Saturday, April 30, 2011

Intestinal pain - Acute intussusception if you avoid can lead to death

What Could Happen If You Avoid The TREATMENT ?
IT Will Get So Extreme.........Lead To DEATH

ACUTE INTUSSUSCEPTION :

INTUSSUSCEPTION is an invagination of size of intestine ( intussuscepiens ) into the immediate portion of bowl ( intussusceptum ) and  most of cases occur in children during the first 5 decades of life. This can often result in an obstructio .The part that prolapse into the other is called the INTUSSUSCEPTUM and the part that recieves it is called INTUSSUSCEPIENS.


In some of children with intussuscetion , an anatomic predisposing condition . Such as Meckle's diverticulum , Burkitt lymphoma, or hamartomatous polyps ,can be found .And in most of the cases are associated with hyperplastic lymphoid tissue.suggesting an infectious causes ,which is not confirmed in most of the cases.By using serology and virus isolation from fecal and pharyngeal swabs.Adeno virus , Rotavirus ,Enterovirus , Human herpes virus  ,Cytomegalovirus and Epstien-barr-virus.some bacterial agents can also involved in this condition include Yersinia ,enterocolitis and salmonella typhimurium and candida albican .


TYPES
Ileocolic  ( 77 % ) 
Ileoileocolic ( 12 % ) 
Ileoileal (5 % ) 
Colocolic ( 2 % ) 
Multiple (! % ) 
Retrograde ( 0.2 % )
Others  ( 2.8 % ) .


CLINICAL FEATURES :


SYMPTOMS
  • Sudden paroxymsm of abdominal pain ,with drawing up of legs and screaming  :each attack lasts a few minutes and recur about every 15 minutes.
  • Facial pallor 
  • Vomiting
  • Listleness and somewhat drawn between the attacks .
  • Stool : intially normal later  blood and mucus are evacuated called  "red currant jelly stool " 
  • when not relieved upto 24-36 hours
        a . Pain becomes contineous
          b. Abdomen distends
          c. Vomiting becomes copious
          d. Absolute intestinal obstruction follows


SIGNS
  • A lump is felt ,which may harden on palpation .
  • PR examination : if intussuscetion has travelled far enough ,its apex ( a conical ) mass will be felt .
  • When not relieved ,upto 24 - 36 hours  


         a . Dehydration
         b . Abdominal distension
         c . Abdominal guarding , tenderness and rebound tenderness if gangrene has occured.


DIAGNOSTIC INVESTIGATIONS :


INTUSSUSCEPTION is often suspected based on history and physical examination , including observation of Dance's sign .Per rectal examination is particularly helpful in children as part of thintussusceptum may be felt by the finger .A definite  diagnosis often requires confirmation by diagnostis imaging modalities .

ULTRASOUND is today considered the imaging advanced technology of choice for diagnosis and exclusion of intussusception due to its high accuracy and lack of radiation.A target like mass ,usually around 3 cm in diameter confirm the diagnosis.


PLAIN ABDOMINAL X-RAY
Revealed increased gas shadow in small intestine and at times absence of cecal gas shadow .


X-RAY WITH BARIUM ENEMA :
Reveal characteristic " claw sign " in ileocolic intussusception .


TREATMENT :


The condition is not usually immediately life threatning.The intussusception can be treated with either a barium or water soluble contrast enema or an air contrast enema .which both confirms the diagnosis of intussusception, and inmost cases successfully reduce it . The success rate is over 80% .Therefore approximately 5 - 10 % of these recur within 24 hours .If it cannot be reduced by an enema or if the intestine is damaged , then surgical reduction is necessary.

PRELIMINARY TREATMENT 


Gastric aspiration should be carried out and contiued during and after operation.
Give IV dextrose - saline solution.


REDUCTION OF INTUSSUSCEPTION
REDUCTION BY HYDROSTATIC PRESSURE


OPERATIVE REDUCTION :


Abdomen is opened through a right lower paramedian incision .First part of reduction is accomplished by squeezing lower part of sausag like mass ,and little intussusception is reduced.Last part is most difficult to reduce and should br withdrawn and gently compressed in a warm saline soaked pack,to
lessen the edema.
After reduction if a specific cause is revealed appropriate treatment is carried out ,eg Meckle's diverticulum.


PROGNOSIS :

The outlook for intussusception is excellent .when treated immediately .but when untreated it can lead to death within 2-5 days .Quick treatment can avoid this surgery .Prolonged intussusception can lead to ischemia and necrosis and it requires surgical resection.


AFTER TREATMENT


Gastric aspiration should be continued for 12-24 hours
Dextrose-saline is given IV or SC with hyaluronidase.
On 2nd day ,gastric tube is removed and sips of water are given.
Few hours later ,feeding is commenced with mother's milk ( if infant is still being breast-fed ).

COMPLICATIONS:

Intestinal obstruction
Gangrene

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