Intussusception
⇒ Intussusception is invagination of one intestinal segment into
lumen of the adjucent segment.
⇒ Different types of the intussusception according to lactions:
Ileocolic
Jejunojejunal
Gastroesophageal
Dueodenojejunal
Cecocolic
⇒ In intussusception, 2 parts:
⇢ There is segment entrapped within the lumen of the intussusception known as intussusceptum.
⇢ The engulfing segment is called as intussuscipiens.
Causes
⇒ Most commonly enteritis, recent abdominal
surgery, intestinal mural disease and intestinal parasitism
⇒ It
is also causes in 8–33% of dogs that undergo renal allograft transplantation
and 5% of dogs that undergo hematopoietic cell grafts.
Pathophysiology
⇒ The exact mechanism of intussusception
generation is not known.
⇒ Many animals are young (< 1 year of age ),
and have a history of recent enteritis.
⇒ The
occurrence of an intussusception leads to a mechanical obstruction of the
gastrointestinal tract. This obstruction can be either partial or complete.
⇒ Vascular
compromised commonly occurred in intussusceptum and can occasionally occurred
in intussuscipiens.
⇒ Compromise
of venous drainage in the face of an intact arterial blood supply leads to
marked edema and intramural haemorrhage that may eventually progress to extravasation of blood into the
intestinal lumen.
⇒ Due to that decrease in oxygen level to
intussuscipiens in mucosal layer.
⇒ This
can lead to the eventual failure of the mucosal barrier and loss of an
effective barrier to bacteria and endotoxin entering the bloodstream from the
bowel lumen.
⇒ There
is vascular compromised leads to intestinal necrosis and eventually leakage of
content into the peritoneal cavity.
⇒ This
is leads to septic peritonitis.
⇒In intussusception, gastrointestinal in which mechanical obstruction, illus
⇒ In cardiovascular, there is fluid loss leads to hypovolemia (vomiting and diarrhoea)
Clinical symptoms
⇒ Vomiting
⇒ Diarrhoea(in with fresh blood or melena)
⇒ Abdominal pain
⇒ Abdominal distention
⇒ Anorexia with weight loss
⇒ This all symptoms seen in acute condition or
have been occurring for weeks or months.
Physical examination of intussusception
⇒ There is discomfort
or abdominal pain in patient with intussusception.
⇒ In sever condition
there is cardiovascular compromise.
⇒ A sausage shaped
(thicken intestinal loop) mass palpated in the abdominal region.
⇒ In ileocolic
intussusception. There is rectal prolapse occurring.it is differential from
rectal prolapse via blind ending fornix at the part.
⇒ Jejunojenal
intussusception more easier palpated than ileocolic intussusception because
they are more common in caudal and ventral to abdomen.
Diagnosis
⇒ A large “coiled spring” appearing filling defect may
be present when barium within the lumen surrounds the intussusceptum.
⇒ In which contrast materials accumulates in the lumen
between the intussusceptum and
intussuscepians.
⇒ Ultrasonography most common used in the detecting
intussusception.
⇒ The ultrasonographic appearance of an
intussusception in the transverse plane is that of a multilayered, target-like
lesion (concentric hyperechoic and hypoechoic rings with an overall width
greater than 8 to 9 mm) with associated proximal fluid accumulation and
diminished intestinal motility.
Treatment
⇒ Immediate surgical intervention is the recommended
treatment for intussusceptions.
⇒ Surgical correction should performed as soon as the
patient is stable enough to withstand anesthesia and surgery.
⇒ A full abdomen exploratory should be performed to
assist in the identifications of any potential underlying causes.
⇒ Some intussusception can be manually reduced by
gently milking the intusussusceptam from within the intussusciptiens.
⇒ Upon reductions, the bowel may or may not by viable.
⇒ If the event that manual reduction is not possible
or bowel has questionable viability, an intestinal resection or entero-anastomosis
is necessary.
⇒ An anastomosis is a
surgical connection between two structures. It usually means a connection that
that is created between tubular structures, such as blood vessels or loops of intestine.
For example, when part of intestine is surgically removed, the two remaining
ends are sewn or stapled together.
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