Intussusception reduction

1. Intussusception is not successful after non-surgical reduction such as air pressure enema. 2. The incidence of more than 24 hours, clinical suspected intestinal necrosis. 3. Recurrent intussusception, especially in children. 4. Adult intussusception. Treatment of diseases: intussusception Indication 1. Intussusception is not successful after non-surgical reduction such as air pressure enema. 2. The incidence of more than 24 hours, clinical suspected intestinal necrosis. 3. Recurrent intussusception, especially in children. 4. Adult intussusception. Preoperative preparation Gastrointestinal decompression, appropriate correction of water and electrolyte disorders, and acid-base balance disorders. Surgical procedure 1. Position: The patient is lying flat; if it is a baby, it should be fixed on a large plate. 2. Incision: Most of the right middle transabdominal rectus incision or right median side incision is used to enter the abdominal cavity. 3. Exploration: After entering the abdominal cavity, use the right hand index finger and the middle finger to touch the inset of the intestine along the direction of the colon to find out the position of the nest and its extent. Once the situation is checked, it can be reset. 4. Reset: Under direct vision in the abdominal cavity, extend one hand to the abdominal cavity, hold it at the top of the nesting part, and gradually squeeze from the distal end to the proximal end. Do not force the proximal end. When the telescope is returned to the cecum or the proximal end of the telescope, the intestine is lifted out of the abdominal cavity, and then the final segment is pushed out gently and evenly with a finger. 5. Handling when resetting is difficult: (1) Put the nesting part into the abdominal cavity, first gently push the proximal end of the nesting part to the distal end with a finger, and then insert a few centimeters to loosen the tightening ring. Then, push from the far end to the near end to reset it. (2) Using a small finger sputum sterile paraffin oil, extend into the sheath sheath and expand the tightening ring. After the finger reaches the tightening ring, it does not expand first. The tightening ring can be used to test the degree of tightening one week, and the adhesion between the sheath sheath and the nesting portion is separated. Take out the little finger to observe, if there is bloody liquid and odor, it means that the intestine has necrosis and should not be dilated. If you think you can expand, the technique should be gentle and slow, and avoid violence, so as not to break through the intestine. (3) If the finger cannot be inserted and cannot be expanded, the sheath can be cut, the tightening ring can be loosened, the nested portion can be reset, and the incision of the intestinal wall can be sutured. If there is intestinal necrosis in the insertion, it should not be forced to reset. When the condition allows, the stress is for intestinal resection and anastomosis [see intestinal folding]. If the condition is very serious, consider intestine external or intestinal fistula [see ileal single-mouth ostomy]. 6. Treatment after reduction Check the intestinal segment and mesentery after resetting. If there is no necrosis or embolism, it can be put back into the abdominal cavity without any suture. If there is no lesion in the appendix, it is generally not suitable to remove it at the same time; if it has been bleeding or necrosis, it should be removed. There are many reasons for adult intussusception. In addition to the dysfunction caused by intestinal infection, it can also be caused by organic lesions. It should be treated properly. If the patient is still in good condition, the existing diverticulum, tumor, etc. should be removed at the same time. In order to avoid recurrence. Otherwise, it is advisable to wait for postoperative recovery and then remove it. If the cecum does not swim, it may not be fixed; if it is a swimming cecum, it should be fixed in the cecum and posterior peritoneum and ileum and colon, or embedded in the retroperitoneum to avoid recurrence of intussusception. For cases where the small mesentery is long and the intestinal fistula is free, the mesangial fold is feasible. After the above treatments are completed, the intestinal tube is placed back into the abdominal cavity, and the abdominal wall is layered and sutured.