interesting_case 4 months old boy with abdominal pain

[Admin]

Case by prof Tariq Altokais, Professor and consultant of pediatric surgery King Saud university, Riyadh, Saudi Arabia
4 months old boy, healthy, brought by parents due abdominal pain and excessive crying for 1 day. Pain is intermittent, pulling his legs up during pain, associated with vomiting. Later he passed blood with stool. On physical examination, he is lethargic, abdomen is distended. US showed a classic target sign at Left iliac fossa.
What is your initial management?

[Admin]

After initial resuscitation and hydration, enema reduction was performed.
Intussusception at the sigmoid colon.


The contrast was not seen in the terminal ileum. So another enema reduction was tried after few hours.


Contrast seen at terminal ileum.
So Feeding started but baby developed vomiting after 8 hours. and Abdomen is distended more.
What will you do?

[Admin]

US was repeated and showed similar findings with target sign at the Left iliac fossa.
what next?

[Admin]

Laparoscopic exploration decided and Laparoscopic reduction done of the intussusception. The intussusceptum was at the level of descending colon. A Mickle’s diverticulum was the leading point. umbilical port site was extended, Mickle’s was resected.