Abstract
Amaç: Bu çalışmada rektal kanaması ve safralı kusması olmasa da aralıklı ve kolik şeklinde karın ağrısı ile
başvuran çocuk hastalarda karın grafisinde şüpheli bir görüntü varsa invajinasyon ön tanısının akılda tutulması
gerektiğini göstermeyi amaçladık.
Gereç ve yöntem: Bu retrospektif, tek merkezli, kesitsel tanımlayıcı çalışmada, Pamukkale Üniversitesi Tıp
Fakültesi Çocuk Cerrahisi Kliniği'nde Eylül 2017-Eylül 2020 tarihleri arasında 0-18 yaş arasında invajinasyon
nedeniyle takip edilen 33 hastanın kayıtları incelenmiştir.
Hastalar demografik veriler, hastaneye yatış süreleri, görüntüleme yöntemleri, pnömotik redüksiyon ve cerrahiye
ilişkin veriler açısından değerlendirildi.
Bulgular: Ortalama yaş 37,4±18,8 aydı. Hastaların şikâyetlerinin başlamasından hastaneye başvurularına kadar
geçen süre 57,3±66,1 saatti. 10 hastada karın grafisinde ileus bulguları vardı. 30 hastada tipik invajinasyon
bulgusu olan bir şampanya kadehi görüntüsü vardı. Ultrasonografi 20 hastada mezenter lenfadenopati
ve 3 hastada “leading point” mevcuttu. 1 hastanın ultrasonografisi normaldi ancak bu hastanın karın grafisi
değerlendirildiğinde invajinasyon şüphesi vardı. Bu hasta floroskopi altında değerlendirildiğinde pnömotik
redüksiyon yapıldı. “Leading point” olan 3 hastanın 1'inde Meckel divertikülü, 1'inde Burkitt lenfoma ve 1'inde
nörofibrom eksize edildi.
Sonuç: Pnömotik redüksiyon cerrahın ameliyathanede, floroskopi altında ve tek başına yapabileceği bir yöntem
olduğu için daha çok tercih edilmektedir. Ameliyathanede floroskopi altında pnömotik redüksiyon denenmesinin
bir diğer avantajı da ileus bulguları olan ve geç gelen hastalarda ameliyatsız tekniği kontrollü bir şekilde
denemektir.
References
- 1. Ein, S.H. and C.A.J.J.o.p.s. Stephens, Intussusception: 354 cases in 10 years. 1971. 6(1): p. 16-27. Doi: 10.1016/0022-3468(71)90663-4
- 2. Munir, A., S.Q. Falah, and D.J.G.J.o.M.S. Waheed, Surgical management of childhood intussusception and its outcome in DHQ Teaching Hospital, DI Khan. 2012. 10(2).
- 3. Grosfeld, J.L.J.J.o.t.A.C.o.S., Intussusception then and now: a historical vignette. 2005. 201(6): p. 830-833.
- 4. Digant, S.M., et al., Ultrasound guided reduction of an ileocolic intussusception by a hydrostatic method by using normal saline enema in paediatric patients: a study of 30 cases. 2012. 6(10): p. 1722. Doi: 10.7860/JCDR/2012/4315.2650
- 5. Stringer, M., S. Pablot, and R.J.B.j.o.s. Brereton, Paediatric intussusception. 1992. 79(9): p. 867-876.
- 6. Samad, L., et al., Prospective surveillance study of the management of intussusception in UK and Irish infants. 2012. 99(3): p. 411-415. Doi:10.1002/bjs.7821
- 7. Henderson, A.A., et al., Comparison of 2-view abdominal radiographs with ultrasound in children with suspected intussusception. 2013. 29(2): p. 145-150. Doi:10.1097/PEC.0b013e3182808af7.
- 8. Farr, C.E.J.A.o.s., The reduction of colonic intussusception by air inflation. 1926. 84(4): p. 588.
- 9. Ein, S.H., et al., Intussusception: toward less surgery? 1994. 29(3): p. 433-435. Doi:10.1016/0022-3468(94)90586-x.
- 10. Sargent, M. and B.J.P.r. Wilson, Are hydrostatic and pneumatic methods of intussusception reduction comparable? 1991. 21(5): p. 346-349. Doi:10.1007/BF02011483.
