scholarly journals Surgical Management of Intussusception in Children: A Retrospective Review of 212 Cases

2021 ◽  
Author(s):  
Rajendra K. Ghritlaharey
Keyword(s):  
Intestinal Obstruction ◽  
Surgical Procedures ◽  
Bowel Resection ◽  
Bowel Perforation ◽  
Primary Objective ◽  
Acute Intestinal Obstruction ◽  
Perforation Peritonitis ◽  
Bowel Gangrene ◽  
Gangrenous Bowel ◽  
Infants And Young Children

Abstract Objectives The primary objective of this study was to analyze and review the demographics of children operated upon for intussusception. Secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and outcome. Materials and Methods It is a single-institution, retrospective study and consists of children below the age of 12 years. This study was conducted at the author’s department of pediatric surgery for the past 21 years, from January 1, 2000 to December 31, 2020. Results During the study period, 212 children were operated upon for intussusceptions and included 146 (68.86%) boys and 66 (31.13%) girls. This review consisted of infants 158 (74.52%), and children of 1 to 5 years of age (30; 14.15%), and 6 to 12 years of age (24; 11.32%). Clinically, 177 (83.49%) children presented with the features of acute intestinal obstruction, and the remaining 35 (16.5%) presented with features of perforation peritonitis. Primary (idiopathic) intussusception was documented in 188 (88.67%) of the cases. Gangrenous bowel was evident in 98 (46.22%) children. Sixty-two percent of the cases required bowel resection. Surgical procedures were executed in children for intussusception in the following order of frequency: (1) operative reduction with or without serosal tear/bowel perforation repair, n = 81 (38.2%); (2) resection of diseased ileum and ileoileal anastomosis, n = 52 (24.52%); (3) resection of diseased ileum ± part of colon and an ileostomy, n = 36 (16.98%); and (4) resection of diseased ileum, cecum, part of colon, and ileocolic (ileo-ascending or ileo-transverse) anastomosis, n = 43 (20.28%). Postoperatively, 9 (4.24%) children required reexploration for the management of their complications. Twenty-one (9.9%) children died during the postoperative period. Conclusion Intussusception remains the most common cause of acute intestinal obstruction in infants and young children. Delay in the referral, diagnosis, and seeking treatment were significantly associated with bowel gangrene, required bowel resection during the surgical therapy, and also culminated in significantly higher mortalities.

scholarly journals Ileosigmoid knotting: an unusual cause of acute intestinal obstruction with bowel gangrene

2019 ◽  
Vol 12 (5) ◽  
pp. e226663
Author(s):  
Raj Kumar ◽  
Pavan Kumar Shamanur Kenchappa ◽  
Kusum Meena ◽  
Brijesh Kumar Singh
Keyword(s):  
Intestinal Obstruction ◽  
Sigmoid Colon ◽  
Bowel Obstruction ◽  
Exploratory Laparotomy ◽  
Large Bowel Obstruction ◽  
Acute Intestinal Obstruction ◽  
Haemodynamic Instability ◽  
Ileocolic Anastomosis ◽  
Bowel Gangrene

Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction rapidly progressing to bowel gangrene. It is characterised by the wrapping of loops of ileum and sigmoid colon around each other. The condition often remains undiagnosed preoperatively; however, it can be suspected by the triad of small bowel obstruction, radiographic features suggestive of predominately large bowel obstruction and inability to deflate the intestine by a sigmoidoscope. We are reporting a case of 56-year-old man who presented with features of acute intestinal obstruction and compensated shock within 24 hours of onset of symptoms. Exploratory laparotomy revealed ISK resulting in gangrene of ileum and sigmoid colon. In view of haemodynamic instability, end ileostomy was done after excising gangrenous segments. The patient improved and stoma closure and ileocolic anastomosis were done after 3 months in follow-up.

scholarly journals Diagnostic accuracy of ultrasound in common acute abdominal conditions

2019 ◽  
Vol 6 (12) ◽  
pp. 4460
Author(s):  
Shashank Deshmukh ◽  
A. Manmadha Kishan
Keyword(s):  
Acute Pancreatitis ◽  
Acute Appendicitis ◽  
Intestinal Obstruction ◽  
Diagnostic Accuracy ◽  
Acute Intestinal Obstruction ◽  
Ct Findings ◽  
Perforation Peritonitis ◽  
Good For ◽  
Operative Findings ◽  
Acute Perforation

