Invaginasi Jurnal2 PDF
Invaginasi Jurnal2 PDF
Invaginasi Jurnal2 PDF
Case Report
Abstract
Background: Colocolic intussusception is rare in children and most cases in adolescents are
produced by a lead-point. A review of the English-written literature revealed only three cases of
colocolic intussusception without lead point.
Case presentation: A seven year-old boy with chief complaint of colicky abdominal pain and
vomiting for five days, dysentery for 4 days, and no response to antibiotic therapy, increasing
pain and abdominal distension was referred to pediatric gastroenterologist. Abdominal x-ray
revealed multiple air-fluid levels and gasless colon. Pseudo-kidney appearance was reported in
abdominal ultrasound at splenic flexure. Colocolic intussusception diagnosis without any lead
point was confirmed in laparotomy and reduced with milk-out procedure.
Conclusion: In children with dysentery especially in presence of colicky abdominal pain,
abdominal distention and no response to antibiotic therapy, abdominal ultrasound to rule out
intussusception is recommended.
Introduction
Intussusception occurs when a portion of the
intestine is telescoped into an adjacent
intestinal segment[1]. It is very common in
children all over the world, especially those
under 2 years[2]. The majority of cases occur in
the region of the ileocecal valve, and no lead
point can be precisely identified[3]. Other types
of intussusception that are rarer and have an
* Correspondence author;
Address: Department of Pediatrics, Shaheed motahhari Hospital, Urmia, IR Iran
E-mail: [email protected]
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Case presentation
A seven year-old boy with colicky abdominal
pain and vomiting followed by dysentery, has
been treated with metronidazole in a local
health-center after positive stool for
Entamobea histolytica cysts. He was sent to
our hospital because of continuation of the
symptoms. During the last 2 days, the
symptoms worsened, his abdomen distended
and his stool was totally bloody.
In physical examination he was conscious,
febrile and severely dehydrated, BP=100/60
mmHg, PR=120/min, RR=32/min, T=38/7C.
Growth and development was normal. Head
and neck were normal; breathing was normal
and heart tachycardiac. Upper part of
abdomen was distended and bowel sounds
were hyperactive. There was diffuse
abdominal tenderness without guarding or
rebound. Other clinical examinations were
normal. Laboratory tests were normal except
for leukocytosis with left shift. Abdominal xray showed thick small bowel wall, multiple
air-fluid levels and gasless lower abdomen
(Fig 1). Pseudo-kidney appearance at splenic
flexure was reported in abdominal ultrasound.
After initial reduction midline laparotomy was
done. Small bowel loops and right colon were
severely distended (Fig 2). Invagination of
lower third of transverse colon into
descending colon was detected as the cause of
obstruction (Fig 3) and was reduced with
milking out procedure. Exact examination for
underlying pathologic lead point was
indeterminate. Postoperative period was
Discussion
375
Conclusion
In children with dysentery especially with
colicky abdominal pain, abdominal distention
and no response to antibiotic therapy, an
abdominal ultrasound should be performed to
rule out intussusception.
References
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