- 11. Bai, Y.Z., et al., Ultrasound-guided hydrostatic reduction of intussusceptions by saline enema: a review of 5218 cases in 17 years. 2006. 192(3): p. 273-275. Doi:10.1016/j.amjsurg.2006.04.013.
- 12. Fishman, M., S. Borden, and A.J.A.j.o.r. Cooper, The dissection sign of nonreducible ileocolic intussusception. 1984. 143(1): p. 5-8. Doi:10.2214/ajr.143.1.5.
- 13. Hernanz-Schulman, M., et al., Effect of radiographic contrast agents on leukocyte metabolic response. 2000. 30(6): p. 361-368. Doi:10.1007/s002470050763.
- 14. Sadigh, G., et al., Meta-analysis of air versus liquid enema for intussusception reduction in children. 2015. 205(5): p. W542-W549. Doi:10.2214/AJR.14.14060.
- 15. Waseem, M. and H.K.J.P.e.c. Rosenberg, Intussusception. 2008. 24(11): p. 793-800.
- 16. Ignacio Jr, R.C. and M.E. Fallat, Intussusception, in Ashcraft's Pediatric Surgery. 2010, Elsevier. p. 508-516.
- 17. Vidmar, D., A.V.J.R. Perovič, and Oncology, Sonographycally guided hydrostatic reduction of childhood intussusception. 2004. 38(4).
- 18. Tander, B., et al., Ultrasound guided reduction of intussusception with saline and comparison with operative treatment. 2007. 13(4): p. 288-293.
- 19. Khan, M.Y., et al., Success rate of ultrasound guided hydrostatic reduction for childhood intussusception. 2012. 20(1): p. 3-6.
- 20. Van den Ende, E., et al., Success with hydrostatic reduction of intussusception in relation to duration of symptoms. 2005. 90(10): p. 1071-1072. Doi:10.1136/adc.2004.066332.
- 21. Soyer, T., et al., Pyloroduodenal intussusception due to diffuse juvenile polyposis in a 3 year-old child: case report. 2020. 62(3): p. 501-504. Doi:10.24953/turkjped.2020.03.022.
Abstract
Purpose: In this study, to show that the pre-diagnosis of intussusception should be kept in mind if there is a suspicious appearance in the abdominal X-ray in pediatric patients with intermittent abdominal pain or discomfort in the form of colic, even though there is no rectal bleeding and bile vomiting.
Material and methods: In this retrospective, single-center, cross-sectional descriptive study, we examined the records of 33 patients who were followed up due to intussusception between the ages of 0-18 at Pamukkale University Faculty of Medicine Pediatric Surgery Clinic between September 2017 and September 2020.
Patients were evaluated in terms of demographic data, hospital admission times, data on imaging methods, pneumatic reduction and surgery.
Results: The average age was 37.4±18.8 months. The time from the onset of the patients' complaints to admission to the hospital was 57.3±66.1 hours. 10 patients had ileus findings on abdominal radiography. 30 patients had the image of a champagne glass, typical of intussusception. Ultrasonography showed mesentery lymphadenopathy in 20 patients, and leading point in 3 patients. Ultrasonography of 1 patient was normal, but when the abdominal radiography of this patient was evaluated, there was a suspicion for intussusception. When this patient was evaluated under fluoroscopy and pneumotic reduction was performed. 3 patients who had leading point. Meckel's diverticulum was detected in 1 of 3 patients, Burkitt's lymphoma in 1, and neurofibroma in 1.
Conclusion: Pneumatic reduction is more preferred as it is a method that the surgeon can do in the operating room, under fluoroscopy and alone. Another advantage of trying pneumatic reduction under fluoroscopy in the operating room is to try the nonoperative technique in a controlled manner in patients with ileus findings and late arrivals.
References
- 1. Ein, S.H. and C.A.J.J.o.p.s. Stephens, Intussusception: 354 cases in 10 years. 1971. 6(1): p. 16-27. Doi: 10.1016/0022-3468(71)90663-4
- 2. Munir, A., S.Q. Falah, and D.J.G.J.o.M.S. Waheed, Surgical management of childhood intussusception and its outcome in DHQ Teaching Hospital, DI Khan. 2012. 10(2).