Background: Ultrasound evaluation is cheap, easily available, even at rural level, and can predict need for surgical intervention in majority of conditions. It involves no exposure to radiation, can diagnose easily, can be repeated any number of times for follow up. Disadvantages are that it is user dependent and distended bowel containing air prevents satisfactory evaluation of abdomen. The objective was to study diagnostic accuracy of ultrasound in common acute abdominal conditions.Methods: All patients presenting to the emergency Department of General Surgery, Narayana general hospital, Nellore with abdominal pain of acute onset and who were diagnosed to be suffering from acute appendicitis, acute perforation peritonitis, acute intestinal obstruction, acute pancreatitis, acute calculous cholecystitis were included in the present study.Results: Diagnostic accuracy of USG for acute appendicitis was little bit low with sensitivity of 71.8% and specificity of 59.1% for operative findings and similar for CT findings. For acute perforation peritonitis it was still very low with sensitivity of 42.9% and specificity of 66.7% for operative findings and similar for CT findings. It was very good for acute intestinal obstruction with sensitivity of 90.9% and specificity of 83.3%, but here it was low compared to CT findings. It was also pretty good for diagnosing acute calculus cholecystitis in comparison with operative as well as CT findings.Conclusions: USG can be used as a diagnostic tool for diagnosis of acute intestinal obstruction and acute calculus cholecystitis but doubtful role in the diagnosis of acute appendicitis and acute perforation peritonitis and acute pancreatitis. 

scholarly journals Management of Symptomatic Meckel's Diverticulum in Infants and Children

2021 ◽  
Author(s):  
Rajendra K. Ghritlaharey
Keyword(s):  
Intestinal Obstruction ◽  
Acute Abdomen ◽  
Surgical Procedures ◽  
Postoperative Period ◽  
Incidental Finding ◽  
Meckel’S Diverticulum ◽  
Meckel's Diverticulum ◽  
Infants And Children ◽  
Adjacent Segment ◽  
Bowel Gangrene

Abstract Objectives The primary objective of the present study was to review the demographics of infants and children operated upon for Meckel's diverticulum. The secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and the outcome. Materials and Methods This study is a single-institutional, retrospective study and descriptive in nature. It consisted of infants and children below 12 years who were operated upon for Meckel's diverticulum. This study was conducted at the author's department of pediatric surgery, and it was performed for 21 years from January 1, 2000 to December 31, 2020. Results Eighty-four children below 12 years were operated upon for Meckel's diverticulum during the study period of 21 years. The ratio for males to females was 3:1. This study consisted of infants, (n = 22, 26.19%), children of 1 to 5 years of age (n =19, 22.61%), and children of 6 to 12 years of age (n = 43, 51.19%). Clinically, children with Meckel's diverticulum presented in the following order of frequency: (1) intestinal obstruction (n = 59, 70.23%), (2) perforation peritonitis (n = 17, 20.23%), (3) lower gastrointestinal bleeding (n = 4, 4.76%), and (4) incidental finding (n = 4, 4.76%). In 35 (41.66%) children, bowel gangrene was detected. One-fifth (n = 17) of Meckel's diverticulum was responsible for the secondary intussusception. In children (n = 84), for Meckel's diverticulum, surgical procedures were performed in the following order of frequency: (1) resection of Meckel's diverticulum, an adjacent segment of ileum and ileoileal anastomosis (n = 36, 42.85%); (2) Meckel's diverticulectomy (n = 32, 38.09%); (3) resection of Meckel's diverticulum, an adjacent segment of ileum with or without cecum and an ileostomy (n = 12, 14.28%); and (4) resection of Meckel's diverticulum, an adjacent segment of ileum, cecum, part of the colon, and ileocolic anastomosis (n = 4, 4.76%). In 8 (9.52%) children, complications were documented during the postoperative period. The present study observed three (3.57%) deaths during the postoperative period. Conclusion Meckel's diverticulum was one of the common causes of acute intestinal obstruction in infants and older children. Ninety percent of children with Meckel's diverticulum presented with features of an acute abdomen. Forty percent of children evidenced bowel gangrene during the surgical procedures. In these children, early diagnosis, timely referral, and institution of surgical therapy for acute abdomen/intestinal obstruction may prevent the development of bowel gangrene and the requirement of bowel resections to some extent.

