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Intussusception with a Pathological Lead Point: Pneumatic Reduction or Surgical Intervention? - Abstract

William Tomlinson , Paul Jackson , Nigel Broderick , Ramnik Patel , Manoj Shenoy

 

Abstract

We wish to report a potential new ultrasound sign to guide management in paediatric intussusceptions. A 10-month-old infant presented with 4 days history of recurrent bilious vomiting, intermittent screaming episodes with a tendency to pull his legs, malena and distended abdomen without any palpable mass. Ultrasound scan confirmed intussusception and showed signs of a possible pathological lead point (PLP). He underwent resection and primary ileocolic anastomosis for an irreducible gangrenous intussusception uneventfully. Pneumatic air enema reduction remains a gold standard in a case of intussusception in an infant with a success rate over 80%, however, there are certain contraindications including gangrene, perforation and we feel that if an ultrasound shows a lead point, a surgical or laparoscopic approach is more suitable and time saving rather than increasing risk of perforation during attempted pneumatic reduction in such cases.

Keywords: intussusception, laparoscopy, laparotomy, lead point, pathological, pediatric, pneumatic reduction, ultrasound

 

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