Intussusception (Telescoping Bowel) mu bana batyetye ne bana batyetye: mbila ya ku maboko too ne ku tshiadi ne tshina tshia nzembu¶

Intussusception ke tshintu tshidi tshitamba kufikisha ku dikanga dia mala kudi bana batekete ne bana batekete badi pankatshi pa ngondo 3 ne ngondo 36: disama dia mu tshifu didi mua kunyanga muoyo mudi tshitupa tshimue tshia mala (misangu yonso ileum wa ku ndekelu kua mala makese) tshienda tshisesuka ne tshibuela munda mua tshitupa tshidi pabuipi (tshidi pabuipi) tshidi mua kukuluka bu mudi dikuluka teleskope, ukoka mishipa yende ya mashi ne mesentery mu tshijengu tshikole. Padi tshimanu tshia mala tshidi tshikuate tshienda tshikola, mashi adi apita mu mishipa adi apingana ne dienda dia mashi mu mishipa didi dijika, bienza tshijengu tshibi tshia diela dia mbila dia tshimpitshimpi, didi kadiyi mua kusankisha mudi muana ukoka binu biende bionso bibidi bikole ku tshiadi kunyima kua minite 15 anyi 20, bishintuluka ne bikondo bia ditalala, dipatuka dia kanyinganyinga, disama dia nsukadi anyi disama dia nsukadi dipanga dia makanda, dilonda pashishe kudi nsukadi ne nsukadi mikunzubile, misambakaja ne "currant jelly". Shi muana mutekete anyi muana mutekete udi wela mbila ya tshimpitshimpi, ukoka maboko ende ku difu, ulua mutekete anyi mukole bua kujuka pankatshi pa bikondo, utua bile bia muitu, anyi upitshisha mashi mu tshilamba tshiabu tshia kulala, ubikile muaba uudi musombele nomba ya tshimpitshimpi diakamue. Paudi muindile mashinyi, tangila buludiki budi butangila dikanga dia mala, hernie strangulated, ne volvulus, disama dia tshiadi ne disama dia mu tshitupa tshia kuinshi tshia ku dia balume, ne disama dia tshiadi, disama dia mu tshifu, ne dipanga dia mâyi mu mubidi.

Bu mudi tshimanu tshia mala mu intussusception wa kumpala tshitshidi ne muoyo, bana bapite pa 85 too ne ku 90 pa lukama badibu bondopa lukasa mu lupitadi ne radiologie wa bana badi mua kuikala ne mala abu adibu bangata ku teleskope bua kupingana bitekete bitekete pa muaba wawu mu minite mikese ku diambuluisha dia **ultrason- anyi fluoroscopy-guided pneumatic (air) anyi hydrostatic () ** enst kuepuka tshishiki dipanda dia mu difu. Kadi, kuindila kumbelu bua "tshintu tshia jelly wa cassis" kumueneka (tshimanyinu tshia ndekelu tshia disama dia mucose necrose) kudi kuenza bua mala adibu bashipe apatuke, ne adi afila disama dia lufu dia peritonite ne septic shock.

