Etiologies tumorales des invaginations intestinales aiguës secondaires chez l'enfant. Cas de deux observations

Introduction : L'invagination intestinale aiguë est connue comme pouvant survenir sur une tumeur chez le grand enfant. Dans ce travail, nous rapportons le cas de deux patientes tout en précisant la nature histologique, le traitement effectué et le pronostic de ces tumeurs.Observations : Les deux patientes respectivement âgées de 3 ans et demi et 11 ans ont été admises en urgence pour douleur abdominale aiguë paroxystique. Le diagnostic de l'invagination intestinale évoqué à l'examen clinique a été confirmé par l'échographie abdominale : iléo-cæco-colique dans le premier cas et iléo-iléale dans le second. La cause tumorale de l'invagination été faite en per opératoire lors de la laparotomie. Nous avons pratiqué une désinvagination, résection tumorale et anastomose intestinale. L'examen histologique des pièces tumorales a mis en évidence un lymphome malin diffus centrocytique, centroblastique du cæcum dans le premier cas (patiente de 3 ans) et un polype adénomateux festonné en dysplasie de bas grade de l'iléon dans le second (patiente de 11 ans). L'évolution après cure de chimiothérapie chez la patiente de 3 ans a été satisfaisante et le recul à deux ans ne montre pas de récidive. Les suites sont aussi simples à 1 mois post-opératoire chez la patiente de 11 ans.Conclusion : Les invaginations intestinales peuvent être un mode de révélation de tumeurs lorsqu'elles surviennent au-delà de la petite enfance. La précision de la nature bénigne ou maligne de ces tumeurs par l'examen immuno-histochimique est capitale et déterminante pour le traitement et le pronostic

Cas rare de prolapsus rectal dû à une invagination intestinale aiguë de diagnostic tardif

Le prolapsus rectal est l'issue par l'anus de la paroi rectale évaginée. L'Invagination Intestinale Aiguë (IIA) réalise un télescopage d'un segment intestinal d'aval par le segment intestinal d'amont pour former le "boudin". Vue tardivement l'évolution se fait vers une occlusion intestinale aiguë sévère, et à l'extrême un prolapsus rectal avec nécrose d'anses intestinales. Dans la littérature les cas de prolapsus rectal dû à une IIA sont rares, du fait de diagnostic précoce. Nous rapportons le cas d'un nourrisson de sexe masculin âgé de 11 mois qui a présenté un prolapsus rectal dû à une IIA, ceci dans le but de souligner les particularités diagnostiques et thérapeutiques de cette présentation clinique et éviter les retards diagnostiques. La prise en charge s'est faite en urgence. Après une courte réanimation, une laparotomie a permis de retrouver une IIA dans sa forme iléo-cæco-colique et de nombreuses adénopathies mésentériques. La désinvagination n'a pas été complète et la décision d'une résection intestinale emportant l'iléon terminal, le cæcum, le côlon ascendant a été prise. L'anastomose était iléo-colique, termino-terminale. Le transit a repris au 3e jour post-opératoire autorisant une alimentation parentérale. Le diagnostic de prolapsus rectal compliquant une IIA est clinique, et le toucher rectal en est l'élément fondamental. L'imagerie ne permet pas de confirmer le diagnostic. En contexte de plateau technique limité, la chirurgie ne doit pas être retardée. Seule la clinique permet de poser un diagnostic précoce et l'indication opératoire

Childhood intussusception: the implications of delayed presentation

Background : In some developing countries; many children with intussusception are reported to present late for definitive therapy. This study determines the effect of delayed presentation on clinical parameters; management; and outcome of childhood intussusception in southeast Nigeria. Methods : Comparative analysis of 87 consecutive children with intussusception managed from January 1998 to December 2007 at the University of Nigeria Teaching Hospital; Enugu; was done. Results : Overall; the mean time from onset to presentation was 3.0 days (range 4 hours to 7 days). Thirteen (14.9) presented within 24 hours of symptoms (group 1) and 74 (85.1) presented after 24 hours (group 2). Clinical presentations were similar in the children with the exception of bilious vomiting; rectal bleeding; and abdominal distension which were significantly commoner in group 2 children (P 0.05). Type of intussusception found at operation did not differ in the groups; but cases in group 2 had higher incidence of bowel complications; and greater risk of failed operative reduction and bowel resection than group 1 patients (P 0.05). Though the postoperative complications did not differ significantly between the two groups; mortality directly related to intussusception occurred only in patients who presented after 24 hours. Conclusion: Significant number of children with intussusception in our setting presented late for definitive treatment. These cases have a higher risk of bowel complications and intestinal resection. Outcome in these patients might be enhanced through improved perioperative care in the short term; or by improving access to; and reducing delays in seeking health care; in the long run

