D Malkan1, M Beth McCarville2

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Pediatric patients with Wilms tumor may develop intussusception, a serious condition where the bowel telescopes. Early diagnosis and surgical intervention are crucial for successful treatment of multiple intussusceptions.

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Area of Science:

  • Pediatric Surgery
  • Pediatric Oncology
  • Gastroenterology

Background:

  • Wilms tumor is a common pediatric kidney cancer.
  • Intussusception is a rare but serious complication in children.
  • Postoperative complications after Wilms tumor treatment require careful monitoring.

Purpose of the Study:

  • To report a rare case of double intussusception in a pediatric patient treated for bilateral Wilms tumor.
  • To highlight the importance of considering intussusception in postoperative patients with abdominal symptoms.
  • To emphasize the need for a high index of suspicion for diagnosing multiple intussusceptions.

Main Methods:

  • Case report of an 11.5-month-old male with bilateral Wilms tumor.
  • Patient presented with postoperative abdominal pain and vomiting.
  • Diagnostic imaging (ultrasound) and surgical exploration (laparotomy) were performed.
  • Manual reduction of intussusception was the primary treatment.

Main Results:

  • The patient was diagnosed with two separate small intestinal intussusceptions (jejunojujenal and ileoileal).
  • Successful surgical treatment was achieved through manual reduction.
  • No immediate postoperative complications were noted after the reduction.

Conclusions:

  • Intussusception can occur as a complication following treatment for Wilms tumor.
  • The presence of multiple intussusceptions necessitates a high index of suspicion for accurate diagnosis.
  • Prompt surgical intervention is vital for managing intussusception in pediatric oncology patients.