Intussusception is a condition in which one segment of
proximal of the bowel invaginates into an adjacent distal segmen and the most
frequent causes of bowel obstruction.
The greatest incidence between 3 months and 6 years of age.
Some large studies report that up to 10% of intussusceptions are secondary to a
pathologic lead point, with increased risk between ages five and fourteen.
Inverted
Meckel's diverticulum or heterotopic pancreas have been reported to act as lead
points. Other causes could be polyps, lymphoma, lymphosarcoma and
enteric duplication cyst.
A Meckel's diverticulum, a true congenital diverticulum, is
a slight bulge in the small intestine present at birth and a vestigial remnant
of the omphalomesenteric duct (also called the vitelline duct or yolk stalk)
Meckel diverticulum is normally obliterated by the 5th week of gestation and found in 1.2% to 3% of the
population with males more
frequently experiencing symptoms but
only 4% of these become symptomatic. Between 4 and 14% of the complications of
Meckel diverticulum can be attributed to intussusceptions. Infrequently, Meckel
diverticulum can invert and invaginate into the ileal lumen and can be the
leading point of the intussusception
Intussusception is a surgical abdominal emergency that in
which one portion of the bowel, usually proximal to the ileocecal valve,
invaginates into an adjacent segment. This process leads to bowel wall edema
which progressively causes obstruction of venous outflow. The bowel becomes
secondary ischemic, which can eventually lead to necrosis and perforation with reported incidence of 1.5–4 cases
per 1000 live births.
The greatest incidence for intussusception is between 3
months and 6 years of age with a higher prevalence in males than females;
however, it is not uncommon in older children. Hyperplastic lymphoid tissue is
believed to act as a lead point. Ileoileal intussusception is rarer and it is
often due to a pathological or congenital lead point. Congenital lead point
intussusception is estimated to be 2%–12% of all cases and it is more likely to
be found in older patient. Inverted Meckel's diverticulum or heterotopic
pancreas have been reported to act as lead points. Other causes could be
polyps, lymphoma, lymphosarcoma and enteric duplication cyst.
A Meckel's diverticulum, a true congenital diverticulum, is
a slight bulge in the small intestine present at birth and a vestigial remnant
of the omphalomesenteric duct. Meckel diverticulum is normally obliterated by the 5th week
of gestation.
Meckel diverticulum is the
most common congenital anomaly of the gastrointestinal tract and is found in
1.2% to 3% of the population with
males more frequently experiencing symptom but only
4% of these become symptomatic. Between 4 and 14% of the complications of
Meckel diverticulum can be attributed to intussusceptions . Infrequently,
Meckel diverticulum can invert and invaginate into the ileal lumen and can be
the leading point of the intussusception . Inversion of Meckel diverticulum is
not yet clearly understood.
The treatment of a symptomatic
Meckel diverticulum begins with adequate resuscitation. Adequate resuscitation
to an appropriate hemoglobin level should be accomplished before operation if
the patient presents initially with bleeding. The
treatment of a symptomatic Meckel diverticulum is resection. This can be done
with open or laparoscopic techniques. A Meckel diverticulum
can be removed by either simple resection of the diverticulum and transverse
closure across the base, or resection of a short segment of ileum containing
the diverticulum with reanastomosis. This decision is based on the key
principle of resecting all the ectopic tissue.
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