Upload
lisa-prudence-merritt
View
218
Download
2
Tags:
Embed Size (px)
Citation preview
IntussusceptionIntussusception
Rory MurphyRory Murphy
History.
HPC• 80 ♂
• 4/7; general malaise.
• 1/7; nausea, profuse vomiting, diarrhoea & “crampy” lower abdominal pain.
• Recent campylobacter gastroenteritis.
PMHx•Chronic Renal Failure. (Dialysis* 3 a week.).•HTN
Physical Exam.
Vitals.
• HR 80 Hypertensive Apyrexial SaO2 95%
Abdominal,• Soft Non-tender. • No gaurding, rigidity or
organomegaly,• Hernial orifices clear. BS+ • PR/FOB not documented
Initial Investigations.
Bloods.
Hb 13
WCC 7.78
Neutophils 6.7
Urea 31
Na 134
Creat 848
LFT’s NAD
Amylase
CRP 26
Stool Culture,Ova&Oocytes.
Neg
Imaging.
PFA:
No gaseous distension of the bowel.
Abdominal U/S:
NAD.
OGD;
Hiatus Hernia Mild Antral Gastritis
Initial Differential Diagnosis and Treatment.
Post-Infectious gastroenteritis/Malabsorptive State.
Nausea and Vomiting intermittently.
9 days post admission symptoms improved.
Resolved gastroenteritis.
Aspiration pneumonia.
Repeat Investigations.
PFA x 2 revealed dilated loops of small bowel.
However clinical discordence patient passing bowel motions and non distended.
Intra-operative Images.
Intussusception exists when a proximal segment
of bowel (intussusceptum) telescopes into the
lumen of the adjacent distal segment.
1 % of all bowel obstructions,
5% of all intussusceptions,
Adult Intussusception.
• Intussusception is a different entity in adults than it is in chlidren.
• Pathology is found in 70% to 90% of cases in the adult population.
• Intraluminal lesions alter normal bowel peristalsis and form leading
edges for the intussusceptum. 9'0
• Adults may present with acute, intermittent, or chronic reported problems."
• The predominant symptoms usually are those of bowel obstruction and, consequently,intussusception often is misdiagnosed initially in the adult population.