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ISSN 0973 - 0958
Inguinal Hernia in Children
Umbilical Hernia in Children
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INTUSSUSCEPTION
Dr. Vivek M. Rege
Pediatric Surgeon & Pediatric Urologist
B J Wadia Hospital For Children, Hurkisondas Hospital,
Wockhardt Hospital, Mumbai
This is a surgical emergency and needs to be diagnosed early so that treatment can be given early with the least complications. Intussusception is the telescoping of proximal intestine inside the distal intestine.
Background: The gastrointestinal tract consists of stomach, small intestine and large intestine. Intussusception occurs when the proximal intestine telescopes into the distal intestine. As seen, the intestine has a mesentery that supplies blood to the intestine. When this telescoping occurs, a number of events can occur in sequence that give rise to an emergency. First, the intestine within intestine compromises the lumen of the intestine, leads to a narrowing and obstruction of the bowel. Since the mesentery gets pulled in along with the intestine, the veins in the mesentery get compressed between the two segments of the intestine-outer and inner. This gradually leads to venous outflow obstruction and congestion of blood in the bowel. Unrelieved, the arteries supplying blood to that intestine which is inside get compressed and blood supply to the inner bowel gets shut off and leads to gangrene. The exact etiology of why this happens is not very well understood, but, usually there is like a leading point that initiates the process like a polyp in the intestine, enlarged patch of lymphatics in the bowel. Also may be seen to occur soon after a viral cold or diarrhea in a child of viral origin.
Presentation: This is a condition commonly found in infants about 6 - 9 months old "just after starting weaning from breast feeds to top feeds. It can occur in either sex, usually chubby children, who are otherwise healthy. The infant will clasically present with sudden attacks of colicky abdominal pain with screaming, drawing up of the legs, crying. The child may have a small vomit, may later become suddenly quiet. This is followed by another attack of severe pain. Gradually the abdomen starts to distend, the vomiting may recur and turn from white to green(bilious). Initially the child may pass normal stool, but later may pass a stool that is a mixture of mucus, blood. This last symptom can shake the parents confidence and they run to the doctor. Examination by the doctor of this child when quiet, may reveal a mass in the abdomen" sausage shaped usually upper midline above the umbilicus. This lump is due to the intussuscepted bowel loops. The history of the pain and screams is very suggestive of this condition, especially given the age of the child.
Pediatric Surgeon & Pediatric Urologist
B J Wadia Hospital For Children, Hurkisondas Hospital,
Wockhardt Hospital, Mumbai
This is a surgical emergency and needs to be diagnosed early so that treatment can be given early with the least complications. Intussusception is the telescoping of proximal intestine inside the distal intestine.
Background: The gastrointestinal tract consists of stomach, small intestine and large intestine. Intussusception occurs when the proximal intestine telescopes into the distal intestine. As seen, the intestine has a mesentery that supplies blood to the intestine. When this telescoping occurs, a number of events can occur in sequence that give rise to an emergency. First, the intestine within intestine compromises the lumen of the intestine, leads to a narrowing and obstruction of the bowel. Since the mesentery gets pulled in along with the intestine, the veins in the mesentery get compressed between the two segments of the intestine-outer and inner. This gradually leads to venous outflow obstruction and congestion of blood in the bowel. Unrelieved, the arteries supplying blood to that intestine which is inside get compressed and blood supply to the inner bowel gets shut off and leads to gangrene. The exact etiology of why this happens is not very well understood, but, usually there is like a leading point that initiates the process like a polyp in the intestine, enlarged patch of lymphatics in the bowel. Also may be seen to occur soon after a viral cold or diarrhea in a child of viral origin.
Presentation: This is a condition commonly found in infants about 6 - 9 months old "just after starting weaning from breast feeds to top feeds. It can occur in either sex, usually chubby children, who are otherwise healthy. The infant will clasically present with sudden attacks of colicky abdominal pain with screaming, drawing up of the legs, crying. The child may have a small vomit, may later become suddenly quiet. This is followed by another attack of severe pain. Gradually the abdomen starts to distend, the vomiting may recur and turn from white to green(bilious). Initially the child may pass normal stool, but later may pass a stool that is a mixture of mucus, blood. This last symptom can shake the parents confidence and they run to the doctor. Examination by the doctor of this child when quiet, may reveal a mass in the abdomen" sausage shaped usually upper midline above the umbilicus. This lump is due to the intussuscepted bowel loops. The history of the pain and screams is very suggestive of this condition, especially given the age of the child.
Gastrointestinal Problems
Intussusception
Common Gastrointestinal
Problems in Children
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