Enza nunku mpindieu¶

1. Ndaku diakamue ku tshibambalu tshia lupitadi tshidi pabuipi nebe anyi ubikile nimero ya lukasa ya muaba unudi. Ela 911 mu États-Unis ne mu Canada, 112 mu Union européenne mujima, 999 mu Royaume-Uni, 000 mu Australie, anyi tangila mukanda wetu wa nomba ya tshimpitshimpi. Shi kudi mushindu, ndaku buludiludi ku Lupitadi lua bana anyi ku lupitadi ludi ne bukole bua kuenza mudimu ne ultrason ne enema wa radiologique bua bana mu mêba 24, anyi ubikile ambulanse diakamue pikala muana mutekete, mutoke, munyanguke anyi wenda utua mâyi a matamba.
2. Lama muana mutekete anyi muana mutekete ku mishiku (NPO: KUENA mabele, mabele, mabele, mayi, Pedialyte, anyi biakudia bikole). Mifuba ya muana idi mikange bikole ne idi mua kulomba diakamue dipuekesha dia kapepe ka tshiamu tshia nzembu mu tshikondo tshia sedation anyi dipanda dia lukasa mu anesthésie générale. Kufila mayi anyi bya kudya mu tshifu tshidi tshibuikila kudi kuenza bua tshifu tshipatuke, kudi kubandisha tshifu pa mutu pa tshifu, ne kuvudija njiwu ya dipuekesha dia mikolo.
3. KUPEDI manga a kanyinganyinga, manga a diluisha disama dia tshiadi, manga a diluisha disama dia tshiadi (loperamide/bismuth), anyi enemas/laxatives ya ku nzubu. Kufila manga a ibuprofen, acetaminophen anyi ondansetron kudi kusokoka bimanyinu bia peritonitis, paudi uteta tshintu tshia ku nzubu tshia rectal, glycerin laxative, anyi OTC mu tshifu tshidi katshiyi tshimueneka udi mua kutapa tshitupa tshia mala tshidi tshifua.
4. Ela tshikondo tshia mbila mu telefone webe ne umvuija tshilejilu tshia "On-Off Switch" kudi munganga wa disungula. Bishilangane ne disama dia tshiadi anyi disama dia matshi mudi muana udila misangu ya bungi munkatshi mua mêba a bungi, intussusception udi ulonda mavuala a dikokangana dia munda (peristalsis) a mu bitupa bia munda: muana udi ufuma ku dinaya anyi kulala udi wela mbila ya tshimpitshimpi bua kumukoka tshiadi ne kikoba tshitoke mu minite 2 to ne ku 5, pashishe udi ulekela kudila mu tshimpitshimpi bu muvuabu batuadije ne udi ulua mutoke, ne tuishi, ne mutshioke munkatshi mua minite 10 to ne ku 30 kumpala kua tshipupu tshidi tshilonda kulua.
5. Lama tshilamba tshia muana tshidi ne bukoya mu tshibombi tshia plastique ne ulue natshi mu nzubu wa lupitadi lua lukasa. Nansha mudi tshintu tshia munda katshiyi tshimueneka bu mashi makunze anyi "jelly wa cassis," too ne ku 70 pa lukama ya bilamba bia mu tshiadi bidi mu intussusception bidi bipeta mashi a muinshi mua buloba (guaiac positive) adi afumina ku disama dia tshimpitshimpi dia lukasa, didi difila munganga tshijadiki tshia lukasa tshia ku luseke lua bulalu.
6. Adimuija bena mudimu ba lukasa lukasa pikala muana mulale tulu, kayi ne tshia kuenza, anyi mutangile anu patoke ("Lethargic Intussusception"). Mu 10 too ne ku 20 pa lukama ya bana batekete, peptides ne cytokines idi mifuanangane ne opioïde idi mipatuka kudi tshikebelu tshia ischémie tshia mu tshifu nepotologique mukole, hylothargie (hyloppineness), ne pinfloppinie balongi kumpala kua bimanyinu bia mu difu anyi mashi a mu tshifu kumueneka, misangu ya bungi bifikisha baminganga ku diamba bibi ne: muana udi ne disama dia meningitis, dia sepsis, dia post-ictal seizure, anyi dia didia dia manga ku mpukapuka pa kumbusha padibu benza ultrason wa mu difu.

Mutshi wa mapangadika: kukonkonona mbila ya bana batekete, dipanga dia makanda, diela dia mabele, ne intussusception¶

flowchart TD
    Start["Muana mutekete anyi muana (nangananga wa ngondo 3 too ne ku 36) udi ne mbila ya tshimpitshimpi, udi utua mikemu, udi upanga bukole anyi udi ne mashi"] --> GreenVomit{"Muana udi wela bile wa vert mutoke anyi wa jaune-vert (Bilious Vomiting), NANSHA udi uleja difu dikole anyi tshipupu?"}

    GreenVomit -->|"EYOWA: DISHIPA DIA MUDIMU / VOLVULUS NANSHA DISHINTULULA DIA NECROTIC"| Emergency["MUSHINDU WA LUPILU WA MUOYO: Bikila ku 911 / 112 / 999 Diakamue, Strictly NPO, IV Fluid Resuscitation & Pediatric Surgery"]

    GreenVomit -->|"NO: Tangila Paroxysmal Screaming & Lethargy Pattern"| PatternCheck{"Muana udiku ne mbila ya minite 2-5 idi ikoka binu ku tshiadi kunyima kua minite 15-30 yonso, dipanga dia lungenyi dikole didi kadiyi diumvuika pankatshi pa bipupu, disama dia mu difu dia ku dia balume, NANSHA mashi/mutoyi mu tshifu anyi?"}

    PatternCheck -->|"EYOWA ku tshimanyishilu tshionso: KUDI BUALU BUA KUDIMUENA"| Ultrasound["Tshibambalu tshia malu a mpukapuka tshia mu lupitadi tshia lukasa: NPO, Lama diaper, Immediate Bedbed Abdominal Ultrasound (Look to Target / Bull's-Eye Sign)"]

    PatternCheck -->|"NO: Kudila kua matuku onso > mêba 3 mu muana wa muana < ngondo 4, kuikala mudimuke bimpe, tshisuku tshiakane, kakuyi diela"| OtherCheck["Tangila ni Infantile Colic, Hair Tourniquet, Corneal Abrasion, Otitis Media, anyi Incarcerated Inguinal Hernia (Misangu yonso umbusha diaper bua kutangila tshiadi.)"]

    Ultrasound --> Reduction["Intussusception mujadikibue kakuyi dipanda anyi peritonite: IV Fluid Bolus + Radiologic Pneumatic (Air) anyi Hydrostatic (Saline) Enema Reduction (85-90% Success Without Surgery)"]

Pathophysiology: mushindu kayi udi mala atangila ne bua tshinyi adi ashipa mashi ende¶

Intussusception udi wenzeka padi tshitupa tshia pabuipi tshia mu tshifu (tshidibu babikila ne: intussusceptum) tshikuata kudi tshipepele tshia dikokangana dia tshifu (peristalsis) ne tshienda tshiya kumpala munda mua lumen wa tshitupa tshia mu tshifu tshidi pabuipi apu (tshidibu babikila ne: intussuscipiens).

