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What is The commonest cause of intestinal obstruction in children between 3 months to 6 years of age and explain in detail?
Ans. a (Intussusception) (Ref. Nelson paediatrics, p. 1569)INTUSSUSCEPTION# Intussusception occurs when a portion of the alimentary tract is telescoped into an adjacent segment. It is the most common cause of intestinal obstruction between 3 mo and 5 yr of age.# Sixty percent of patients are younger than 1 yr, and 80% of the cases occur before 24 mo: it is rare in neonates.# The incidence varies from 1 to 4/1,000 live births.# The male:female ratio is 4:1. A few intussusceptions reduce spontaneously, but if left untreated, most will lead to intestinal infarction, perforation, peritonitis, and death.Etiology and Epidemiology# The cause of most intussusceptions is unknown.# The seasonal incidence has peaks in spring and autumn.# Correlation with prior or concurrent respiratory adenovirus (type C) infection has been noted, and the condition may complicate otitis media, gastroenteritis, Henoch-Schonlein purpura.# The risk of intussusceptions in infants <1 yr of age after receiving a no longer available tetravalent rhesus-human reassortant rotavirus vaccine within 2 wk of immunization was increased.# Lymphoid nodular hyperplasia is another related risk factor. Prominent mounds of lymph tissue lead to mucosal prolapse of the ileum into the colon, thus causing an intussusception.# In 2-8% of patients, recognizable lead points for the intussusception are found, such as a Meckel diverticulum, intestinal polyp, neurofibroma, intestinal duplication, hemangioma, or malignant conditions such as lymphoma. Intussusception can complicate mucosal hemorrhage, as in Henoch-Schonlein purpura or hemophilia.# Cystic fibrosis is another risk factor.# Postoperative intussusception is ileoileal and usually occurs within 5 days of an abdominal operation.# Lead points are more common in children >2 yr of age.Pathology# Intussusceptions are most often ileocolic, less commonly cecocolic, and rarely exclusively ileal.Clinical manifestations# Spasmodic intermittent abdominal pain;# "Red currant" jelly stools# Palpable lump.# Dance sign, n "Empty RIF" signDiagnosis# Ultrasound is investigation of choice.# Ba enema is now 2nd line investigation# USG signs:- "Doughnut or target" appearance in transverse images.- "Sandwich or hamburger" sign in longitudinal images- Pseudokidney sign# Ba emema signs:- "Claw"sign- "Coiled-spring" signRx# Hydrostatic reduction# Air reduction is associated with fewer complications and lower radiation exposure than traditional contrast hydrostatic techniques.# The success rate of radiologic hydrostatic reduction under fluoroscopic or ultrasonic guidance is =50% if symptoms are present longer than 48 hr and 70-90% if reduction is done in the 1st 48 hr.# If manual operative reduction is impossible or the bowel is not viable, resection of the intussusceptions is necessary with end-to-end anastomosis.# Corticosteroids may reduce the frequency of recurrent intussusception.