​What is Surgery - intussusception treatment

​What is Surgery - intussusception treatment
Intussusception 
DEFINITION The process of an intestine segment, the intussusceptum, invaginating into the adjacent intestinal lumen, the intussuscipiens, resulting in bowel vascular compromise or obstruction. 

AETIOLOGY 
three years: Many cases are idiopathic (up to 90%), with lymphoid hyperplasia in Peyer's patches, Meckel's diverticulum, polyp, and haematoma. 

Henoch–Schonlein purpura, blood dyscrasias (owing to submucosal haematomas), and recent upper respiratory tract infections in children. 

Juvenile/Adult: A mass in the gut wall or lumen, such as a polyp, tumour, or Meckel's diverticulum, accounts for roughly one-third of small-bowel cases and two-thirds of large-bowel cases. 

EPIDEMIOLOGY
The prevalence is 1–3/1000. Usually affects children under the age of three (majority in 3- to 9-montholds). In adults, it is quite rare. 


HISTORY 
Intermittent episodes of acute stomach discomfort in children, often accompanied by leg drawing up. Bloody mucus that resembles'red currant jelly' can be passed PR. It can resemble intestinal blockage in later stages, with vomiting and distension. Adults may have a wide range of symptoms.

EXAMINATION In the right hypochondrium, there is a'sausage-shaped' lump. Shock symptoms include paleness, hypotension, and tachycardia. Abdominal distension and tinkling bowel noises are signs of blockage. Abdominal guarding, rebound, and the absence of bowel sounds are all symptoms of peritonism. 


PATHOLOGY/PATHOGENESIS
 A diseased 'lead point' causes bowel telescoping and aberrant peristalsis. The ileocolic junction is the most common location, however ileo-ileal and colocolic junctions can also occur. If not treated, venous congestion and oedema develop on the bowel wall, with the risk of infarction and perforation. 

INVESTIGATIONS 
AXR: May reveal a lack of air on the right side of the bowel or blockage features. The intusscepted segment shows as a target-shaped lump on ultrasound. Contrast/Air enema: This is the traditional method of demonstrating intussusception, with contrast at the location giving the impression of a coiled spring. This has the potential to be therapeutic . FBC, U&Es, ABG (for lactic acidosis), and G&S are all blood tests. 

MANAGEMENT 
Supportive measures include IV fluid resuscitation, analgesics, antibiotic cover, and NG tube insertion if vomiting occurs. Therapeutic enema: Can be administered with barium, air, or saline to reduce the invaginating segment back. Perforation, peritonitis, or a suspected tumour are all contraindications. 

Surgical: If enema fails to treat the problem or if there are symptoms of peritonitis, surgery is required. To minimise intussusception, the afflicted bowel is gently massaged. Resection of the implicated segment is required if the involved bowel is non-viable, cannot be decreased, or if Meckel's diverticulum is discovered. It's possible to do it laparoscopically. 

COMPLICATIONS Ischemia, haemorrhage, blockage, and perforation are all possible outcomes. 

PROGNOSIS 
Up to 10% of paediatric cases can have spontaneous decrease. The recurrence rate is 5–10%. If treated promptly, it can be beneficial; but, if not treated promptly, it can be fatal.