Routine Surgical Intervention for Childhood Intussusception in a Developing Country

Objective/Purpose: We aim to determine the basis for the routine surgical treatment of intussusception in southeast Nigeria. Methods: We analyzed 71 children operated for intussusception between June 1998 and May 2006 at the University of Nigeria Teaching Hospital Enugu; southeastern Nigeria. Results: The median age at presentation was 6 months (range 3 months to 7 years); and the average duration from onset to presentation 3.2 days (range 4 hours to 7 days). Forty-six (64.8) had ileocolic intussusception; 7 (9.9) colocolic; and 5 (7.0) ileoileal. In 31 (43.7); there was no identifiable cause; while mesenteric lymphadenopathy and inflamed Peyer's patches were noted in 37 (52.1); and polyp in 3 (4.2). Manual reduction was successful in 39 (55); while 32 (45) required bowel resection for gangrene; or irreducibility. After average follow up of 9.7 months (range 4-22 months) there was no recurrence; but overall mortality was 6 (8.5) from septicemia. Late presentation; dearth of facilities and trained manpower; and lack of multidisciplinary collaboration may contribute to the regular surgical treatment. Conclusion: Intussusception in our setting is characterized by late presentation; high rate of bowel resection; and high mortality. Surgery may remain our main stay of treatment until deficiencies in time to diagnosis; specialized facilities; and personnel improvement

Bowel resection in Nigerian children

Background : Although bowel resections are commonly done for congenital malformations in children in developed countries; they usually follow neglected and preventable acquired diseases of the intestine in developing countries. Objectives : To determine the indications and outcome of bowel resections in children of a developing country in a university teaching hospital. Materials and Methods: Data of the patients operated (from birth to 15 years) was retrospectively collected over eight years (January 1999 to December 2006). The biodata of children included the following: Indications for operation; type of operations; duration of admission; and outcome of treatment including complications. Patients with Hirschsprung's disease were excluded from the study because bowel resection forms part of their definitive surgical management. Results : There were 70 patients (38 boys and 32 girls). The age ranged between four hours to 15 years (median; five months). There were 16 (22.9) neonates; 26 (37.1) infants; and 28 (40) grown children. The indications were congenital anomalies in the 16 neonates. Also; 23 (88.5) infants had intussusception; 2 (7.7) had midgut vovulusm and 1 (3.8) had congenital small intestine band. Among the grown children; typhoid ileal perforation (TIP) was seen in 14 (50.0); intussusception in 5 (17.9); and other causes in nine patients. Overall; intussusception was the most common indication for bowel resection; followed by TIP. A total of 24 patients developed 33 complications. Complications included wound infection in 47.8and anastomotic leak in 42.8. The duration of admission ranged between 4-35 days (median; 15 days). The overall mortality was 17.1-; which was highest among neonates (56.3); followed by the infants (26.9-). Conclusion : Bowel resections are mainly done for intussusception and complications of TIP at our centre. Late presentation; preexisting malnutrition; and nonavailability of parenteral nutrition contributed to unacceptable morbidity and mortality

Les invaginations intestinales aigues du nourrisson et de l'enfant en milieu africain: interet d'un diagnostic precoce

But : L'objectif de ce travail etait d'ameliorer le diagnostic de l'invagination intestinale aigue du nourrisson et de l'enfant en milieu africain. Materiel et methodes : A partir d'une etude retrospective sur trois ans; 10cas d'invagination intestinale aigue du nourrisson et de l'enfant ont ete colliges et traites dans le service de chirurgie pediatrique de l'Hopital Gyneco-Obstetrique et Pediatrique de Yaounde. Resultats : La repartition des patients selon l'age a note un pic de frequence situe entre 3 et 12 mois. La predominance du sexe feminin a ete remarquable avec 70des cas. Le delai de consultation a ete en moyenne de 72H avec des extremes allant de moins de 24H a 7 jours. 50des patients ont vu leur traitement debuter avec un retard de plus de 48H. Le traitement operatoire a ete de mise chez tous nos patients. Le pronostic a ete favorable dans tous les cas; sans recidive; avec un recul moyen de 20 mois. Les auteurs soulignent le retard encore porte au diagnostic en milieu africain et les implications therapeutiques qui en decoulent. La litterature est revisee et des solutions sont proposees pour ameliorer le diagnostic

Presentation and management outcome of childhood intussusception in Lagos: a prospective study

