This video shows how an ileocolic intussusception in a young child can be managed laparoscopically.
WeBSurg.com, Mar 2008;8(03).
1. Case history 00'16''This video demonstrates the technique for a laparoscopic reduction of an ileocolic intussusception. The case is that of a 12-month-old child who presented with clinical signs of an intussusception.
2. Trocar positioning 00'31''This was confirmed on ultrasound but subsequent attempt at radiographic reduction was unsuccessful and the child now requires laparoscopic intervention. Three trocars are used to do this, one placed sub-umbilically for the camera, and two working ports placed along a diagonal line.
3. Case commences 01'05''Reverse Trendelenburg positioning is used throughout. Here you see the intussusceptum that has migrated down to the sigmoid colon. Sequential placement of bowel graspers helps to advance the intussusceptum in a retrograde fashion. At all times, careful attention is paid to avoid serosal injury to the bowel.
4. Retrograde reduction in left colon 01'38''In this particular case, the instrument on the right is an atraumatic bowel grasper and the one on the left is a Babcock forceps. The intussusception is slowly being advanced from the descending colon through the transverse colon and into the ascending colon, whereupon, the ileum will be reduced from the cecum. Pushing the intussusceptum in a retrograde fashion can be tedious. However, it significantly contributes to the eventual reduction of the intussusception and the success of the intervention.
5. Continued reduction across transverse colon and down ascending colon 03'08''Here the intussusceptum is being advanced along the hepatic flexure and around to the descending colon.
6. Ileocolic reduction 03'30''Our attention is now turned to the ileocolic junction where we can see the intussusception enter into the colon. At this point in the case, the small bowel is pulled from the colon. A steady pulling motion is necessary in order to avoid tearing of the bowel. The left hand is used to retract the intussusceptate while the intussusceptum is pulled. Although the small bowel frequently retracts back into the colon after its release, continued attempts are necessary as each pull reduces the edema allowing for ultimate reduction. Here note is made at the appendix being present in the middle of the screen. Although it now appears that the intussusception is completely reduced, further inspection makes clear that there is still some more to be reduced. Now it appears that the intussusception is almost reduced except for one last anterior portion. Further steady traction means that now it is completely reduced.