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Postoperative intussusception in childhood
1Department of Pediatric Surgery, Johannes Gutenberg University, Langenbeckstrasse 1, D-55131 Mainz, Germany.
Insights
Postoperative intussusception in children is a rare complication following abdominal surgery. Early diagnosis and surgical intervention are crucial, as non-invasive methods are not recommended.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Postoperative intussusception is a rare complication following intra-abdominal procedures in children.
- This condition can occur after various surgeries, including appendectomies and intestinal resections.
Purpose of the Study:
- To analyze the incidence, clinical presentation, diagnosis, and management of postoperative intussusception in pediatric patients.
- To highlight the differences in management compared to idiopathic intussusception.
Main Methods:
- Retrospective case series of five children who developed intussusception postoperatively over a 10-year period.
- Review of medical records, including surgical history, clinical symptoms, diagnostic imaging (ultrasound, radiographs), and treatment outcomes.
Main Results:
- Five cases of postoperative intussusception were identified after diverse intra-abdominal surgeries.
- Common symptoms included abdominal distension, pain, and bilious vomiting; ultrasound was diagnostic in most cases.
- Intussusceptions were ileocolic, ileoileal, and jejunojejunal; operative management was required in all cases, with successful manual reduction.
Conclusions:
- Postoperative intussusception requires prompt surgical intervention, often via laparotomy and manual reduction.
- Non-invasive hydrostatic reduction is contraindicated due to risks to intestinal anastomoses and potential for missed diagnoses.
- Distinguishing postoperative from idiopathic intussusception is critical for appropriate management decisions.
Abstract:
Over a period of 10 years, five children developed postoperative intussusception after intra-abdominal procedures at the Department of Pediatric Surgery of the Johannes Gutenberg University Mainz. Two appendectomies, one ileal resection for a Meckel's diverticulum, one operative procedure for Hirschsprung's disease plus intestinal neuronal dysplasia type B, and one hiatoplasty with jejunostomy preceded the intussusception. Three of the five children were older than 2 years. The clinical symptoms consisted primarily of abdominal distension, diffuse abdominal pain, bilious vomiting, and rectal bleeding in one case. Preoperative diagnosis was achieved in four cases by abdominal ultrasound. Plain abdominal radiographs demonstrated dilated loops of small intestine with air-fluid levels in four of the five cases. In the case without radiographic findings, the jejunojejunal intussusception was missed even by a bowel follow-through. The intussusceptions were ileocolic (3), ileoileal (1), and jejunojejunal (1). A hydrostatic procedure to reduce an ileocolic intussusception was not successful. Operative treatment of the intussusception was performed in three cases within 5 days, once at 32 days, and once 3 months after the primary operation, in all cases by laparatomy and simple manual reduction without intestinal resection. In contrast to idiopathic intussusception, noninvasive hydrostatic procedures are not indicated in postoperative intussusception, since protection of intestinal anastomoses from hydrostatic pressure and exclusion of other causes of postoperative ileus are mandatory.