Author/Editor		Vidmar, Dubravka; Višnar-Perovič, Alenka
Title		Sonographycally guided hydrostatic reduction of childhood intussusception
Translated title		Dezinvaginacija s hidrokolonsonografijo pri otroku
Type		članek
Source		Radiol Oncol
Vol. and No.		Letnik 38, št. 4
Publication year		2004
Volume		str. 269-73
Language		eng
Abstract		Background. Intussusception is the most common cause of bowel obstruction in children under two years of age. The proximal part of the bowel and its mesentery (the intussusceptum) enter within that part immediately beneath it (the intussuscipiens). Being pulled by peristalsis the mesenterial vessels get compressed which result in ishaemia of the bowel wall. Most intussusceptions are ileocolic. The diagnosis can be confirmed by a contrast enema or ultrasound. Sonography demonstrates a so-called »target-within-a-target« patfern (in cross-section) with thickened edematous bowel wall with or without vascularisation and prestenotic dilatation with increased peristalsis. Therapeutic reduction can be attempted by a contrast enema (following diagnostic procedure) or by air, both under fluoroscopic monitoring, or by normal saline under sonographic guidance. Patients and methods. We detected sonographically intussusception in three girls of 15, 16 and 18 months having typical clinical signs. We continued with hydrostatic reduction under the sonographic guidance. The reduction was attempted with a saline enema on body-temperature, introduced by the equipment for contrast enema. The bottle o f normal saline was hung up 1 m over the examination desk. We needed few liters of saline to replace lost liquids due to the incomplete occlusion of rectum. Meanwhile we monitored the moving of the intussusceptum back into the proximal direction. Criteria for a succesful reduction were the disappearance of the intussusceptum and the passage of fluid through the ileocecal valve. Results. Success was proven in all three girls. No complications occured and the pain relieved immediately after the procedure. There were no signs of intussusception on sonography after 2 and 12 hours. We saw a slightly edematous wall of ileocecal valve and terminal ileum. Due to their exellent clinical conditions they were discharged from hospital after a second sonography. (Abstract truncated at 2000 characters).
Summary		Izhodišča. Invaginacija je najpogostejši vzrok črevesne obstrukcije pri otrocih, mlajših od dveh let. Proksimalni del črevesa in njegov mezenterij (intususceptum) se uvihata v distalni del (intususcipiens), nato ju peristaltika vleče naprej, pri čemer se komprimira mezenterialno žilje. Najpogostejša je ileokolična invaginacija. Diagnozo lahko postavimo z irigografijo ali ultrazvokom. Ultrazvočni znaki so t.i. »kokarda v kokardi, zadebeljena stena z ali brez znakov prekrvavitve ter prestenotična dilatacija z ojačano peristaltiko. Dezinvaginacijo lahko izpeljemo s kontrastnim sredstvom ali z zrakom pod rentgensko kontrolo ali s fiziološko raztopino pod ultrazvočno kontrolo. Bolniki in metode. Pri treh deklicah v starosti 15, 16 in 18 mesecev smo ob tipični klinični sliki ultrazvočno diagnosticirali ileokolično invaginacijo in nadaljevali z dezinvaginacijo pod ultrazvočno kontrolo. S pomočjo sistema za uvajanje barija pri irigografiji smo v široko črevo dovajali fiziološko raztopino, ogreto na telesno temperaturo. Posoda s tekočino je bila 1 m nad preiskovalno mizo. Količina uporabljene tekočine je bila več litrov, ker je zaradi nepopolne okluzije rektuma precej tekočine odteklo. Ultrazvočno smo opazovali potovanje vrha invaginata nazaj v proksimalni smeri. Poseg smo zaključili, ko je izginila tipična slika »kokarde v kokardi« in je prišlo do refluksa tekočine v terminalni ileum. Rezultati. Poseg je bil uspešen in je potekal brez komplikacij pri vseh treh deklicah. Bolečine so takoj po posegu prenehale. Ob kontrolnih pregledih po 2 in 12 urah ni bilo več znakov invaginacije. Nekoliko edematozna je bila stena valvule Bauchini in terminalnega ileuma. Klinično stanje deklic je bilo normalno, tako da so bile odpuščene v domačo oskrbo neposredno po drugi ultrazvočni kontroli. Zaključki. Dezinvaginacija s hidrokolonsonografijo je zaradi visoke učinkovitosti in odsotnosti ionizirajočega sevanja metoda izbora. Zapleti doslej niso opisovani.
Descriptors		INTUSSUSCEPTION HYDROSTATIC PRESSURE TREATMENT OUTCOME INFANT