الفهرس 
UNDERSTANDING INTUSSUSCEPTIONOnly 14 pages are availabe for public view
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Abstract
I
ntussusception is one of the commonest causes of intestinal obstruction in children, it occurs in all age groups but its mean is between 4 and 7 months of age.
Intussusception was recognized as far as 1674 (Barbette, Peyer), but was first described in detail by Hunter in 1793.
Intussusception is the invagination of one part of the intestine into another part. This causes intense local edema of the intussusceptum, which in turn produces venous compression, congestion, and stasis. If and when this process continues unabated, bowel congestion and pressure increase and ultimately produce ischemic changes leading to bowel necrosis (gangrene) in the intussusceptum.
The presence of two classic symptoms (abdominal pain, vomiting) and two classic signs (abdominal mass, rectal bleeding) helps make the diagnosis of intussusception in an infant or child. Diagnosis can be confirmed by sonography and contrast enema.
The treatment of intussusception has evolved from primarily operative management to the preference for radiological reduction with either air or barium contrast. The published success rate of radiological reduction averages 80% but varies widely between 40% and 90%.
Pneumatic reduction of intusssuception as an alternative to surgery was first performed in 1793 by Hunter’s by using hand bellows applied to the anus.
Pneumatic reduction of intussusception had been shown to decrease the length of hospitalization, shorten recovery, and reduce the risk of complications associated with major abdominal surgery and decreases hospital cost.
In the past, immediate operative intervention was required if an intussusception was irreducible by enema techniques. However, at surgery 10% were found to already be reduced and another 40% were easily reduced manually. It was therefore speculated that surgical intervention may possibly have been avoided in half the cases if another delayed enema was attempt.
The use of delayed, repeated reduction attempts is mentioned in several series with variable success rates.
We performed a prospective study over 6 months period during which 55 patients had proven intussusceptions were seen in the Pediatric Surgery Department, Ain Shams University.
In our study, performing a second trial increased the overall reduction rate by 12% thus increasing our reduction rate from 66% to 78%.
Essential criteria for the second trial include: no sign of peritonitis, initial partial reduction of the intussusception, clinical improvement and stable vital signs.
We have shown that air enema associated with the use of delayed, repeated reduction attempts is a safe and effective technique for intussusception reduction with a high success rate. The decreased operative rate will also be responsible for an associated decrease in morbidity, a shorter hospital stay and a decrease in the hospital cost.