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    Intussusception Case

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    Teena Shamu
    This document summarizes the medical history and management of an 8-month-old female infant admitted with intussusception. The infant presented with vomiting, bloody stools, and abdominal swelling. After initial resuscitation, she underwent surgery where 30cm of gangrenous bowel was resected. She was admitted to the ICU post-operatively where she received further resuscitation and treatment. Over subsequent days, her condition stabilized and she was discharged from the ICU after showing signs of recovery and tolerance of feeds.

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    Intussusception Case

    Uploaded by

    Teena Shamu
    40 views19 pages
    This document summarizes the medical history and management of an 8-month-old female infant admitted with intussusception. The infant presented with vomiting, bloody stools, and abdominal swelling. After initial resuscitation, she underwent surgery where 30cm of gangrenous bowel was resected. She was admitted to the ICU post-operatively where she received further resuscitation and treatment. Over subsequent days, her condition stabilized and she was discharged from the ICU after showing signs of recovery and tolerance of feeds.

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    This document summarizes the medical history and management of an 8-month-old female infant admitted with intussusception. The infant presented with vomiting, bloody stools, and abdominal swelling. After initial resuscitation, she underwent surgery where 30cm of gangrenous bowel was resected. She was admitted to the ICU post-operatively where she received further resuscitation and treatment. Over subsequent days, her condition stabilized and she was discharged from the ICU after showing signs of recovery and tolerance of feeds.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    40 views19 pages

    Intussusception Case

    Uploaded by

    Teena Shamu
    This document summarizes the medical history and management of an 8-month-old female infant admitted with intussusception. The infant presented with vomiting, bloody stools, and abdominal swelling. After initial resuscitation, she underwent surgery where 30cm of gangrenous bowel was resected. She was admitted to the ICU post-operatively where she received further resuscitation and treatment. Over subsequent days, her condition stabilized and she was discharged from the ICU after showing signs of recovery and tolerance of feeds.

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    AN ILL PRINCESS

    DR CHIMHUNDU SITHOLE T
    DR SHAMU DZVANGA T Y J
    FEB 2020
    MORBIDITY AND MORTALITY MEETING
    OUTLINE
    History
    Work up
    ICU admission
    Preop evaluation
    Intraop mgx
    Post op mgx
    HISTORY
    8/12 old female
    Referral from Chipinge>Mutare>HCH
    6 day hx – projectile vomiting, bilious vomiting
    - red currant jelly stool
    -abdominal swelling
    Systems review
    hot body
    Loss of appetite
    BACKGROUND HX
    Mother is para 1 , booked preg, code o
    Delivered NVD at term
    Bwt 3100g
    Immunziations up to date
    PMHX and PSHX
    Current weight 8,6kg
    EXAMINATION
    General- very ill looking baby, lethargic, dehydrated , warm to touch, pale
    Abdomen- globally distended, tender, reduced bowel sounds
    Chest – RR 41, equal air entry , no added sounds
    CVS – PR 178, SI SII no SIII , no murmurs
    CNS- lethargic, moving all limbs
    FBC WCC Hb 5,4 plat 427 mcv 67,1 wcc 16,37
    U and e-
    Diagnosis- INTUSSUSCEPTION
    SURGICAL MGX
    DAY 1 DAY 2
    Admit c1 O/E severely dehydrated, lethargic, pale(hb 5,9)
    Iv fluids- bolus 70mls N/saline, ½ DD 37,6 mls - no venous access, IO inserted bolus of N/saline
    per hour 237mls then maintenance 70mls /hr
    Antibiotics- cef and metronidazole -admit ICU
    NGT -keep NPO
    Keep NPO and prep for theatre - For emergency laparatomy
    Catheterise pt- no urine output( received 2 more
    boluses )
    PREOP ASSESSMENT
    -called to assess pt for theatre
    - 8day hx of vomiting , abd distension, passing red currant jelly stool
    0/E very ill looking , severely dehydrated child with no venous access, lethargic , pale ++,
    warm to touch, temp 37,6 deg C
    WT 8,6KG
    Chest- on oxygen per face mask spo2 96, chest clear
    CVS- PR 175, BP 96/72 SI SII, no SIII, no murmurs
    Abd- grossly distended with reduced bowel sounds
    Gus –minimal urine in urine bag
    FBC WCC Hb 5,4 plat 427 mcv 67,1 wcc 16,37
    U and e-
    ASA IVE , NOT FIT FOR THEATRE PENDING ADEQUATE RESUSCITATION
    PLAN
    1. Admit ICU
    2. Insert CVC
    3. bolus r/lactate 170 mls
    4. transfuse packed cells
    5. post cvc insertion CXR
    6. ct –iv antibiotics,
    RESULTS AFTER RESUSC
    FBC U and E
    HB 10,6 NA 139

