|Year : 1983 | Volume
| Issue : 2 | Page : 125-126A
Contiguous direct and retrograde intussusception in association with necrotizing enteritis (a case report).
KL Rao, AA Purohit, KK Yadav, IC Pathak
K L Rao
|How to cite this article:|
Rao K L, Purohit A A, Yadav K K, Pathak I C. Contiguous direct and retrograde intussusception in association with necrotizing enteritis (a case report). J Postgrad Med 1983;29:125-126A
|How to cite this URL:|
Rao K L, Purohit A A, Yadav K K, Pathak I C. Contiguous direct and retrograde intussusception in association with necrotizing enteritis (a case report). J Postgrad Med [serial online] 1983 [cited 2022 May 20 ];29:125-126A
Available from: https://www.jpgmonline.com/text.asp?1983/29/2/125/5537
Majority of the intussusceptions in children start at the ileocaecal region. Usually, the proximal part of the gut is invaginated into the distal bowel, but retrograde intussusception in children is an extremely rare event.
An 18 month old made child, weighing 6.5 kg was admitted with the history of passing blood and mucus per rectum of 8 days' duration with bilious vomiting and progressively increasing distension of abdomen. The child was very sick, restless, with moderate anaemia and severe dehydration. Abdomen was distended with visible peristalsis, tense with areas of vague tenderness and guarding, no palpable mass and exaggerated bowel sounds. Dark altered blood and mucus were seen on rectal examination. Plain skiagrams of the abdomen showed features of intestinal obstruction.
At laparotomy, two intussusceptions were found in the colon, an ileocolic and another retrograde colocolic type [Fig. 1]. The ileocolic intussusception was reducible but gangrenous patches were observed on the reduced portion. The colocolic intussusception was irreducible and gangrenous [Fig. 2]. An extended right hemicolectomy with ileocolic anastomosis was performed. The post-operative course was complicated by bronchopneumonia and persistent ileus till the eighth day, when a high output enterocutaneous fistula necessitated a second laparotomy, where gross features of necrotizing enteritis were present. One perforation in the first part of the duodenum, two perforations with gangrenous edges in the jejunum and patchy gangrene of the proximal ileum were seen. Closure of perforations, gastrostomy, resection of a foot of ileum and end to end anastomosis were made. Four days later the child died of severe diarrhoea and septicemia. The resected bowel was negative for secondary causes of intussusception.
Retrograde intussusceptions are rare. Akehurst found, on review of literature from 1677 to 1955, only 103 cases of retrograde intussusceptions of the entire gastro-intestinal tract in both children and adults. In our Institute, this is the only such case in 14 years and out of 122 intussusceptions.
The mechanism of intussusception is not obvious in the primary variety. Reymond suggested that local changes in the intestinal wall coupled with the forces of peristalsis will cause intussusception. Whether this intussusception is antegrade or retrograde is purely by chance. The rarity of clinically manifest retrograde intussusception is explained by the production of proximal intestinal obstruction, build up of pressure and spontaneous reduction of intussusception. If an antegrade intussusception precedes the retrograde type, this proximal pressure is not available for such spontaneous reduction. Apart from rarity, another interesting feature of our case is the development of necrotizing enteritis. Although the exact aetiology of this is not known, it is probable that the same offending agent causing irritability of the gut has produced both the intussusception by irregular peristalsis and necrotizing enteritis by vascular damage. Another possibility is that the prolonged intestinal distention secondary to distal obstruction might have caused damage to blood vessels and consequent ischemia.
|1||Akehurst, A. C.: Retrograde intussusception: A report of a case and a review of 103 cases in the literature. Brit. J. Surg., 43: 207-213, 1955.|
|2||Reymond, R. D.: The mechanism of intussusception; a theoretical analysis of the phenomena. Brit. J. Radiol., 45: 1-7, 1972.|