ANATOMICAL FEATURES AS CAUSES OF INTUSSUSCEPTION IN CHILDREN
About the author:
Grytsenko Y. M., Grytsenko M. I.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
Causes of intussusception in children are still unclear. It is probably the anatomical features that require surgical reduction in children aged over one year who have been diagnosed with insussusception and its relapses. Clinicians advocating conservative tactics point out on the low incidence rate of insussusception in clinical practice, including cases of the recurrence of insussusception in children over a year. The present study aimed at determining the incidence rate of insussusception due to anatomical features in children and elaborating the approach towards its correction. Through the period from 1986 to 2018, 258 children diagnosed to have insussusception aged from 3 months to 13 years underwent the treatment at the Surgical Pediatric Department, Poltava. The recurrence of insussusception was observed in 17 cases in 12 children. Conservative treatment was performed in 184 patients (71,3%); surgery was performed in 74 children (28,7%). Insussusception due to anatomical features was seen in 17 cases that made up 6,5% of all cases of insussusception and 22,9% of cases treated surgically. The analysis of anatomical causes of insussusception has shown that 12 cases were due to Meckel’s diverticulum, 3 cases were due to enterocyct, 1 cases were due to developed due to each of those conditions as intestinal polyposis and rectal lymphosarcoma. By their age, children with insussusception due to anatomical features can be distributed into the following groups: patients under a year – 8 children (47,1%), patients from 1 to 3 years – 5 children (29,4%) and over 3 years – 4 children (23,5%). The number of cases due to anatomical features found out during the operation in the children under 1 year and over 1 year did not significantly differ. 4 children with reccurent insussusception were operated on. During the surgery on recurrent insussusception, no anatomical features that might cause the problem were detected in each of the cases. Aсcording to the results obtained, Meckel’s diverticulum has been found as the commonest cause of insussusception. We have also proposed aseptic removal of Meckel’s diverticulum that does not require the wide opening of intestinal lumen. This technique can be used in every case despite of the width of the base of Meckel’s diverticulum. As an alternative to multiple sections or segmental resection of intestine in case of polyps, we have proposed the technique for removal of multiple polyps of large and small intestines. The study has demonstrated the anatomical peculiarities do not play a leading role in the occurrence of insussusception in children over 1 year and in cases of the recurrence of insussusception, therefore they can not be regarded as absolute indication for emergency operation. The prospects for further investigation may include the changes in management of children with insussusception the onset of which is not longer than 24 hours, in children over 1 year and in children with insussusception towards the broadening of indications for conservative treatment.
intestinal intussusception, anatomical features, children.
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 Part 1 (150), 2019 year, 112-115 pages, index UDK 616.34-007.272-053.2