00:01
Although some patients may require surgery, particularly with signs of ischemia or perforation,
the vast majority of patients respond quite well to non-operative reduction.
00:12
There are a couple of options.
00:15
There's therapeutic enemas.
00:17
This is a hydrostatic reduction where a column of barium is inserted into the rectum at a certain height.
00:23
This height is optimized to both reduce the intussusception, but also to minimize the risk of perforation.
00:30
This can be performed hydrostatically with either contrast barium or water-soluble contrast.
00:36
Similarly, pneumatic or air enemas have increasing use in patients with reduction of intussusception.
00:44
There's no need for barium in this situation.
00:47
Both have fairly good success.
00:50
Please also keep in mind, this is not as useful if it's not ileocolic.
00:56
In any other portions of the intestines, pneumatic or therapeutic hydrostatic enemas
may not be able to reduce the proximal of the section.
01:03
It is worth mentioning that in 10% of cases, intussusception recurs after reduction.
01:08
Now, in this situation where patients do not reduce intussusception with the enemas therapy, there are some indications for surgery.
01:22
For example, if the patient develops peritonitis,
remember, in babies, they may not be able to present with classic findings of peritonitis as in adults.
01:32
Everything generally just hurts.
01:34
But if you find that there is discoloration of the skin, this may be a sign of peritonitis.
01:40
Next, pneumoperitoneum.
01:43
This suggests likely perforated.
01:45
Although you don't know where the perforation is, this is an absolute indication for surgery.
01:51
And lastly, as is in the case with most kids, progressive clinical deterioration.
01:56
As a reminder, if a clinical scenario is presented to you and the patient has suspicion for ischemia or clinical deterioration,
I strongly recommend that you go to the operating room.
02:08
In the operating room, this is how we take care of intussusceptions.
02:14
Generally, it's recommended that you push the invaginated segment out rather than pulling it out.
02:21
This reduces the perforation risk.
02:23
It’s common physics.
02:25
If you're successful or not successful, management is a little bit different.
02:31
If you're able to reduce intussusception in children by simply pushing out the invaginated segment and the segments appear viable,
then complete the procedure by doing an appendectomy.
02:45
However, if you are not easily able to reduce intussusception, it’s probably safer to perform a segmental resection.
02:54
Let's review some very important clinical pearls and high-yield information.
02:59
In patients who do not succeed an enema reduction, they can be repeated.
03:05
Additionally, if a patient initially succeeds with enema reduction and re-intussuscepts,
they’re also a candidate for enema reduction as long as these patients do not demonstrate any signs or indications for surgery that we've discussed.
03:22
And for your examination, remember, lead points are rare in children.
03:28
Lymph nodes, however, is the most common lead point, usually following upper respiratory infection.
03:34
However, if an intussusception is presented in an adult patient, think about cancer as most patients -
adult patients with intussusception have a lead point to explain why they develop a non-idiopathic non-ileocolic intussusception.
03:53
Let's talk about Meckel's Diverticulum
This is a small congenital diverticular
of the small intestines
that often finds its way onto tests.
04:01
It is often described
as following the rules of 2's
meaning it occurs in 2% of the population,
but only 2% of those patients
develop symptoms.
04:10
Usually it is two inches in length,
normally located within two feet of the ileocecal valve.
04:17
And commonly symptomatic in children
less than two years of age.
04:20
The symptoms include abdominal pain, bowel
obstruction, bleeding and intussuspection
if the diverticular
inverts into the bowel lumen.
04:29
Thank you very much for joining me on this discussion of intussusception.