Pediatric surgery. Treatment of acute intestinal intussusception (lecture notes)

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Pediatric surgery. Treatment of acute intestinal intussusception (lecture notes)

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48. Treatment of acute intestinal intussusception

The basic principle of treatment of intussusception - early disinvagination is possible. Surgical tactics and methods of therapeutic measures depend on the localization and form of implementation, the timing of admission and the age of the child. There are two main methods of disinvagination - conservative and operative. Conservative treatment of invagination is relatively simpler and more atraumatic than the surgical method. It is based on the principle of mechanical action on the intussusceptum injected under pressure into the colon of liquid or air.

Recently, for the conservative treatment of intussusception, mainly dosed air injection into the colon is used.

Conservative treatment Intussusception of the intestines is indicated in infants with early admission to the hospital (up to 12 hours from the onset of the disease) and the established localization of the head of the intussusceptum in the colon.

Preoperative should be short-term and intensive, individual plan for each patient.

Postoperative treatment. The patient is placed in an intensive care unit, cardiac medications, broad-spectrum antibiotics, and oxygen therapy are prescribed. All children undergo prolonged epidural anesthesia for 4-5 days to prevent and treat intestinal paresis. Anti-adhesion physiotherapy is prescribed.

To detect relatively frequent hyperthermia, the child's body temperature is measured every 2 hours. An increase in temperature above 38 ° C is an indication for antipyretic measures.

Feeding of patients in whom the operation ended with disinvagination begins 6 hours after the intervention. Breastfed children are prescribed expressed human milk 15-20 ml every 2 hours. After a day, in the absence of vomiting and improvement in general condition, 10-15 ml of milk is added to each feeding, bringing to the 4-5th day to a normal amount corresponding to the mass body and age of the child.

These days, the missing amount of fluid is administered intravenously. If vomiting occurs after the first feeding, then the child is prescribed parenteral nutrition for a day, gastric lavage every 3-4 hours, and only after that fractional feeding begins again.

Older children 6-8 hours after the disinvagination operation are allowed to drink warm tea or glucose in the amount of 30-50 ml, prescribing parenteral nutrition at the same time. From the 2nd day, if there is no vomiting, a liquid diet is used, transferring to the postoperative table after 2-3 days, and the usual diet is allowed from the 6-7th day.

For children who underwent resection of the intestine, parenteral nutrition is carried out for three days, allowing them to drink a limited amount of liquid from the second day. Then a liquid postoperative table is prescribed and the diet is continued for up to two weeks. With an uncomplicated postoperative period, the child is discharged on the 12-14th day.

Authors: Drozdov A.A., Drozdova M.V.

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