Intussusception of the intestine in the newborn

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Intussusception   of   the   intestine   in   the   newborn

Authors
F Becmeur, D Christmann, I Kauffmann
Mots-clés
pediatrics,operation,small bowel
Type de vidéo
Durée
07'00''
Publication
2004-09
Popularité
Favoris
Favorites Media
Audio
en
Sous-titres
en
E-publication
WeBSurg.com, Sept 2004;4(09).
URL: http://www.websurg.com/doi-vd01en1090e.htm

Intussusception   of   the   intestine   in   the   newborn

1. Case presentation 00'17''
Intussusception in infants is most often treated in Strasbourg by serum enema guided by ultrasonography. The success rate is more than 90%. In case of failure, we propose a treatment by laparoscopy. We begin by an open laparoscopy and suture the umbilicus with the optical trocar allows to lift the abdominal wall during the procedure. The bowel loops are enlarged and the operative field is very narrow. That’s why we are used to introducing the 3mm operative trocar in the optical trocar in order to avoid any bowel injury. The first trocar is in the left lower quadrant and a 2nd here is in the left flank. This procedure is mandatory for little children. It’s necessary to have a very good mobility for the instruments, that’s why the child is lying on the left side of the operative table at the end of the table. You can move the instruments as you want. Here we’re looking for the place of the intussusception. The forceps are very thin, 2.7mm and the bowel is thick because of the edema. That’s why it’s often difficult to hold the bowel. The next step is to detach the internal cylinder from the external cylinder of the intussusception trying to insufflate CO2 between the 2 cylinders. It may be called aerodissection. It’s not easy but necessary. In this case of rheumatoid purpura, we found a bloody abdominal cavity. We tried the same technique and then it will be necessary to do as we did for an open surgery, that is to push this way the head of the internal cylinder in order to avoid tearing of the bowel if we just draw it out. Then it’ll be easy to treat the intussusception. Look at the importance of the peritoneal extravasation with a lot of fibrin that can provide adhesions or bands after surgery whatever you do. Here’s there’s no problem. The bowel is safe. Appendectomy is not necessary. This is the head of the intussusception here. Here the question was to know if we could leave the bowel without intestinal resection. We will see. Are there hematomas or necroses? It depends on your experience and your optimism too. Here it was an ileo-ileal intussusception with an incarcerated band of greater omentum. It was very easy to reduce this intussusception, which could not be reached by any enema. At the end of the procedure, we look for the appendix but it’s not necessary to remove it.