Prepared by: Bishly. Case Study. Demographic Data. CASE NO: 14xxx NAME: Baby H AGE: 3 yrs old SEX: Male DIAGNOSIS: Intussusception. Physical Assessment. Vital Signs: BP- 90/60 HR- 126 bpm RR- 26/ min T- 38.5 C SPO2- 98%. General Assessment.
abdominal pain associated with fever for 2 days
Febrile (Temp- 38 C)
SPO2- 97 %
WT- 13 kg
PR- 112 bpm
Child cries intermittently and recovers from the pain
Ultrasound done (shows “doughnut- like image”-target
1. The cause can fall into one of the three categories: Idiopathic, Lead point, or Post operative.
2. Invagination results in complete intestinal obstruction.
3. Classification of location:
- covers >90% of cases
- viral 50%-rotavirus, adenovirus, Peyer’s patch hypertrophy
-Polyps, cysts, tumors, diverticulum and hematomas
-Due to interrupted motility from the anesthesia or direct handling of the intestine.
Invagination results in complete intestinal obstruction.
Decreased blood supply & eventually cuts off. Intestine becomes curved, sausage like, and bowel begins to swell
Necrosis of involved segment occurs may result to bowel death, leading to significant loss of intestine
A small tube is placed in the rectum and air passed
through the tube. The air travels into the intestine and
outlines the bowel on the X-rays. If intussusception is
present it will show the telescoping piece in the
intestine. At the same time the pressure of the air
unfolds the bowel that has been turned inside out and
instantly cures the blockage. Air enema uses <120 mm
Hg of pressure.
Barium is a liquid mixture that is used in placed of air and works in the same way to fix the blockage.
The radiologist usually decides which test is most appropriate to perform. Both procedures are very safe and usually well tolerated by child, although there is very small risk of infection or bowel perforation (a hole in intestine). The success rate is over 80%. However, approximately 5 – 10% of recurrence, which usually occurs within 72 hours following the procedure.
The abdomen is opened and the part that is telescoped in is squeezed out (rather than pulled out) manually by the surgeon or if the surgeon is unable to successfully reduce it or the bowel is damage, the affected section will be resected. More often, the intussusception can be reduced by laparoscopy, whereby the segments of intestine are pulled apart by forceps.
Laparotomy (reduction/resection) - indications:
Intussusception 36 hours after reduction. Review signs and symptoms with parents. is considered as one of the most common causes of bowel obstruction in infant and toddlers. In this case most patients may have deceiving healthy appearance, usually well nourished and generally above average in physical development. This fats and healthy appearance is apt to mislead us in the early hours of patient’s illness, we must not be reluctant as it may progress rapidly and makes child desperately ill. Any presence of unusual signs and symptoms must be reported immediately, so proper treatments and intervention may be given to prevent further complication.
Early detection and immediate seek for medical assistance may lead to a better prognosis and for patient’s fast recovery.