In adults, intussusception usually has organic lesions and requires surgical removal of the lesion. In pediatric patients, most intussusceptions can be corrected by air enema, while some children require surgical repositioning. In both adults and pediatric patients, it is necessary to first reset the intestinal tube of the intussusception, and then decide further surgery according to the intestinal lesion.
1. Determine the presence of the mass. The abdomen must be explored again after anesthesia to determine that the mass is still present, regardless of the certainty of preoperative ultrasound or enema results. Surgeons are not afraid of surgical difficulties, but of releasing an empty cannon, remember! Remember!!!
2, after finding the overlapping intestinal tube first determine the type of overlapping.
The small intestine can be directly put forward outside the incision to reset, but to explore other intestinal tubes, I once encountered a case of three small intestine overlapping cases. The ileocecal sleeve should be explored to see the position of the sleeve head, whether the cecum and appendix of the sleeve are snapped in together, and the tightness of the sleeve opening.
3.Manipulation reset.
Do not try to reposition the intra-abdominal cavity, but should be repositioned under direct vision by raising the sleeve outside the incision. This can avoid collateral damage, and can be more intuitive understanding of the reset situation, simply feel the head of the sleeve in and out can not reflect the actual reset situation.
A finger is used to reach through the sleeve opening to understand the tightness of the sleeve, to separate the adhesions, and to remove the exudate between the intestinal laminae. Since the highest tension is in the mesentery, pulling on the intestinal tube is actually pulling on the mesentery, which not only does not work, but may also tear the mesentery. Therefore, do not expect to pull the intestinal tube out of the sleeve.
The correct method is to extrude the sleeve into the intestine via the sleeve head. But simply pushing down on the sleeve head is often not successful in resetting it, why? Because the intestinal canal is flexible and as a direct result of pushing down on the sleeve, the intestinal canal becomes shorter, but instead of being uncoupled, it expands in all directions ——– and becomes thicker! The shortened intestine is not only more difficult to exit through the sleeve, but also severely tears the outermost layer of the colon. Even if the reset is successful, how to deal with the fragmented colonic pulpy layer!
At this point, you can hold the sleeve with your right hand to stop the outward expansion of the intestinal tube, and push down on the head of the sleeve with your left hand. When the right hand feels the increased tension in the sleeve, then slowly and forcefully squeeze —— similar to squeezing toothpaste. This way the sleeve will exit the intestine and the intestine will not be severely torn. The resetting process should emphasize the word slow, slowly squeeze —- slowly out, leaving enough time for the edematous and thickened intestinal tube to deform and withdraw. Especially the last moment, more pressure to reduce, slow down the speed.
4, to determine the intestinal tube activity, the book many methods. If it cannot be determined, routine line intestinal tube heat. At this time, it is recommended to return the intestinal tube to the abdominal cavity hot compress. First, the action time is long. The abdominal cavity itself has a certain temperature, and the insulation effect is good. Second, to avoid the tension caused by the external intestinal tube on the intestinal mesentery, which affects the blood flow of the intestinal tube. Third, simultaneous heat application to the intestinal tube, mesentery and peripheral intestinal tract mesentery is beneficial to the recovery of local blood flow and collateral circulation. Fourth, the heat is balanced to avoid scalding in the hot front, while the back is still cold.
5, additional surgery.
There is intestinal necrosis or organic lesions need to be resected and anastomosed.
Such as simple overlap, the recent prevailing view is not to do prophylactic modification.