Laparoscopic-assisted extracorporeal surgery for an irreducible intussusception in a child
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Laparoscopic-Assisted Extracorporeal Surgery for an Irreducible Intussusception in a Child Innovative Technique T. Dionysis, R. Nataraja, Y. Abed El Khaleq, Z. Mukhtar Received 18/01/2013 Accepted 26/02/2013
Abstract We describe the technique applied in an infant presenting with an intussusception secondary to a Meckel’s diverticulum who underwent a successful laparoscopic-assisted extra-corporeal resection of an irreducible intussusception and resection of the necrotic diverticulum. This umbilical approach avoided the need for a formal laparotomy, resulting in a favourable cosmetic result, and also a hastened recovery of the patient. This technique should therefore be considered as a potential option in the operative management of infants presenting with both a failed air enema and laparoscopic reduction of an intussusception.
Key words:
Intravenous leiomyomatosis, Τhoracoabdominal approach, Venous thrombosis
Introduction Intussusception is a common cause of both acute abdominal pain and bowel obstruction in children younger than twelve months, with a peak incidence between five to ten months of age [1]. The aetiology of intussusception in the majority of cases is unclear, with more than 90% of ileocolic intussusceptions being idiopathic and therefore without an obvious lead point [2]. Intussusceptions that are secondary to a pathological lead point usually present in older patients and potential causes include Meckel’s diverticulum, small bowel lymphoma and intramural haematoma in children with H.S.P. [3].
T. Dionysis (Corresponding author), - 2nd Paediatric Surgery Department Athens Childrens Hospital ‘Pan&Aglaia Kuriakou’ R. Nataraja, Y. Abed El Khaleq, Z. Mukhtar - Paediatric Surgery Department, St George’s Hospital Department of Paediatric Surgery, London e-mail: [email protected]
The characteristic infantile clinical presentation includes episodes of abdominal colic with associated drawing up of the legs and crying. These episodes occur in 15-30 minute cycles, in between which the infant is usually asymptomatic. There may also be vomiting of undigested milk and potentially the presence of streaks of blood in stools (red currant jelly stools). An abdominal mass may also be palpated, classically “sausage-like”, in the right upper part of the abdomen and extending into the epigastric region. The treatment of choice is usually an enema reduction, either hydrostatic or pneumatic, which is successful in the majority of cases. Operative intervention is therefore reserved for those failing repeated attempts at radiographic reduction [4]. Various approaches are adopted for this operative management of intussusception but the optimum modality of treatment is still under debate [5]. Traditionally, a formal laparotomy is performed, and intussusception is reduced by gentle manipulation. With the advent of minimally invasive surgery, the laparoscopic approach has been taken up by many paediatric surgical centres with good outcomes reported [5]. In cases where intussusception cannot be reduced laparoscopically, th
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