Remove the intussusception under the guidance of digitized background removal imaging

This is an automatically translated article.

The article is professionally consulted by MSc, BS. Dang Manh Cuong - Doctor of Radiology - Department of Diagnostic Imaging - Vinmec Central Park International General Hospital.
Intussusception is a common surgical disease in young children, occurring when a segment of intestine is turned upside down, entering the lumen of the adjacent bowel. This is the cause of mechanical intestinal obstruction, both occlusion and ligation. There are many ways to treat intussusception, the doctor will choose based on the situation and health conditions of the child.

1. Overview

Intussusception is one of the most common causes of acute abdominal pain in young children. Intussusception occurs when part of the alimentary canal inserts into the next, most commonly in children between 6 months and 2 years of age. Most cases of intussusception in this age group are idiopathic. In which the ileocecal intussusception occupies the majority.
Currently, although there are different non-surgical intussusception methods, all are based on the principle: Apply pressure to the top of the intussusception to push the loop back into its normal position. The technique of intubation is divided into 2 groups depending on the substance to apply pressure, namely:
Air intubation: Today is commonly used, if the patient comes early in the first 24 hours, the success rate is 90%. It is necessary to use X-ray combined with clinical to evaluate successful intussusception; Detachment with solution (including water, Ringer's solution or physiological saline): Can be done easily in the ultrasound room and also monitor the results of intubation by ultrasound without having to use X-rays. The success rate when removing the cage with water is about 50 - 89%. In addition, in some other cases, it is also possible to remove the intussusception under the guidance of digital background erasure, or with barium or surgical treatment.

2. When to remove the intussusception under digital scan to remove background?

2.1. Point

Intussusception can be performed under the guidance of digital background erasure scan when the patient meets one of the following conditions:
Age < 3 months or > 5 years old; Symptoms have persisted, especially for more than 48 hours; Blood in the urine ; Small bowel obstruction;

2.2. Contraindications

Conversely, do not proceed with the technique if the patient has:
Severe dehydration; Peritonitis ; Shock; Septicemia ; There is free gas in the abdomen; Exhausted physical condition;

3. Prepare

3.1. Executor

Specialist doctors and assistants; Electro-optical technician; Nursing staff; Anesthesiologist or technician (if patient is uncooperative).

3.2. Vehicle

Ultrasound machine; Digital background eraser (DSA capture); Lead vest and apron for X-ray shielding; Indentation and wiring system; Pressure gauge.

3.3. Medical supplies

General anesthetic (if indicated) Physiological saline solution 2000ml; Rectal catheter; Ultrasonic gel; Paraffin lubricating oil.

3.4. Patient

The patient is clearly explained about the procedure to cooperate well with the doctor; Fasting and drinking before 6 hours, only drink no more than 50ml of water; Lying supine in the intervention room; Install vitals monitor: Breathing rate, pulse, blood pressure, electrocardiogram and SpO2 ; Skin antiseptic; Cover with sterile perforated towels; Give sedation if the patient is too excited and refuses to lie still.

3.5. Test form

Preparation is similar to other techniques of digital background removal:
Inpatient medical records; The order of performing the procedure has been approved; X-ray film, computed tomography and magnetic resonance (if any).

4. How to proceed

Step 1: Insert the catheter into the intestine The doctor will insert a rectal catheter, then connect the rectal catheter to the enemas system.
Step 2: Intubation of water or gas into the lumen of the intestine Water/air is introduced slowly into the colonic framework under consistent pressure.
Step 3: Perform cage removal Monitor the progress of cage removal under the guidance of DSA (digital angiography). Based on the obtained signs, adjust the de-intubation pressure accordingly.
Last step: Finish the trick.

5. Some notes

In general, the technique of intussusception under the guidance of digital background erasure is considered successful when:
The entire intussusception has disappeared; Used vapors or fluids may be able to pass through the cage; X-ray film shows air evenly distributed in the bowel loops (Football sign). As with any other procedure, the risk of complications is low. Specifically in this case are:
Intestinal perforation: Appears in less than 1% of cases, if any, urgent surgical treatment is required; Recurrence: Repeat the procedure above or consider other more appropriate techniques. Most of the intussusception in older children has a physical cause, so it is important to find out and solve it thoroughly. This disease is also prone to recurrence, often with ileocecal-colon intussusception, so if the technique fails, the most effective method can be considered to be surgical removal of the intussusception.
Vinmec International General Hospital is a hospital with a full convergence of general and specialized doctors performing, examining, operating, diagnosing and treating digestive diseases. In particular, at Vinmec, the technique of intussusception is also performed and provides optimal treatment results for customers.
Before taking a job at Vinmec Central Park International Hospital from December 2017, Doctor Dang Manh Cuong has over 18 years of experience in the field of ultrasound - diagnostic imaging in Transport Hospitals. Hai Phong, MRI Department of Nguyen Tri Phuong Hospital and Diagnostic Imaging Department of Becamex International Hospital.
Customers can directly go to Vinmec Health system nationwide to visit or contact the hotline here for support.