Open reduction of intussusception

Surgical treatment of intussusception in the treatment of intussusception. Intussusception refers to a disease caused by the insertion of a proximal intestinal tube into the distal lumen. It is one of the common acute abdomen diseases in pediatric surgery. Most infants and young children within 1 year of age, especially those with 4 to 10 months of age, have the highest incidence. The incidence is significantly reduced by less than 4 months and greater than 2 years of age. Curing disease: Indication Invasive reduction of the intestine tube is suitable for transurethral enema or gas enema can not be reset, or suspected intestinal necrosis, intestinal perforation, should not do gas, barium enema; recurrent intussusception or suspected organic lesions Intussusception, as well as back-to-knot intussusception, is also difficult to reset with gas or barium enema. Once the small intussusception is suspected, surgery should also be performed. Contraindications Early intussusception non-surgical treatment has a high success rate, so non-surgical treatment should be preferred in such cases. Preoperative preparation Children without dehydration and acidosis can be treated with open venous access, placement of nasogastric tube and early surgery. In case of dehydration, acidosis or shock, short-term fluid replacement, blood transfusion and anti-shock treatment are required. The operation was performed immediately after the above positive treatment. Antibiotics should be given before surgery. Surgical procedure 1. Incision Commonly used incisions include a right middle lower abdomen transverse incision or a right lower abdomen oblique incision. 2, reset Cut the layers of the abdominal wall and protect the incision with a saline pad. The surgeon extends the right hand into the abdominal cavity and looks for a nested mass along the colon from the left abdomen. The mass is mostly located in the hepatic curvature of the colon or in the ascending colon. The nested intestine tube is placed outside the incision, and it is safer to restore under direct vision. During the recovery, the thumb and fingers of the operator alternately squeeze the head of the nest. Apply even force, and the lumps gradually recede until they are completely reset. During the recovery process, it is forbidden to pull the intubated proximal end of the intestine by hand to prevent aggravation or intestinal rupture. In the process of recovery, it must be patient and meticulous, and the action should be gentle. If the rupture of the muscular layer of the intestinal tract of the sheath occurs, it is more careful to prevent the rupture site from expanding or even causing mucosal rupture, which complicates the operation. Intestinal edema, color bruising, congestion, and even subserosal hemorrhage or submucosal hemorrhage. The darkened part of the color can be covered with a warm saline gauze pad, and the mesangial side is closed with 0, 25% procaine. If the intestines recover from peristalsis and the blood supply is good, the intestines can be returned to the abdominal cavity. If the intestine is still purple after the above treatment, the pulsation of the blood vessel is not obvious, and the peristaltic wave cannot pass, indicating that the intestinal tube viability is still questionable. If the intestinal necrosis is unclear, or if the condition of the sick child is bad, the extra-intestinal surgery should be performed first in order to shorten the operation time and carry out active anti-shock treatment. After 24 hours, if the intestines recover blood and have good color, the intestine can be re-operated into the abdominal cavity; if the intestinal tube is necrotic, an intestinal resection and anastomosis should be performed. complication 1. Intussusception recurrence Due to the long intussusception time, an ellipsoidal depression and local intestinal edema often leave behind the ileal end. This is because the intestine tube that is inserted into the sheath is compressed by the ileocecal valve. If the indentation on the wall of the intestine is not treated after the reset, it may become a nesting point and cause the inlay to recur. Therefore, the depression should be pressed with saline gauze during the operation to restore it to normal. After recurrence of intussusception, clinically, the sick children re-emerged with symptoms such as paroxysmal crying, vomiting, bloody stools and abdominal masses. Because the first operation has just been completed, it is not suitable for enema treatment and should be treated again. 