ANATOMY OF ILEOCOLIC INTUSSUSCEPTION (90% OF ALL PEDIATRIC CASES)

   Proximal Small Bowel                          Distal Large Bowel
   (Terminal Ileum)                              (Ascending Colon)
   "THE INTUSSUSCEPTUM"                          "THE INTUSSUSCIPIENS"
   (Invaginates Inside)                          (Outer Receiving Sleeve)
            |                                             |
            v                                             v
   ====================\                    +===========================
                        \                   |  ===================
    Normal Lumen  --->   \==================|=>  TELESCOPED APEX  ===>
                        /  [Trapped Mesentery|   ("Lead Point": Swollen
   ====================/    & Blood Vessels] |    Peyer's Patch Lymph)
                                            +===========================
                                                          |
   CROSS-SECTION ON ULTRASOUND:                           v
        ( ( (  O  ) ) )                   1. Venous & Lymphatic Compression
   "TARGET SIGN" or "DOUGHNUT SIGN"       2. Bowel Wall Edema & Mucus Outpouring
   (Concentric alternating rings of       3. Arterial Strangulation & Mucosal Sloughing
    outer & inner bowel walls)               ("Currant Jelly" Blood + Mucus Stool)
                                          4. Transmural Necrosis & Perforation (24-72 hrs)

1. Bua tshinyi bana ba ngondo 3 too ne ku 36 batu bapeta disama dia "Idiopathic" Ileocolic Intussusception (90% ya bilumbu)¶

Mu 90 pa lukama ya bilumbu bidi bienzeka pankatshi pa ngondo 3 ne bidimu 3 (ne tshipimu tshinene tshidi pankatshi pa ngondo 5 ne 9), dipima dia bintu didi dienzeka ku tshiamu tshia ileocecal mudi ileum wa ndekelu mukese udisangisha ne cecum munene ne colon udi ubanda (intusception ileocolique). - The Viral "Peyer's Patch" Trigger: Bua tshinyi muana wa ngondo 7 udi ne makanda a mubidi udi utangila mala ende mu tshimpitshimpi? Tshimanu tshia tshifu tshia muana tshidi tshiuwule tente ne bitupa bia mubidi wa lymphoïde bidibu babikila ne: Peyer's patches. Matuku makese kunyima kua disama dia mu tshiadi tshia kuulu (adenovirus) anyi tshipupu tshia mu tshifu (gastroenteritis), anyi imue misangu mu matuku 1 anyi 7 kunyima kua dipeta dia kumpala anyi dibidi dia dikuba dia rotavirus, bitupa ebi bia Peyer bidi bivula munda mua tshimanu tshia mala bua kuluisha tshipupu. - Mushindu udi tshitupa tshia lymphe tshidi tshiuwule tshienza mudimu bu "Lead Point": Mavuala a peristaltique a muana adi apangadika ne: tshitupa tshia Peyer tshidi tshipatuka tshidi tshiuwule bu tshitupa tshia biakudia ne adi ateta bua kutshikoka kumpala mu tshitupa tshia digestion, tshikoka tshimanu tshijima tshia terminal ileum pamue natshi kupitshila ku ileum wa dia balume mu valve colon.

2. Padi "Tshintu tshia kumpala tshia disama" tshilelela tshikale tshilema (Bana < 3 months or > 3 too ne ku 5 bidimu)¶

Padi intussusception wenzeka pambelu pa tshikondo tshia bidimu 3 too ne ku 36 (nangananga kudi bana bapite pa bidimu 3 too ne ku 5 anyi batshidi muinshi mua ngondo 3), anyi padibi bipingana misangu ya bungi, baminganga badi bakeba Pathologic Lead Point (PLP) udi ukoka munda mua mala: - Meckel's diverticulum (tshitupa tshia kumpala tshia bana, tshidi tshipatuka mu mala makese), - Henoch-Schonlein Purpura (IgA Vasculitis) udi ukebesha submucosal hematoma mu tshimanu tshia mala makese (pa tshibidilu ileo-ileal intussusception; tangila Henoch-Schonlein purpura ne IgA vasculitis), - Bipupu bia mu mala (bipupu bia bana batekete anyi disama dia Peutz-Jeghers), - Disama dia mu mala (disama dia Burkitt) kudi bana ba bidimu bipite pa 5 too ne ku 6, - Cystic fibrosis (meconium/fecal plugs mu tshitupa tshia ndekelu tshia ileum), anyi intestinal duplication cysts.

