Intestinal cages are treated by inflatable removal of the cage or surgical surgery depending on the specific case. Today with the progress of medicine, laparoscopic surgery is widely applied due to its more advantages than open surgery.
Laparoscopic surgery to remove the intestinal cage and fix the ileum is a highly effective method for children with intestinal cages to help them recover quickly and avoid complications.
1. What is a intestinal cage?
- Intestinal cage is a pathology created by a segment of the intestine entering the next intestinal passage that creates intestinal obstruction syndrome according to the mechanism of knots and bottlenecks. Intestinal cage can occur in the small intestine entering the small intestine or the small intestine entering the colon.
- Intestinal cage is a common abdominal emergency in children especially breastfeeding babies that are rare in adults and are prone to omission. Children with intestinal cages may experience dangerous complications such as: Perforation of the intestines, intestinal necrosis that causes total peritonitis, which can cause septic shock, even death if not diagnosed early and treated in a timely manner.
- Intestinal cage treatment includes conservative treatment of removing the cage with steam or water and surgery. Surgery includes open surgery and laparoscopic surgery. Laparoscopic surgery is applied in some cases to treat the special-level intestinal cage of the ileum.
2. Diagnosis of intestinal cage
Diagnosis is based on the following symptoms:
Children with intestinal cages with clinical manifestations include:
- The child cries every time due to abdominal pain. This is the main symptom and assesses the duration of intestinal cage.
- Quit breastfeeding.
- Vomiting out feed that has just sucked, there are cases later than vomiting out of digested food.
- Bleeding: after abdominal pain 6 -12 hours.
- The examination may palpation of the cage block or abdominal wall reaction when touched. Visit the blooded rectum according to the glove, which can touch the head of the cage mass.
- Ultrasound: is the first option that can find cage block images such as:
- On the cross section: beer-shaped with an increased center area and a sound-reducing peripheral.
- On the vertical cutting area: Sandwich shape.
- X-ray of the colon with photocracy: gradually replaced by ultrasound, almost little use for the diagnosis of intestinal cages.
3. Intestinal cage treatment
3.1. Remove the cage with an inflatable
It should be done as soon as possible.
- Late after 48 hours.
- It's bad or shocking.
- There are complications of intestinal cages such as perforation of the intestines, complete intestinal obstruction shown clinically as well as X-rays.
When it is not possible to remove the intestinal cage with an inflatable, there are contraindicents of removing the intestinal cage with steam, the intestinal cage has a physical cause.
Note when performing surgery:
- It is necessary to prepare before performing surgery such as: Electrolytic rehydration and acid alkali balance, gastric clearance and the use of antibiotics to prevent infection.
- Surgery involves open surgery and laparoscopic surgery. In which, laparoscopic surgery brings high efficiency to shorten the hospital stay but requires the facility to be fully equipped and experienced surgeons.
4. Laparoscopic surgery to remove the intestinal cage and fix the ileum
- Laparoscopic surgery is introscopy for intestinal cage removal:
- When removing the cage with steam fails.
- The patient arrives late after 24 hours.
- Recurrent intestinal cage (>2 times) without certain causes (laparoscopy removes the cage combined with diagnosis).
- Fixative fixity of the ileum:
- The intestinal cage of the ileum recurs more than 2 times.
- There is no cause of intestinal cage.
- Remove the cage completely.
- Contrain specifying:
- General contraincularity of laparoscopic surgery includes: coaalysis disorders, hemolysis disorders, severe cardi lung disease.
- Complete intestinal obstruction or intestinal obstruction.
- The process of conducting:
- Put the glass trocar in the abdomen, pump CO2.
- Observe the abdomen, assess whether peritonitis, there is intestinal obstruction, perforation of the intestines or not.
- Use 2 soft clips to manipulate the cage block. One hand pulls the cage neck (the near intestine segment) out of the head of the cage (the dismedest of the intestines).
- When removing the cage, it is necessary to check the intestinal passage with anemia or necrosis lesions, re-examine the entire intestine to assess the digestive circulation.
- Fix the clues if in design. Proceed to the removal of the appendix, fixed stitches in turn the positions of the ileum, the base of the appendix and the end of the ileum into the lateral abdominal wall with just insoluble.
5. Accidents and handling
- Complications in surgery:
- General complications such as trocar-related accidents (bleeding, perforation of the mesenterosis of the mesenterosis …), bleeding during surgery and handling similar to any other case.
- Perforation of the intestines by holding the intestines and transferring open surgery to puncture, wash the abdomen with an endoscopy or open surgery.
- Post-surgery complications:
- Infection of the incision and care for the incision.
- Appendicitis after appendicectence causes peritonitis.
- Intestinal paralysis, intestinal obstruction after surgery.
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