    Plat 340 K 3,7


    HCT 30 U 4,4
    MCV
    CR
    INTRAOP MGX
    Monitors attached, preoxygenated for 5mins
    Modified RSI ketamine 17mg, sux 17mg , intubated with size 4,o ett
    Analgesia – paracet , fentanyl
    M.relaxation-atracurium
    Maintenance- isoflurane 1- 2,5 %
    Vitals
    Spo2: 98-100
    Hr :142- 180
    Bp:70/32- 90/53
    Ebl:
    GUS:
    SURGICAL FINDINGS
    - bowel examined and intussusception identified
    -unsuccessful reduction attempted
    -30cm of gangrenous bowel resected
    -230cm of viable bowel remained
    - resection of terminal ileum, ascending colon and transverse colon was done
    ICU READMISSION
    Post op- reversed and extubated
    Plan
    1. o2 per face mask
    2. ketamine infusion
    3. paracetamol
    4.Iv fluids-
    5. post op fbc, u and e
    6. ranitidine
    7. iv antibiotics
    8.monitor ngt output
    9. chest physiotherapy
    PROGRESS ON ICU
    Day 1- NGT output 400mls, fluids replaced accordingly(r/lactate made up to 5%,
    passing stoolx6, urine 3mls per kg /hr
    Vitals-hr 141-171, BP 96/68-124/93, temp 36-38, rr 30 spo2 98%
    Gen:pale, well hydrated, cold peripheries chest: clear
    FBC RESULT:WCC 9,43 HB 9,6 MCV 77,2 PLT 222
    Day two : no vomiting, NGT output 0mls, no abd swelling
    Gen: alert, pink, apyrexial, periorbita edema
    Vitals: hr 110-138, rr 31-39, spo2 97-99%, temp35-36,9, BP 70/48-113/84
    GUS : 1ml/kg/hr
    Plan: commence EBM,reducenfluids, ct analgesia and IV antibiotics
    PROGRESS IN ICU
    Day 3- tolerating feeds, passing yellow stool , no edema, apyrexial
    Vitals: hr 150, spo2 95-100%, temp 37,8 rr 32 gus-2-3mls/kg/hr abd:? Surgical site
    infection
    Plan: pus swab, dailydressings, allow to breastfeed,ct rest of mgx
    Day 5- noted to have ana sarca, pyrexia, surgical site infection, passed red currant
    jelly
    FBC WCC5,57 HB 10,3 MCV 67,8 PLT 34 U&E :NA 138 K 3,7 U 1,5
    Problems: hypoalbuminemia, low plt, microcytic anaemia ,
    Plan: ct daily dressings, reduce fluids, ct antibioitcs, nutritional rehab,
    breastfeeding ++
    PROGRESS ON ICU
    Day 6 – suture line dehiscence , paasing yellowish well formed stool
    Vitals : stable
    plan: chase pus swab, ct feeding and iv antibiotics, dripmdown, remove NGT,
    normal diet, suture gaping line
    Day7- tolerating feeds, stable vitals ? Discharge to ward, zno paste, ct dressings and
    antibioitcs
    SWOT ANALYSIS
    Strengths: Weaknesses:
    Medical vs Surgical Emergency Referral system
    Teamwork during resuscitation Junior first contact
    Cooperation in delaying the case for 1 Lack of IV access up to point of severe
    day dehydration

    Meticulous reviewing of patient by team Delay in transfusing

    Presence of competent ICU registrar at Delay in recognizing need for ICU /


    escalation
    all times
    Lack of confidence in nursing of
    ventilated patients
    SWOT ANALYSIS
    Opportunities: Threats:
    Mutli disciplinary meetings Loss of ventilated patients
    Training of nursing staff Loss of patients at district level due to
    low threshold of referring
    Post resuscitation guidelines in wards
    and ICU Junior staff communication with seniors
    Recognition of sick patients on the ward
    Lack of bair huggers and other warming
    devices for patients in ICU
    A HAPPY PRINCESS
    THANK YOU

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