3. Tshikondo tshia 4-stage vascular strangulation cascade¶

Padibu bakoka mala a munda (intussusceptum) munda mua tshilamba tshia pambelu (intussuscipiens), tshitupa tshia mashi tshidi tshienza bu tshipepele (mesentery) tshidi tshikoka ne tshikuata bikole pankatshi pa bimanu bibidi bia mala: 1. Tshitupa 1 - Dipangisha dia mashi ne mashi (Mêba 1 too ne ku 12): Bu mudi mashi ne mashi adi ne bimanu bitekete, bidi ne bukole bukese, badi babanji kufina. Mashi a mu mishipa kaena mua kupatuka mu mala adibu baleje ne teleskope to, adi afila dibutuka dinene ne difu (edema) didi dikanga teleskope bikole menemene ne kadiena kabidi mua kupatuka nkayadi to. 2. Tshitupa 2 - Goblet Cell Mucus Outpouring + Capillary Bleeding ("Currant Jelly"): Padi tension wa mu mishipa wenda ubanda, selile ya goblet idi mu tshitupa tshia mala tshidi tshipuekesha luya idi ipatula mucus mutoke mukole padi mishipa ya mucose idi miule tente itshibuka ne ipatula mashi mu lumen. Bisambakaja pamue ne bipatuka mu tshiadi, mashi aa makunze ne mutoyi wa gelatine bidi bienza "currant jelly" stool. 3. Tshitupa 3 - Ischemie artérielle & Mucosal Necrosis (Mêba 12 too ne 36): Divulangana didi divula kupita tension wa mu mishipa, dikosa oxygène mupiamupia ku tshimanu tshia mala. 4. Tshitupa 4 - Gangrene transmural, Perforation, & Septic Shock (Hours 24 to 72): Tshimanu tshia mala tshidi tshifua tshidi tshipatuka, tshipatula bactérie ya mu tshifu (peritonitis), tshikebesha hypovolemic ne septic shock.

Kumanya intussusception vs. gastroenterite, infantile colic, ne meningitis¶

Bu mudi intussusception misangu ya bungi ulonda mashika a virus anyi tshipupu tshia mu tshifu ne utuadija ne kudila ne dibutuka dia tshitupa tshîpi kumpala kua mashi kumueneka mu tshifu, udi umue wa ku malu a tshimpitshimpi adibu batamba kujingulula bibi mu malu a bana.

Tablo wa difuanyikija dia malu a luondapu: Intussusception vs. Viral Gastroenteritis vs. Infantile Colic vs. Incarcerated Hernia¶

Buteyi bua "Lethargic / Encephalopathic Infant" (Bua tshinyi intussusception udi ufuanangana ne Meningitis anyi Overdose)¶

Tshimue tshia ku bintu bia mushinga mukole bia mu lupitadi mu malu a luondapu lua lukasa lua bana ntshia se: bana batue ku 10 anyi 20 pa lukama badi ne disama dia intussusception badi ne "Painless or Lethargic Intussusception": - Padi tshifu tshia muana tshilua tshikole, tshifu tshidi tshipatula endorphines endogènes (opioïdes peptides) ne cytokines inflammatoires mu mashi. - Mu muana wa ngondo 5 too ne ku 10, manga aa adi afumina munda adi enza mudimu buludiludi mu buongo bu dose wa morphine: muana udi ufika mu nzubu wa luondapu mutekete (hypotonique), mutoke, mulale tulu (mukole bua kujuka), ne mêsu a nsongo anyi matekete ne mupuya mukese, imue misangu kumpala kua tshitupa tshimue tshia mashi tshidi tshimueneka anyi tshidi tshimueneka kudila kudi kumueneka. - Baminganga batu misangu ya bungi benza dipanda dia mu tshiadi (dipanda dia mukolo) bua disama dia meningitis, batu balomba bua kuenza CT wa mutu bua kumanya disama dia mutu, anyi bafila manga a naloxone bua disama dia opioïde kumpala kua kumanya ne: muana udi ne mala a teleskope. Muana yonso udi ne disama dia tshimpitshimpi didi kadiyi diumvuika, dishintuluka dia lungenyi, anyi dinyanguka dia tshimpitshimpi udi ne bua kuenza ultrason wa mu difu dia minite 2.

Dimanya dia mu lupitadi: tshiamu tshia ultrason "tshimanyinu tshia tshipatshila" (bujalame bua 98% too ne ku 100%)¶

Paudi ufika ku tshibambalu tshia malu a mpukapuka, tshikebelu tshia mushinga mukole tshia disama dia intussusception ntshia lukasa, katshiyi tshisama, katshiyi ne radiation Abdominal Ultrasound:

ULTRASOUND APPEARANCE OF INTUSSUSCEPTION (SENSITIVITY 98% TO 100%)

1. TRANSVERSE VIEW (Cross-Section):        2. LONGITUDINAL VIEW (Side Profile):
   "THE TARGET SIGN" / "BULL'S-EYE"           "THE PSEUDOKIDNEY SIGN"
   or "DOUGHNUT SIGN"                         or "SANDWICH SIGN"

          . - = = = - .                        +-----------------------------+
      . '   . - = - .   ' .                    | Outer Bowel Wall (Hypoechoic|
    /     /   . - .   \     \                  +-----------------------------+
   |     |   | (O) |   |     |                 | Echogenic Mesenteric Fat    |
    \     \   ' - '   /     /                  | & Trapped Blood Vessels     |
      . '   ' - _ - '   ' .                    +-----------------------------+
          ' - _ _ _ - '                        | Inner Invaginated Bowel     |
   (Diameter > 2.5 to 3.0 cm;                  +-----------------------------+
    Concentric alternating rings               (Layered tubular appearance
    of edematous bowel walls &                  resembling a kidney in the
    bright central mesenteric fat)              right upper abdomen)