scholarly journals STUDY IN PAEDIATRIC AGE GROUP UNDERGOING EMERGENCY LAPAROTOMY : OBSERVATIONAL STUDY

2021 ◽  
pp. 1-2
Author(s):  
Akash KR. Gupta ◽  
Manoj KR Das ◽  
Marshal D Kerketta
Keyword(s):  
Intestinal Obstruction ◽  
Acute Abdomen ◽  
Gastrointestinal Diseases ◽  
Acute Intestinal Obstruction ◽  
Emergency Laparotomy ◽  
Age Group ◽  
Common Cause ◽  
Colonic Atresia ◽  
Paediatric Age ◽  
Perforation Peritonitis

INTRODUCTION: Acute abdomen can be defined as “syndrome included by wide variety of pathological conditions that require emergent medical or more often surgical management.” Acute abdomen is caused due to gastrointestinal diseases such as intestinal obstruction and perforation peritonitis. AIM: The aim of our study was to observe the common cause in paediatric age group undergoing emergency laprotomy in our institutions. MATERIAL AND METHODS:This prospective study included 77children aged below or equal to 15years, underwent emergency laprotomy for acute intestinal conditions between January 2019 to December 2019 in RIMS,RANCHI. We excluded neonates ,patients of jejunoileal colonic atresia and stenosis, anorectal malformation(ARM), congenital pouch colon, neonatal necrotizing enterocolitis(NEC), hirschprung’s disease, gastrointestinal tumor. RESULTS: Total of 77 laprotomies were performed in emergency in children below or equal to 15 years age,59(76.62% ) were boys and 18(23.37% )were girls with male:female ratio of 3.2:1. 36(46.75%) cases were done for acute intestinal obstruction and 41(53.24%) cases were done for perforation peritonitis.20(25.97%)emergency laprotomy was performed in the age group 1-5 years and 57(74.02% ) were performed in the age group 5-15 years. Causes in order of frequency for intestinal obstruction were intussusceptions, post operative band/adhesion, abdominal tb obstruction, meckel’s diverticulum and worm obstruction. Causes in order of frequency for perforation peritonitis were typhoid, abdominal tb, appendicular perforation and abdominal trauma. CONCLUSION: In our study maximum emergency laprotomy was performed in male patients with male:female ratio of 3.2:1. Perforation peritonitis was more common than acute intestinal obstruction. 5-15 year age group were more commonly affected. Typhoid ileal perforation was the most common cause for emergency laprotomy followed by intussusception.

scholarly journals A Study on Raised Serum LDH Level in Acute Intestinal Obstruction – A Marker of Bowel Gangrene

2020 ◽  
Vol 3 (1) ◽  
pp. 120-123
Author(s):  
Anantha Kumar Nateson ◽  
Suresh Nayak Basavanayak ◽  
Sudarsan Srikanth
Keyword(s):  
Intestinal Obstruction ◽  
Venous Blood ◽  
Cost Effective ◽  
Abdominal Distension ◽  
Serum Levels ◽  
Acute Intestinal Obstruction ◽  
Number Of Patients ◽  
Study Results ◽  
Bowel Gangrene ◽  
Aseptic Conditions

Background: Bowel gangrene is a major abdominal catastrophe associated with high mortality rate. Intestinal obstruction accounts for 20%   of all surgical emergencies around the world. The present study aims to estimate the LDH levels in patients with acute intestinal obstruction and correlate with bowel viability. Subjects and Methods: In this study, the estimation of serum LDH was conducted in 45 cases of acute intestinal obstruction who were admitted in surgical wards. After fulfilling the inclusion and exclusion criteria the study subjects were recruited. All the cases were thoroughly examined. Time of presentation and onset of symptoms were noted. Under aseptic conditions, 3 ml venous blood samples were collected from the study subjects, centrifuged at 3000 rpm and separated serum sample was used for the estimation of lactate dehydrogenase (LDH) and the estimated value of serum LDH is compared with the viability of the bowel intra operatively. Results: The total number of patients presented with obstruction is 45 out of which 25 were found to have elevated LDH which is about 55.56%. Out of 25 patients presented with elevated LDH, 20 patients found to have gangrenous bowel. 60% presented with abdominal pain and 40% had irreducible swelling. Most commonly associated symptoms are vomiting (84%) followed by abdominal distension (40%), obstipation (36%), pyrexia (24%), blood in stools (8%) and diarrhoea (4%). Per rectal examination showed 76% had normal faecal staining, 12% blood stained faeces and 8% empty. Complications observed were anastomotic leak 8%, wound infection 16%, wound gaping 8%, burst abdomen 8%. Conclusion: The present study results indicate that ischemic changes in any part of the bowel can cause elevation in the serum levels of LDH and a higher value of >1000 IU/L strongly indicates an underlying gangrenous change. It is a less invasive, cost effective and easily available diagnostic tool to diagnose bowel ischemia/gangrene. Hence it is more useful in centres where the diagnostic facilities are limited.