2. Abdominal incision splitting It is a common complication after intussusception. The causes are as follows: 1 preoperative obstruction, a large amount of gas accumulation and effusion in the proximal intestine, unsatisfactory peritoneal suture when the abdomen is closed; 2 infection of the abdominal cavity and incision, more common in intestinal necrosis, intestinal perforation and postoperative intestinal resection ; 3 postoperative complications of pulmonary complications, pneumonia, atelectasis, severe cough in sick children, or crying, irritating, swallowing a large amount of gas after surgery, causing severe abdominal distension and increased abdominal pressure; 4 rectus abdominis The incision is also prone to rupture under the above-mentioned adverse factors, so more pediatric surgeons prefer to choose a transverse incision. Prevention of incision dehiscence: 1 Obstruction of the proximal air effusion is obvious, should try to discharge the contents of the intestines to reduce the bloating. 2 to prevent intra-abdominal infection, intraoperative operation should be gentle, reduce damage to the intestinal tract. In case of intestinal necrosis, and the bowel resection, the abdominal cavity and incision should be properly protected to prevent pollution. Antibiotic treatment was used during and after surgery. 3 patients with critical illness should strengthen supportive therapy, blood transfusion or plasma if necessary, and postoperative attention to protein supply. 4 In the operation, if the intestine is flatulent, there should be good anesthesia when the abdomen is closed to ensure satisfactory peritoneal suture. If the sick child is generally in poor condition, consider reducing the suture. 5 to do postoperative care, prevent and timely treatment of postoperative pulmonary complications. Postoperative wounds with abnormal bloody secretions and local bulging, which is a sign of incision rupture, should be discovered and treated in time. For children with only peritoneal rupture, abdominal banding is used. The butterfly tape fixation reduces the incision tension, and it is expected to be healed in the first stage. If the full thickness of the abdominal wall is split, it should be sutured in time. If there is abdominal infection during the operation, the flow strip should be put out, and the incision can be taken out from the right lower abdomen. 3. Infection When the stack causes a blood vessel disorder in the intestine, a large amount of bacteria can contaminate the abdominal cavity through the intestinal wall. In the process of intestinal resection, the contents of the intestine can sometimes contaminate the abdominal cavity. In addition, the sick child is critically ill and has poor resistance to infection, which may cause infection of the abdominal cavity or incision. Most of the intra-abdominal infections can be absorbed by themselves after strengthening supportive therapies and applying effective antibiotics. Incision infection should be drained in time. The means of preventing infection are: pay attention to aseptic operation during surgery, properly protect the incision; if it is contaminated during surgery, it should be treated with abdominal cavity; apply antibiotics. 4. Intestinal adhesions and adhesive intestinal obstruction After the reduction of the intestine tube, the serosal layer of the intestine is traumatized, secondary to cellulose exudation, and intestinal adhesion or even obstruction after operation. During the operation, the intestine should be properly protected to avoid exposing the intestine to the air for a long time. When the sarcolemma is broken during surgery, it should be repaired in time. Pay attention to stop bleeding during operation. Obstruction occurring early in the operation is mostly caused by membranous adhesion. At this time, the adhesion is generally loose, and non-surgical methods can be adopted, including fasting, gastrointestinal decompression, and correction of water and electrolyte balance disorders. Long-term obstruction after operation is mostly due to adhesion band or internal malleolus torsion. Generally, the fiber band is hard and tough. Non-surgical treatment is not easy to be successful, and it is easy to delay the disease. Therefore, surgery is often used. Intraoperative removal of the adhesion zone, in the case of extensive adhesion and difficult to separate, can be used for intestinal resection and anastomosis. Some authors advocate short-circuit surgery of the proximal and distal intestines in this situation, but because of the occurrence of blind paralysis, most authors do not like to do this surgery. 5. intestinal necrosis and perforation Insufficient estimation of inactivated intestinal tube vitality during operation, or intraoperative intestinal tube viability is good, postoperative intestinal mesenteric injury, secondary thrombosis, delayed intestinal necrosis and perforation; also seen in intestinal necrosis or intestinal perforation In the case of repair, the anastomotic edema and congestion of the anastomosis are easy to cause the incision to heal. Postoperative observation should be closely observed, early diagnosis, and timely surgical treatment.