• Bua tshinyi bimfuanyi bia mu tshifu kabiena bikumbane to: Bimfuanyi bia mu difu bidi bikumbane too ne ku 25 too ne ku 50 pa lukama bia bantu badi ne disama dia intussusception dia kumpala. Badi balomba bua kuenza rayon X patupu nangananga pikala munganga wela meji ne: kapepe ka munda mua tshifu (dibutuka) kumpala kua kuteta bua kukepesha enema.
• Tshidi ultrason wambila munganga wa radiologie ne munganga wa dipanda:
• Udi ujadika Tshipatshila / Tshimanyishilu tshia Bull's-Eye (pa tshibidilu > 2.5 cm mu bule bua pambelu mu difu dia balume, pa kumona < 1.5 cm mu intussusceptions ya tshitupa tshîpi ya mu mala makese idi ijika nkayayi).
• Udi utangila Dienda dia mashi dia Color Doppler munda mua tshimanu tshia mala tshidi ne teleskope ne ukeba mashi adi makuate pankatshi pa bipese anyi mayi a mu tshifu adi kaayi ne tshintu.

Buondapi bua mu lupitadi: kabuyi bua dipanda, dipuekesha dia enema wa mu mikolo anyi wa mu mâyi¶

Kumpala kua kutuadija kuteta bua kukepesha, kasumbu ka malu a mpukapuka kadi kateka mulongo wa mu mishipa (IV), kafunda laboratoire ya nshindamenu, kafila bolus wa mâyi a mu mishipa (20 mL/kg wa 0.9% Normal Saline anyi Lactated Ringer's) bua kulongolola dipanga dia mayi mu tshitupa tshisatu, udi ulengeja tshifu ne tshiamu tshia nasogastrique pikala muana wenda unyunguluka, ne udimuija tshisumbu tshia baminganga ba bana bua kuimana pabuipi.

1. Tangila bintu bisatu bidi kabiyi biumvuangane ne dipuekesha dia enema¶

Enema wa radiologique kena ne tshia kuenzeka nansha kakese pikala tshimue tshia ku bimanyinu bisatu bidi bilonda ebi tshimueneka (bana aba badi baya bululuka mu nzubu wa dipanda bua kuenza laparotomie): 1. Pneumoperitoneum (Kapepe ka tshianana mu difu pa X-ray): Udi uleja ne: mala mmamane kupatuka. 2. Peritonitis wa mu lupitadi: Difu dikole, bu mabaya, ditekete dikole didi dileja ne: mala adi mafue anyi adi ne mputa. 3. Tshipupu tshia septique anyi tshia hypovolemique tshidi katshiyi tshishindame tshidi katshiyi tshishindama lukasa ne dipingaja dia mayi mu mushipa.

2. Mushindu udi dipuekesha dia enema didi kadiyi dia dipanda dienza mudimu (85% too ne ku 90% dia ditanta)¶

Shi kakuena dibutuka anyi disama dia mu tshifu, munganga wa bana udi wenza mudimu wa diondapangana Ileocolic Enema Reduction mu tshiamu tshia fluoroscopie anyi tshia ultrasons: - Tshiamu tshia katetere tshitekete tshidi tshiteka bitekete bitekete mu tshiadi tshia muana ne mataku adi alamakaja pamue bua kuenza tshimanyishilu tshimpe. - Mushindu A - Pneumatic (Air) Enema under Fluoroscopy: Lupepele lua luondapu ludi lubueja bitekete bitekete mu tshifu padi munganga wa tshiamu tshia nzembu utangila ku tshiamu tshia X-ray tshia dose mikese, kayi ulekela nansha kakese ne: tension wa munda mua tshifu upita 80 too ne ku 120 mmHg. Tshilamba tshia kapepe tshidi tshisaka ileum mutangile kunyima kupitshila mu tshitupa tshia munda tshidi tshipita ne tshidi tshibandila too ne paditshi tshipingana mu tshitupa tshia ileocecal valve mu ileum wa ndekelu (tshidi tshijadikibua ku dimona dia kapepe kapingana mu mala makese). - Mushindu B - Hydrostatic (Warm Saline or Water-Soluble Contrast) Enema under Ultrasound: Warm normal saline muele ku bule bua 3 feet (90 too ne ku 100 cm) pa mutu pa mesa udi ubuela bitekete bitekete mu tshifu muinshi mua dimona dia ultrason mu tshikondo tshia bushuwa (zero radiation) too ne padi tshipatshila tshijima tshijika ne mu mâyi a mukele adi kaayi ne kale ileocecal valve mu ileum wa ndekelu. - Ntshinyi tshienzeka pikala diteta dia kumpala dienda anu tshitupa tshia mala? Shi muana ushala mushindame kayi ne disama dia peritonite ne enema wa kumpala ukepesha ndambu wa intussusception, mikenji idi ifila lungenyi lua diteta dia enema dipingaja dia matuku a bungi (kuindila minite 30 too ne ku meba 2 bua kuvula kua mala mu tshitupa tshia mala kumpala kua kuteta musangu muibidi anyi musangu muisatu udi kayi ne njiwu udi usungila bana ba bungi ku dijinga dia dipanda.