Background: Intussusception is the commonest cause of bowel obstruction in infancy and childhood. Early diagnosis and effective management have reduced its morbidity and mortality in developed countries. Aim: To document the presentation; management and treatment outcome of intussusceptions at the Lagos University Teaching Hospital (LUTH). Patients and Methods: One hundred seventy-four consecutive cases of this condition seen in children presenting at LUTH over a 5-year period were prospectively studied. Details of symptoms and signs; pre-hospital care; treatment; and outcome in LUTH were documented. Results: The triad of abdominal pain; bloody mucoid stools and palpable abdominal mass was seen in 106 (61) of the cases. One hundred thirty-five (77.6) had been admitted and treated with antibiotics and intravenous fluids in primary healthcare centers for an average of 3 days before referral to the LUTH. Prolonged mean duration of recognizable symptoms of 3 days accounted for a 70.4bowel resection rate. Wound infection occurred in 61 (36.1); whereas fecal fistulae developed in six (3.6); and burst abdomen in five (3) of cases. Seven (4.1) patients developed incisional herniae. Overall; mortality rate was 12.1. Conclusion: The early symptoms of intussusception would seem to be missed by primary healthcare workers in Lagos; with consequently high morbidity and mortality. There is an urgent need to re-emphasize these symptoms to first-line healthcare providers and parents through public enlightenment campaigns

Un lipome du grele a l'origine d'une invagination intestinale aigue

L'invagination intestinale aigue de l'adulte est rare et souvent secondaire. La symptomatologie clinique est polymorphe. Nous en rapportons un cas lie a un lipome de l'intestin grele et se manifestant de maniere subaigue dans un tableau de douleur abdominale chronique associee a un syndrome subocclusif. Les differents aspects de la prise en charge sont discutes a travers une revue de la litterature

Paediatric intussusception in Benin city, Nigeria

Intussusception is one of the leading causes of intestinal obstruction in children. This study reports our experience in the management of intussusception in Benin City; Nigeria. This was a 10-year retrospective review of intussusception in children at the University of Benin Teaching Hospital from January; 1997 to December; 2006. Twenty four children were admitted with intussusception (M: F = 1:1.4) within the period. Only three patients (12.5) presented within 24 hours of onset of illness. Ten (41.6) presented between one and four days; seven (29.2) between five and 10 days; while four (16.6) presented between 11and14 days. Abdominal pain; irritability; blood in stools; vomiting; abdominal distension and palpablemass in various combinations were the clinical features. All the patients; except one (4); were below the age of one year. There was much delay before presentation of infantswith intussusception; with high attendant mortality

Acute intussusception following a pull-through operation for hirschsprung disease

Acute post-operative intussusception is a rare. This is a report of two cases of acute intestinal intussusception were observed in two children aged 14 months and 2.5 years following operation for Hirschsprung's disease. The first signs appeared at the tenth and the fifth post operative day after a satisfactory post-operative period. These signs were not evocative (pains and more or less stopping of the transit). Acute intussusception should be considered in the differential of post -The signs of premature post-operatory occlusion happen in the two weeks of the intervention in hirsch- sprung disease must help to mention the diagnosis of post-operative intestinal invagination. operative intestinal obstruction occurring within two week of pull-through operation forHirschsprung's disease

Un cas d'invagination intestinale post traumatique de l'adulte

L'invagination intestinale post-traumatique est rare. Nous en rapportons un cas chez un homme de 30 ans victime d'une contusion abdominale. Six jours apres l'accident; il avait presente un syndrome occlusif. L'echographie avait permis de visualiser un boudin d'invagination. La laparotomie avait montre une invagination ileo-ileale dont la desinvagination manuelle avait permis de liberer 30cm d'ileon dont la vitalite etait satisfaisante. Le segment invagine etait oedemateux avec presence d'un petit hematome parietal probablement a l'origine de l'invagination. Les suites operatoires etaient simples. Les particularites diagnostique et therapeutique de l'invagination intestinale post traumatique de l'adulte sont discutees

Pancreas ectopique; cause inhabituelle d'une invagination intestinale aigue

Un pancreas ectopique a l'origine d'une d'invagination intestinale est rare. Nous en rapportons un cas chez une femme de 33 ans qui avait presente une occlusion intestinale aigue du grele. L'exploration chirurgicale en urgence montrait une invagination ileo-ileale dont l'origine etait une tumeur grelique de 1;5cm de diametre. L'histologie concluait en un ilot pancreatique ectopique. Les suites operatoires etaient simples. Les aspects epidemiologiques; diagnostiques et therapeutiques sont discutes