Step 1: Surgical Anatomy
Intussception can occur at any age, but only 10% occur after the age of 2. All intussceptions in the adult population need to be managed by segmental resection, and the technique is described in Chapter 23 , Small Bowel Resection and Anastomosis.
Step 2: Preoperative Considerations
Nonoperative Management: Once the diagnosis of intussception is made and resuscitation is initiated, hydrostatic or pneumatic reduction can be considered in the absence of peritonitis, perforation, advanced sepsis, or gangrenous bowel. This decision is made by the surgeon. These techniques have been successful in 75% to 94% of cases. After the procedure the patient should be observed NPO for 24 hours.
Operative Management: Indicated in children with signs of shock, peritonitis, or incomplete reduction. Antibiotics, nasogastric tube decompression, and intravenous fluids are given preoperatively.
Step 3: Operative Steps
A right lower quadrant transverse muscle-splitting incision or lower midline incision is appropriate. The incision can be extended if required. ( Figure 28-1 )