Intussusception is a form of intestinal obstruction in which one segment of the intestine telescopes into the next.

Assessment and preoperative management

Intussusception is most frequent in children less than two years of age.

Diagnosis

Medical management

To medically manage intussusception:

Operative technique

1	Give the patient a general anaesthetic with a muscle relaxant. Place the child supine and prepare the skin with antiseptic. Open the abdomen through a midline incision centred at the umbilicus; make the incision either through or around the umbilicus (Figures 7.28 and 7.29).
Figure 7.28
Figure 7.29
2	After opening the peritoneum, locate and examine the intussusception. Make no attempt to reduce the telescoped bowel by pulling on its proximal end, but instead “milk” it in a retrograde manner with the fingers of one hand inside the abdomen pressing against the fingers of the other hand outside the abdomen (Figures 7.30 and 7.31). Once the bowel has been reduced into the ascending colon, deliver the colon through the wound and reduce the remaining intussusception slowly, inspecting the ensheathing layer for serosal and muscular tears (Figure 7.32).
Figure 7.30
Figure 7.31
Figure 7.32
3	If the intussusception is not fully reducible, or if the bowel is gangrenous, resect the section of involved bowel. If you are experienced, construct an ileocolic anastomosis. If you are a non specialist practitioner, exteriorize the two ends of the bowel through the abdominal wall, forming an ileostomy and a non-functioning mucous fistula.
4	Close the wound in layers using absorbable suture for the peritoneum and muscle, and non-absorbable suture for the skin. If the bowel ends have been exteriorized, refer the patient for anastomosis by a qualified surgeon. An ileostomy will produce large quantities of fluid. The patient will require fluid based on body weight plus the fluid lost through the ileostomy. Replace the loss with normal saline.