3. Padibu dijinga ne dipanda (Laparoscopie anyi Laparotomie) (10% too ne ku 15% ya bilumbu)¶

Shi dipuekesha dia enema wa tshiamu tshia nzembu kadiyi dikumbane anyi kadiyi mua kupingaja munda mua mala kupitshila ku tshiamu tshia ileocecal, munganga wa bana udi uya ne muana mu nzubu wa dipanda: - Dikepesha dia ku bianza (Njila wa Cope): Ku diambuluisha dia dipanda dikese dia kuinshi dia ku dia balume anyi laparoscope, munganga udi ufina ("mabele") bitekete bitekete tshitupa tshia ku mutu tshia intussusception panyima (kakukoka nansha kakese ileum wa pabuipi, udi mua kutshibula mala adi matekete). - Dikosolola dia mala: Shi mala adibu bamone ne teleskope adi ne gangrene/necrotic, manyanguke, anyi adi afumina ku tshintu kampanda tshidi tshinyanguka (bu mudi: diverticulum wa Meckel anyi polyp), munganga udi umbusha tshitupa tshidi tshinyanguke ne ulamakaja kabidi bitupa bidi bimpe.

Mulongo wa dikonkonona dia ku luseke lua bulalu bua baledi ne baminganga: dikonkonona dia dipanga dia mâyi mu mubidi, dibuela dia mashi mu mashi, ne bimanyinu bia mu difu¶

Padibu baya ne muana mutekete anyi muana mutekete udibu bela meji ne: udi ne disama dia intussusception ku tshibambalu tshia malu a mpukapuka tshia mu lupitadi, baminganga ne baledi badi ne bua kulonda bimpe mushindu udi mashi enda ne mushindu udiye wenda ukola mu difu kabayi bamufina bikole pa difu:

• Tangila dîba dia diuja dia kapila ne dibuela dia mashi mu dikoba: Fina bitekete bitekete munkatshi mua difu dia muana (sternum) anyi mpala wende munkatshi mua masekonde 5 ne uleke. Dikala didi ne tshia kupingana mu muinshi mua masekonde 2. Dikumbaja dia kapila dia 3 sekonde anyi kupita apu, bitupa bia mubidi bidi ne mabala mashika, anyi dikoba dia tshitoke didi dileja ne: tshifu tshidi tshibuikila tshidi tshiela plasma wa bungi ("tshitupa tshia busatu") mu tshimanu tshia tshifu ne mu tshifu, bienza bua hypovolemic shock ikale kumpala.
• Tangila dikuma dia mutshima ne mushindu wa kupuyakana: Dikuma dia mutshima mu dikisha dia pa mutu pa 160 too ne ku 180 mu minite mu muana mutekete (nansha pankatshi pa bikondo bia kudila padi muana mulale talalaa) ntshimanyinu tshinene tshia dijimija dia mayi, disama dia mala, anyi disama dia sepsis.
• Tangila dikala dia nsukadi pa tshilamba tshitoke: Misangu yonso kuata anyi tangila nsukadi pa tshilamba tshitoke anyi tshilamba tshitoke.
• Mabele/biakudia bitoka, bitoka, anyi bia jaune: Difuisha dia kumpala didi difumina ku dikola dia mijilu ya mu tshiadi padibu bakoka tshitupa tshia munda tshia mubidi.
• Mashi a tshisuku tshia lime anyi a tshisuku tshifiike tshia epinard (Bilious Vomiting): Bidi bileja dikanga dia mala dijima kuinshi kua ampulla wa Vater; manyisha munganga wa tshikebelu diakamue paudi ufika.
• Tangila tshilamba tshia kulala ne ubala tshilamba tshia kulala tshidi ne mâyi mu mêba 12 adi mapite: Umbusha tshilamba tshia kulala tshijima mu tshikondo tshia tshikebelu, bua kutangila tshifu bua kumanya ni kudi mashi adi kaayi malelela anyi mu tshisuku tshia "currant jelly" tshikunze tshifiike, ne bua kukonkonona bipese bia mu tshiadi ne tshia mu tshifu/mu tshiadi bua kujadika ne: muana kena ne disama dia tshiadi tshia mu tshiadi to.
• Keba tshimanyishilu tshia Dance ne tshitupa tshia kuulu tshia ku dia balume tshiuwule: Padi muana udiumvua bimpe pankatshi pa mbila, munganga udi ulenga tshifu bitekete bitekete utu umvua tshintu tshikole, tshitekete, tshikosa **"mu tshimfuanyi tshia sosise" mu tshitupa tshia kuulu tshia ku dia balume anyi munkatshi mua tshitupa tshia kuulu tshia ku dia balume (udi telescope munda mua tshifu colon transverse), udi ulonda kudi diumvua dia munda mutupu, dia munda mutupu mu tshitupa tshia kuinshi tshia dia balume (tshimanyinu tshia Dance) bualu tshitupa tshia cecum ne tshia ileocecal mbikokibue kuulu pambelu pa muaba watshi wa pa tshibidilu.

