జీర్ణకోశ & జీర్ణ వ్యవస్థ

నైరూప్య

A Case Report on Post-Operative Intussusception, Post Primary Volvulus Derotation and Decompression

Yesewbelay Minale

Intussusception is process in which a segment of intestine enters into adjoining intestine lumen causing bowel obstruction. Intussusception is unusual in adults, and the diagnosis is commonly overlooked.

In this case report the patient was 40 years old and was admitted to the surgical ward after he had undergone laparotomy for the diagnosis of small bowel obstruction 2ry to primary volvulus .The presentation to emergency room at that time was colicky type of central abdominal pain, 2-3 episodes of vomiting of bilious matter of 3 days and abdominal distention.

The condition was smooth up to the 3rd postoperative day at which time he restarted to complain central abdominal pain associated with abdominal distention. He had also 2 episodes of vomiting of ingested matter.

On Physical Examination
Vital signs are Blood pressure-120/60; Pulse rate-82 beats/min; (Respiratory Rate) RR-24 beats/min; Temperature-36.7°C but on abdominal examination he had previous surgical scar, slightly distended abdomen which was hyper-tympanic to percussion. On per rectum examination, the rectum was empty. Abdominal X-ray showed multiple air fluid level and abdominal ultrasound which was done after a day showed small bowel obstruction 2ry to intussusception. Then after 2 L of ringer lactate was given over 30 min, catheter and nasogastric tube inserted and re-laparotomy done. The intraoperative finding was ileoileal intussusception with 2.5 cm one siteileal imminent perforation at the mid intussucipiens for which reduction and resection of the imminent perforation and ileoileal anastomosis done. This patient had smooth postoperative course and discharged after 7 days of hospital stay. Therefore to have early diagnosis and management of possible risk of intussusception post small bowel volvulus surgery especially as in this particular case, it is extremely important to take this case for the future care of intraoperative manipulations of bowel and to have future studies of similar cases in the area.