Vivek M. Rege
Intussusception - Treatment
Nowadays, the therapy is combined with the diagnosis. In case of Barium Enema, it is given under x ray image intensifier through a can placed at 3 feet above the child. The barium flows with pressure of gravity and not hand force. This hydrostatic force of the liquid barium itself after making a diagnosis, begins reducing the intussusception. This occurs as the liquid pushes the proximal inner intestine backwards and out of the distal bowel till the entire intussusception is reduced. This procedure is done by the combination of the pediatric surgeon and the radiologist. A very similar procedure can be done under Sonography control and use of Normal Saline liquid. The advantage is that in this there is no exposure of the child to radiation. Completion of the process can be visualized in both procedures and a repeat sonography after 8 hours will confirm no residual or recurrent intussusception is present. In this procedure, the child remains in the hospital for 2 days, there is no surgery, no scar, no operative pain and is back on oral feeds in 48 hours.

Figure: Progressive reduction of the Intussusception
Progressive reduction of the Intussusception

Figure a: Progressive reduction of the Intussusception
Progressive reduction of the Intussusception

Figure b: Progressive reduction of the Intussusception
Progressive reduction of the Intussusception

However, in some cases that are brought to the doctor late, or where these procedures fail, the option is to do an open surgery under general anesthesia. The child abdomen is opened and the bowel is inspected, and the intussusception area is localized, and the manual reduction is begun if possible the intestines are checked for gangrene or perforation after reduction and if normal the abdomen is closed. If the intussusception cannot be reduced or there is gangrene of the intestine, such intestine has to be removed and the remaining parts of the intestines are joined together and then the abdomen is closed. These children are very toxic soon after surgery and may go into generalized sepsis and require high antibiotics for a long time of 10 days, along with intravenous fluids no oral intake for 7 days and long period of hospitalization.

Figure: Intussusception leading to gangrene
Intussusception leading to gangrene

Intussusception Intussusception 01/06/2001
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