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THE PAEDIATRIC ABDOMEN

THE PAEDIATRIC ABDOMEN. INTUSSUSCEPTION Diagnosis by Ultrasound Treatment by Imaging and Air Enema. Anne Connell. Mater Children’s Radiology. INTUSSUSCEPTION. PART OF THE INTESTINE FOLDS ON ITSELF LIKE A TELESCOPE. SYMPTOMS Crying Pulling Up Legs Vomiting Stools like “currant jelly”

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THE PAEDIATRIC ABDOMEN

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  1. THE PAEDIATRIC ABDOMEN INTUSSUSCEPTION Diagnosis by Ultrasound Treatment by Imaging and Air Enema AnneConnell MaterChildren’sRadiology

  2. INTUSSUSCEPTION PART OF THE INTESTINE FOLDS ON ITSELF LIKE A TELESCOPE

  3. SYMPTOMS Crying Pulling Up Legs Vomiting Stools like “currant jelly” PALE

  4. CAUSES 90% Idiopathic Unsure but it is believed that a virus may be the cause.( Anomalies with peristalsis) 10% Pathologic A polyp, tumour or other mass within the intestinal tract is caught by the normal contractions, creating a “lead point” which pushes along causing the intussusception

  5. Plain Films

  6. TYPES of INTUSSUSCEPTION IleoIleal Small bowel/small bowel. May spontaneously resolve Straight to surgery Child with up to 5 at same time.

  7. TYPES of INTUSSUSCEPTION Ileo Cecal Small bowel/ Large bowel Radiology Intervention Air Enema to reduce by “pushing it back”

  8. TYPES of INTUSSUSCEPTION Colocolic Large bowel/large bowel Usually the elderly No Radiology intervention Straight to surgery

  9. Ultrasound examination 1. PRESENCE ? No Full Abdomen scan Yes 2. WHERE IS IT Further down the colon- the longer it’s been there decreases the chance of reduction 3. FLUID Free Fluid and trapped fluid These are signs of possible rupture

  10. ULTRASOUND PICTURE

  11. 4. LEAD POINTS Nodes Polyps Meckel’s Diverticulum Duplication cysts 5.PERFUSSION( Blood Flow) Within the walls of the intussusception Reduced flow can be necrosis BUT oedema also causes this.

  12. INTUSSUSCEPTION REDUCTION

  13. AIR ENEMA REDUCTION ENEMA ALWAYS PERFORMED WITH SURGICAL COVER PRESENT AIR REDUCTION ENEMAS ARE ALWAYS ATTEMPTED EASIER THAN SURGERY WITH G.A’s etc.

  14. AIR ENEMA

  15. NECROTISING ENTEROCOLITIS NEC Disease of premature infants in the Intensive Care Unit Breakdown of the mucosal wall of the intestine which allows bacteria &/or air to enter the bowel wall Believed to be related to some combination of infection and ischemia

  16. PRESENTATION First or Second Week of Life SYMPTOMS Abdominal Distension Feeding Intolerance Increased Aspirates From N.G.tube Sepsis

  17. DECUBITUS SUPINE HORIZONTAL BEAM

  18. RADIOGRAPHIC FINDINGS Normal Suggestive Diagnostic

  19. SUGGESTIVE Focal dilation of bowel Featureless “unfolded” appearance of small bowel loops with separation of bowel loops suggestive of bowel wall thickening

  20. N E C Appearance of “unfolding” of loops of small bowel

  21. SUGGESTIVE Focal dilation of bowel Featureless “unfolded” appearance of small bowel loops with separation of bowel loops suggestive of bowel wall thickening An unchanging gas pattern over serial films is of concern.

  22. DIAGNOSTIC Definite Sign PNEUMATOSIS ( gas in bowel wall)

  23. TREATMENT When NEC is suspected Bowel rest ( nothing orally) Antibiotics Monitored with serial abdomen films

  24. DIAGNOSTIC DEFINITE SIGN PNEUMATOSIS ( gas in bowel wall) FREE INTRAPERITONEAL AIR INDICATES SURGERY

  25. POSITION LOCATION UAC and UVC LINES

  26. anne.connell@mater.org.au Anne Connell

  27. GRATEFUL THANKS FOR ULTASOUND ASSISTANCE Ivan Simic And Dr Umesh Shetty for his advice

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