- 3. Grosfeld, J.L.J.J.o.t.A.C.o.S., Intussusception then and now: a historical vignette. 2005. 201(6): p. 830-833.
- 4. Digant, S.M., et al., Ultrasound guided reduction of an ileocolic intussusception by a hydrostatic method by using normal saline enema in paediatric patients: a study of 30 cases. 2012. 6(10): p. 1722. Doi: 10.7860/JCDR/2012/4315.2650
- 5. Stringer, M., S. Pablot, and R.J.B.j.o.s. Brereton, Paediatric intussusception. 1992. 79(9): p. 867-876.
- 6. Samad, L., et al., Prospective surveillance study of the management of intussusception in UK and Irish infants. 2012. 99(3): p. 411-415. Doi:10.1002/bjs.7821
- 7. Henderson, A.A., et al., Comparison of 2-view abdominal radiographs with ultrasound in children with suspected intussusception. 2013. 29(2): p. 145-150. Doi:10.1097/PEC.0b013e3182808af7.
- 8. Farr, C.E.J.A.o.s., The reduction of colonic intussusception by air inflation. 1926. 84(4): p. 588.
- 9. Ein, S.H., et al., Intussusception: toward less surgery? 1994. 29(3): p. 433-435. Doi:10.1016/0022-3468(94)90586-x.
- 10. Sargent, M. and B.J.P.r. Wilson, Are hydrostatic and pneumatic methods of intussusception reduction comparable? 1991. 21(5): p. 346-349. Doi:10.1007/BF02011483.
- 11. Bai, Y.Z., et al., Ultrasound-guided hydrostatic reduction of intussusceptions by saline enema: a review of 5218 cases in 17 years. 2006. 192(3): p. 273-275. Doi:10.1016/j.amjsurg.2006.04.013.
- 12. Fishman, M., S. Borden, and A.J.A.j.o.r. Cooper, The dissection sign of nonreducible ileocolic intussusception. 1984. 143(1): p. 5-8. Doi:10.2214/ajr.143.1.5.
- 13. Hernanz-Schulman, M., et al., Effect of radiographic contrast agents on leukocyte metabolic response. 2000. 30(6): p. 361-368. Doi:10.1007/s002470050763.
- 14. Sadigh, G., et al., Meta-analysis of air versus liquid enema for intussusception reduction in children. 2015. 205(5): p. W542-W549. Doi:10.2214/AJR.14.14060.
- 15. Waseem, M. and H.K.J.P.e.c. Rosenberg, Intussusception. 2008. 24(11): p. 793-800.
- 16. Ignacio Jr, R.C. and M.E. Fallat, Intussusception, in Ashcraft's Pediatric Surgery. 2010, Elsevier. p. 508-516.
- 17. Vidmar, D., A.V.J.R. Perovič, and Oncology, Sonographycally guided hydrostatic reduction of childhood intussusception. 2004. 38(4).
- 18. Tander, B., et al., Ultrasound guided reduction of intussusception with saline and comparison with operative treatment. 2007. 13(4): p. 288-293.
- 19. Khan, M.Y., et al., Success rate of ultrasound guided hydrostatic reduction for childhood intussusception. 2012. 20(1): p. 3-6.
- 20. Van den Ende, E., et al., Success with hydrostatic reduction of intussusception in relation to duration of symptoms. 2005. 90(10): p. 1071-1072. Doi:10.1136/adc.2004.066332.
- 21. Soyer, T., et al., Pyloroduodenal intussusception due to diffuse juvenile polyposis in a 3 year-old child: case report. 2020. 62(3): p. 501-504. Doi:10.24953/turkjped.2020.03.022.
Details
| Primary Language | English |
|---|---|
| Subjects | Paediatrics |
| Journal Section | Research Article |
| Authors | |
| Publication Date | April 1, 2022 |
| Submission Date | August 14, 2021 |
| Acceptance Date | October 29, 2021 |
| Published in Issue | Year 2022 Volume: 15 Issue: 2 |
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