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REFERAT

Click to edit Master subtitle style Adviser : Dr. Sjaiful,Sp.B Created by : Regina

INTUSSUSCEP TION

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DEFINITION
Intussuception is a medical condition which a part of intestine has invaginated into another section of intestine. The part that prolapses into another,called intussuceptum. The part that receives, called intussuscipiens.

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ETIOLOGY
1. Idiophatic

In most infants and toddlers with intussusception, the etiology is unclear. One theory to explain the possible etiology of idiopathic intussusception is that it occurs because of an enlarged Peyer patch; this hypothesis is derived from 3 observations:
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the illness is preceded by an upper

Causal (> 2 years old-adult):


Inverted Meckels diverticulum intestine polip Leiomioma Leiosarkoma Hemangioma Lymphoma intestine Duplication

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INCIDENCE
q Often found at 3 months - 2 years q Prevalence: 1-2 patients among 1000 live

births ,boys : girls = 3: 1

q Patients are usually healthy babies,

breastfeeding, good nutrition and optimal growth


q There are connecting the invagination due to

impaired peristaltic, 10% are preceded by a solid feeding and diarrhea

q Ileocolica => 75% 7/13/12

PATHOPHYSIOLOGY

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Intussusception Type
Dependent naming junction between intussusceptum and intussuscipiens (by location) :
Ileo-ileal = just involving the ileum Ileo-colica = ileum and colon as the

intussusceptum intussuscipiens
Colo-colonic colica =just involving the colon Ileocaecal around ileo caecal If found walls consist of five layers, it is often
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Clinical Symptomps :
1 vomiting

2 colic abdomen 3 palpable tumor as sausage 4, 5 red current jelly stool

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Palpable lump as sausage and the lump can be move. (DANCE SIGN)

Tumor may not be palpable because it's hidden behind the left rib arch (position No. 3)
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DIAGNOSIS
Anamnesa Physical Examination
Digital Rectal Examination : anal

spinchter tony weak, palpable pseudoportio, in handscoen feces with mucus.

Laboratory

10.000/mm3)

Leukocitosis (>

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Radiology
Contrast enema/ Barium Enema

Coiled Spring sign

Barium enema shows intussusception in the descending colon can be the treatment too.

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Abdominal ultrasonography reveals the classic Do

nuts target sign of an intussusceptum inside an

Abdominal Plain Photo :


Air distribution is uneven in the intestine pushed to the left upper intestine next phase - a sign of intestinal obstruction => picture of " air fluid level

If there is perforation => can be seen "free air

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air fluid level

DIFFERENTIAL DIAGNOSIS
VOLVULUS coffee bean appearance HIRSCPRUNG
Congenital ,hystory late meconium, schapoid stomach ( like frogs stomach), in Digital Rectal Examination can find burs feces.

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Rectal prolaps or prolaps recti, which usually occurs repeatedly and on a digital rectal mucosa found association between the perianal skin, whereas the invaginations found a gap. Gastro - enteritis, when followed, by invagination can be tagged if found changes in pain, vomiting and bleeding. Amoeba dysentery, diarrhea here contain mucus and blood, as well as the obstipasi, when dysentery accompanied by severe abdominal pain, tenesmus and fever
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COMPLICATION
Dehidration Obstructive Ileus Ischemia and intestin necrosis Peritonitis Death

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MANAGEMENT
Radiologic Hydrostatic Reduction Laparotomy
Repositioning or Milking a segmental resection with an end-to-end

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PROGNOSIS
Ad Vitam : Dubia Ad Functionam : Dubia Ad Sanationam : Dubia The outcome of intussusception depends on the duration of symptoms before treatment initiation. Most infants will recover if treatment is initiated within the first 24 hours. Untreated intussusception is almost always bad. Overall even with treatment, approximately 1-2% of 7/13/12 affected children will die.

age 0-6 months 6-8 months 8-10 months

food Breast milk or formula milk Breast milk, milk porridge, filter tim rice Breast milk, milk porridge, filter tim rice, mashed fruit Breast milk, tim rice, vegetable and fruit Breast milk, milk porridge, vegetables and fruit, snack for baby

10-12 months

12-24 months

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THANK YOU

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