scholarly journals Management of Patent Vitellointestinal Duct in Infants

2021 ◽  
Author(s):  
Rajendra K. Ghritlaharey
Keyword(s):  
Intestinal Obstruction ◽  
Wedge Resection ◽  
Acute Intestinal Obstruction ◽  
Paediatric Surgery ◽  
Single Institution ◽  
Acute Small Bowel Obstruction ◽  
Considerable Morbidity ◽  
Gangrenous Bowel ◽  
Delay In Seeking Treatment ◽  
Patent Vitellointestinal Duct

Abstract Objectives This study was undertaken to investigate and review the clinical presentation, surgical procedures executed, and the final outcome of infants managed for the patent vitellointestinal duct. Materials and Methods This is a single-institution, retrospective study and included infants who were operated for the patent vitellointestinal duct. This study was conducted at author’s Department of Paediatric Surgery during the last 20 years; from January 1, 2000 to December 31, 2019. Results A total of 24 infants were operated for the patent vitellointestinal duct during the study period and comprised 20 (83.3%) boys and 4 (16.6%) girls. The age of infants ranged from 7 days to 10 months, with a mean of 88.41 ± 64.9 days. Twenty-three (95.8%) infants were operated within 6 months of the age, 17 (70.8%) of them were operated within 3 months of the age. Only one (4.1%) infant was operated at the age of 10 months. Among 24 infants, 13 (54.1%) were presented with features suggestive of acute intestinal obstruction and remaining 11 (45.8%) were presented with fecal discharges through the umbilicus without intestinal obstruction. Among 13 infants who presented with acute intestinal obstruction, 12 had prolapsed bowel and 6 of them also had gangrenous bowel. Operative procedures were executed (n = 24) in the following order of frequency: (1) resection of patent vitellointestinal duct, wide wedge resection of ileum,and ileal repair (n = 13, 54.1%); (2) resection of patent vitellointestinal duct, small segment of ileum, and ileoileal anastomosis (n = 9, 37.5%); and (3) resection of patent vitellointestinal duct, segment of ileum, and an ileostomy (n = 2, 8.33%). Postoperatively, two (8.3%) infants developed anastomotic leak and peritonitis one each, later on, both of them died. Conclusion Patent vitellointestinal duct not only present with fecal discharges through the umbilicus but half of the infants presented with prolapsed bowel and with features of acute small bowel obstruction. Delay in seeking treatment for such cases was associated with considerable morbidity and mortality and therefore the patent vitellointestinal duct should be excised at the earliest.

scholarly journals Role of procalcitonin in predicting the bowel gangrene and ischemia in acute intestinal obstruction

2021 ◽  
Vol 8 (3) ◽  
pp. 852
Author(s):  
Harindranath H. R. ◽  
Praveen K. H. ◽  
Lakshmi Vijaykumar
Keyword(s):  
Intestinal Obstruction ◽  
Statistical Tests ◽  
Acute Intestinal Obstruction ◽  
P Value ◽  
Mesenteric Ischaemia ◽  
Good Tool ◽  
Bowel Ischaemia ◽  
Midline Laparotomy ◽  
Bowel Gangrene

Background: Acute intestinal obstruction being the most common presentation on intestinal ischaemia and bowel gangrene. This study mainly concentrated on need for new marker for early prediction mesenteric ischaemia. Procalcitonin as a marker for stoppage of conservative management in intestinal obstruction.  Methods: Out 70 patients 45 underwent conservative and 25 eventually underwent surgery (midline laparotomy). Procalcitonin levels in both are observed at regular intervals and compared and analysis done using appropriate statistical tests. Results: Level of procalcitonin was found to be higher in patients who need surgery consistantly when compared with those who were in conservative line of management with mean PCT level 2.19 and 2.23 in conservative line with mean PCT of 3.68 and 6.58 for surgical need at presentation and after 48 hrs respectively with p value <0.0001 which is significant.  Conclusions: PCT at presentation can be a very good tool for predicting the bowel ischaemia and gangrene as an early indicator and also it can be used as a marker for need for surgery in patients managing conservatively for intestinal obstruction.  

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