Nomba ya tshimpitshimpi ya mu tshijengu ne mikenji ya bibambalu¶

Intussusception udibu bela meji ne: udi ne bua kuikala ne lutatu lua bungi mu malu a dipanda dia bana ne a tshiamu tshia nzembu:

• Etats-Unis ne Canada: Ela 911 anyi ndaku diakamue ku Tshibambalu tshia malu a mpukapuka a bana / Lupitadi lua bana (bu mudi nzubu ya diambuluisha dia lukasa lukasa ya mu tshimenga ne nzubu ya bungi ya bantu bakole idi kayiyi ne munganga wa bana bua kuenza mudimu wa dipuekesha dia enema wa kapepe anyi wa mâyi a mukele). Bilombola bilondeshela Tshilongelu tshia bena Amerike tshia malu a bana (AAP) ne Tshilongelu tshia bena Amerike tshia dipanda dia bana (APSA) mikenji ya luondapu.
• Royaume-Uni: Tela 999 anyi ndaku buludiludi ku lupitadi Tshibambalu tshia malu a mpukapuka a bana (A&E). Muinshi mua NICE Acute Abdominal Pain ne Royal College of Surgeons / BSPED protocoles, bana badi ne disama dia tshiadi anyi badi bela meji ne: badi ne disama dia tshiadi badi ne bua kuenza diakamue luondapu lua bana ne lua radiologie.
• Buobumue bua matunga a ku Mputu: Ela 112. Bilombola bilondeshela mikenji ya Société européenne de radiologie pédiatrique (ESPR) ne Association européenne des surgeons pédiatriques (EUPSA).
• Australie ne Nouvelle-Zélande: Ela 000 mu Australie anyi 111 mu Nouvelle-Zélande. Bilombola muinshi mua Royal Children's Hospital (RCH) Melbourne Clinical Practice Guidelines for Intussusception.
• India ne Asia-Pacific: Ela 112 (anyi 108 mu Inde), 995 mu Singapour, 119 mu Japon ne mu Corée du Sud, anyi 999 mu Malaysie ne mu Hong Kong. Enda ku lupitadi lua mushinga mukole ne ultrason wa bana wa mêba 24 ne dipanda dia bana.

Nkonko itubu bela misangu ya bungi¶

Bua tshinyi muana udi ne disama dia intussusception udi wela mbila kunyima kua minite 15 anyi 20 ne pashishe wenza malu mupuwe anyi mulale munkatshi mua minite?¶

Mala makese a muntu adi akola mu mavuala (peristalsis) kunyima kua minite 15 anyi 20 bua kuya ne biakudia kumpala. Mu intussusception, dîba dionso didi mutoyi wa peristaltique ututa tshitupa tshia mala tshidi tshitangile ku teleskope, udi ufinya bikole mala adi makuate ne ukoka tshitupa tshia mala tshidi ne mijilu ya bungi, wenza minite 2 anyi 5 ya disama dikole dia colique mudi muana wela mbila ne ukoka binu bionso bibidi ku tshiadi tshiende. Padi tshipepele tshia dikokangana tshipita, disama didi dijika bua tshitupa tshîpi, dishiya muana mutoke, mutoke, ne mutshioke anyi mutshioke bikole too ne padi tshipepele tshia peristaltique tshidi tshilonda tshifika minite 15 pashishe.

Bua tshinyi disama dia tshiadi didi mua kuenza bua muana amueneke bu udi ne disama dia meningitis anyi disama dia mu buongo?¶

Mu bilumbu bitue ku 10 too ne ku 20 pa lukama, tshimanu tshia mala tshidi katshiyi ne oxygène tshidi tshipatula bungi bunene bua peptides (endorphines) ne cytokines inflammatoires mu mashi a muana. Bintu ebi bidi bienza mudimu mu buongo bua muana bua kumufikisha ku dipanga bukole, ku dipanga dia misunya (dipanga dia bukole), ku dimona dia tshianana, ne ku mêsu makese, imue misangu kumpala kua muana kupitshisha mashi mu tshifu anyi kuleja disama dia mu difu didi dimueneka patoke. Baminganga batu babikila bualu ebu ne: "disama dia mu lungenyi anyi dia dipanga dia lungenyi," ne ultrason wa lukasa wa ku luseke lua bulalu udi uleja diakamue dikanga dia mala disokoka.

"Cassis jelly stool" udi umueneka mushindu kayi, ne bana bonso badi ne disama dia intussusception badi nadi anyi?¶

Tshitanda tshia jelly wa currant tshidi tshimueneka bu jam wa gelatine mukunze anyi wa maroon musambakaja mu tshilamba tshia kulala. Bidi bienzeka padi dikanga dia mijilu munda mua mala adibu baleje ku teleskope dienza bua tshitupa tshia munda tshia mala tshipatuke ne tshipatuke mashi mu bitupa bia munda bia mala bidi bipatuka mu selile ya goblet. Ino, bana batyetye pa 25 to ne ku 50 pa lukama batu ne tuishi tua currant jelly tudi tumueneka padibu bafika mu nzubu wa lupitadi lua lukasa bualu ntshimanyinu tshia ndekelu tshia disama dia mucose ischémie; Kuindidi nansha kakese bua kumona mashi mu tshilamba tshia kulala kumpala kua kuya ku lupitadi.

Mmunyi mudi enema wa kapepe anyi wa mâyi a mukele mua kulongolola mala a teleskope kakuyi dipanda?¶

Mu tshikondo tshia dipuekesha dia enema ku diambuluisha dia ultrason anyi dia rayon X, munganga wa bana udi uteka tshintu tshipepele mu tshifu tshia muana ne ubueja bitekete bitekete kapepe ka luondapu (enema pneumatique) anyi mâyi a mukele a kapia (enema hydrostatique) mu mala manene. Mulongo wa kapepe anyi wa mayi udi unyunguluka ku nsongo ya mala makese bu piston, unzulula teleskope kunyima kupitshila mu mala too ne padiye upingana muaba wende wa pa tshibidilu. Mudimu ewu udi kauyi wa dipanda udi ukumbana kudi bana 85 too ne ku 90 pa lukama padibu bawenza kumpala kua dîba.

Dikuba dia rotavirus anyi disama dia mashika dia pa tshibidilu didi mua kufikisha ku disama dia tshiadi anyi?¶

Misangu ya bungi ya disama dia mu tshifu didi difumina ku disama dia mu mikolo (bu mudi adenovirus) anyi disama dia mu tshifu didi dienza bua tuzubu tua mu tshifu tudi munda mua tshimanu tshia munda mua mala makese (bipese bia Peyer) tuvula ne tuenza mudimu bu "tshintu tshia kumpala" tshidi tshikokibua mu tshifu. Dikuba dia rotavirus dia ku mishiku didi ne njiwu mikese menemene (pabuipi ne muntu 1 anyi 5 wa pa mutu pa bana 100 000 badibu batue, nangananga mu matuku 7 a kumpala kunyima kua dikuba dia kumpala anyi dibidi), eku dipangisha binunu bia bantu bua kubuela mu lupitadi bua dipanga dia mâyi mu mubidi dia rotavirus; baledi badi anu balomba bua kutangila kudila kua binu too ne ku tshiadi mu lumingu ludi lulonda dikuba dia mubidi.

Intussusception udi mua kuenzeka kabidi kunyima kua bamane kumulongolola anyi?¶

Eyowa. Intussusception udi upingana mu bana batue ku 8 too ne ku 12 pa lukama kunyima kua dipuekesha dia enema wa kapepe anyi wa mâyi a mukele, ne pabuipi ne tshitupa tshia dipingana edi didi dienzeka mu mêba 24 anyi 72 a kumpala eku tshitupa tshia lymphoïde tshidi tshiuwule mu tshimanu tshia mala tshitshidi tshienda tshikepela. Shi mbila ya tshijengu, kuimana ku maboko too ne ku tshiadi, dibutuka, anyi dipanga dia lungenyi dipingana diakamue ku tshibambalu tshia malu a mpukapuka, bilumbu bidi bipingana bidi mua kukepeshibua kabidi ne enema mukuabu, nansha mudi dipingana dia misangu ya bungi dilomba bua kukonkonona tshintu tshidi tshilombola bu mudi diverticulum wa Meckel.

Miaba ne buludiki bua mbulamatadi¶

• Tshilongelu tshia bena Amerike tshia malu a bana (AAP) ne tshisumbu tshia bena Amerike tshia dipanda dia bana (APSA, États-Unis): Mibelu ya malu a luondapu ne bipeta bia dipanda dia bana badi ne disama dia ileocolic Intussusception.
• Royal Children's Hospital (RCH) Melbourne (Australia): Clinical Practice Guideline: Intussusception, Emergency Assessment, Ultrasound Target Sign, and Pneumatic Enema Reduction.
• Bulongolodi bua malu a bukola bua mubidi pa buloba bujima (OMS): Disama dia munda dia bana batekete ne bana: Disama, Dileja dia mu lupitadi ne Dilombola, Mushindu wa kumona malu pa buloba bujima.
• Tshilongelu tshia ditunga tshia malu a bukola bua mubidi ne a dilama dia bana (NICE) ne tshilongelu tshia bukalenge tshia malu a bana ne makanda a mubidi a bana (RCPCH, Royaume-Uni): Dimanya ne disungula dia disama dia mu mala dia bana ne disama dia tshiadi.
• Société européenne de radiologie pédiatrique (ESPR): Mibelu ya dikonkonona dia ultrason ne dipuekesha dia disama dia intussusception kudi bana.

Malu adi apetangana¶

• Dikanga dia mala, disama dia tshiadi tshikole, ne bimanyinu bia tshimpitshimpi bia volvulus
• Henoch-Schonlein purpura (IgA vasculitis), palpable purpura, ne intussusception triage
• Pyloric stenosis, projectile non-bilious vomiting, ne metabolic alkalosis
• Disama dia tshiadi, tshiadi tshitapuluke, tshiadi tshia munda, ne disama dia mu tshitupa tshia kuinshi tshia ku dia balume
• Disama dia tshiadi, disama dia mu tshifu, ne dipanga dia mâyi mu mubidi