Intussusception (Telescope Bowel) mu bana b’inzoya n’abakiri bato: Gusemerera kuva ku mavi gushika ku gikiriza n’ugusemerera kw’ibitoke vy’umukara¶

Intussusception ni co kintu gisanzwe gitera ubuzibuzi bw’amara mu bana b’inzoya n’abakiri bato bari hagati y’amezi 3 n’amezi 36**: ikibazo c’inda gishobora gutuma umuntu apfa aho igice kimwe c’amara (hafi y’igihe cose igice c’amara ( terminal ileum c’amara mato) kigenda kija hasi ( nk’uko nyene telesikope ishobora gusenyuka, ikwegera imitsi yayo bwite y’amaraso n’igihimba c’irondoka mu mpeta igumye. Uko uruhome rw’amara rwafashwe ruvyimba, amaraso yo mu mitsi arasubira hejuru kandi imitsi y’amaraso iranyiganyiga, bikaba bituma haba uruzitiro ruteye ubwoba rwo gusemerera kw’agahomerabunwa, kudahumurizwa aho umwana akwegera amavi yompi ashikamye ku gikiriza buri minota 15 canke 20, sile alternativing periods** urushe, canke ubunebwe bukomeye bw'imitsi**, hanyuma hakaza gukorora n'ugusesa amaraso "currant jelly" bivanze n'umutuku mwiza. Iyo uruyoya canke umwana mutoyi yerekanye induru zitunguranye, akakwegera amavi yiwe ku nda, akagira ububabare budasanzwe canke akagorwa no kuvyuka hagati y’ibihe, akaruha amaraso y’icatsi kibisi, canke akarenga amaraso mu mpuzu yiwe, hamagara abo mu karere iwanyu . inomero z'ivyihutirwa ubwo nyene. Mu gihe urindiriye gutwara, nusubiremwo ubuyobozi bujanye n’ivyo ku ubuzibuzi bw’amara, ububabare bw’amaraso, n’ububabare bw’amaraso, appendicite n'ububabare bwo mu gice co hasi c'iburyo, na ubumara bw’ibifungurwa, indwara y’ibihaha, n’ukubura amazi mu mubiri.

Kubera ko uruhome rw’amara mu gihe c’ugutera imbere rukiriho, abana barenga 85 gushika ku 90 kw’ijana bavuwe vuba cane mu bitaro bikoresheje ubuhinga bwa radiologie y’abana barashobora gusubirwamwo buhoro buhoro mu mara yabo mu minota mikeyi hakoreshejwe ubuhinga butabagwa ultrasound- canke hydroscopy-gust (sa) enema, kwirinda rwose kubagwa mu nda. Ku rundi ruhande, kurindira muhira ko "amavyi y'umunyu w'umukara" abonekera (ikimenyetso c'inyuma c'ugupfa kw'umubiri) bituma amara yanyozwe ashobora gutoboka, bikaba bitera peritonite yica n'uguhungabana kw'amaraso.

Ivyo ubikore ubu¶

1. Genda mu bitaro biri hafi bijejwe ivy’ubuvuzi vyihutirwa ubwo nyene canke uhamagare inomero y’ubuvuzi bw’ivyihutirwa yo mu karere kawe. Hamagara kuri 911 muri Leta Zunze Ubumwe za Amerika no muri Canada, 112 mu bihugu vyose vy’Ubumwe bw’Uburaya, 999 mu Bwongereza, 000 muri Australiya, canke urabe urutonde rwacu rw’ibihe vyihutirwa inomero z'ivyihutirwa. Niba bishoboka, genda ubwo nyene ku Bitaro vy’Abana canke ku bitaro bifise ubushobozi bwo gukora amasaha 24 y’ubuvuzi bw’abana n’ubuvuzi bw’amajwi, canke uhamagare ambulance ubwo nyene iyo umwana afise ubunebwe, afise ibara ry’agahama, afise ububabare bw’umubiri, canke ariko araruka amazi y’icatsi kibisi.
2. Gumana uruyoya canke umwana muto ataco akora mu kanwa (NPO: NTA mata, amata y’abana, amata y’ibere, amazi, Pedialyte, canke ivyokurya bikomeye). Amara y’umwana arazibirwa rwose kandi bishobora gusaba ko umuntu ahita agabanya umuyaga/umunyu mu gihe ariko arabagwa vyihutirwa. Gutanga amazi canke ivyokurya mu nda ipfutse bituma umuntu atera inda y’ibisasu, bigatuma amara agira hejuru y’aho apfutse, kandi bikongera ingorane zo guhumeka mu mahaha.
3. NTUKIGERE utanga imiti y’ububabare, imiti igabanya iseseme, imiti igabanya iseseme (loperamide/bismuth), canke imiti yo mu rugo/imiti yo gusohora. Gutanga ibuprofen, acetaminophen, canke ondansetron bipfuka ibimenyetso vy’indwara y’ibihaha, mu gihe ugerageza gukoresha umuti wo mu rugo udatera iseseme, O amara ashobora gutobora utugingo ngengabuzima tw’amara twapfuye.
4. Igihe c'ibice vy'ugusemerera kuri telefone yawe maze udondore umuforomakazi w'ivy'ugusemerera uburyo bwo "On-Off Switch". Bitandukanye n'ububabare busanzwe canke ububabare bwo mu matwi aho umwana aguma arira amasaha menshi, intussusception ikurikira imipfunda y'ugutera (peristalsis) y'amaraso kuva ku gukina: umwana gusemerera amavi akwegerewe ku gikiriza n’urukoba rwiwe rutukura mu minota 2 gushika kuri 5**, hanyuma bagahagarika kurira bukwi na bukwi nk’uko batanguye bagaca batukura, bagaca bacika ibara ry’agahama, bagaca bacika ibara ry’agahama, bagaca bacika ibara ry’agahama mu minota 10 gushika kuri 30 imbere y’uko umupfunda ukurikira utera.
5. Bika umupira w'umwana uherutse kwanduza mu gafuko k'ipulasitike maze uwuzane mu cumba c'ubuvuzi bw'ivyihutirwa. Naho amavyi yoba atarasa n'amaraso atukura cane canke "umunyu w'ibitoke," gushika kuri 70 kw'ijana vy'amavyi mu gihe c'igerageza ry'amaraso y'umubiri (guwel positive ve) lining, bikaba bituma umuganga w’ivyihutirwa ashobora guca abona ibintu biri iruhande y’igitanda.
6. Mugabishe abajejwe ivyihutirwa ubwo nyene iyo umwana asinziriye bidasanzwe, afise ubumuga bwo mu mutwe, canke abona ataco abona ("Lethargic Intussusception"). Mu bana bashika kuri 10 gushika kuri 20 kw’ijana, amapeptide n’amacytokine ameze nk’imiti y’ibitera ububabare, n’ibinyabuzima bitera ububabare bw’amaraso biva mu mara (floppiness), na pinpoint pupils** imbere y’uko hagaragara ibimenyetso vyose vyo mu nda canke amavyi y’amaraso, ivyo bikaba bituma kenshi abaganga bafata nabi ko umwana afise indwara ya meningitis, sepsis, post-ictal seizure, canke gufata imiti mu mpanuka kiretse hakoreshejwe ultrasound yo mu nda.

Igiti c'ingingo: gusuzuma ugusemerera kw'uruyoya, ubunebwe, uguruka kw'amaraso, n'ugutera imbere¶

flowchart TD
    Start["Uruyoya canke Umwana (Cane cane Ufise Amezi 3 gushika ku 36) Agira Insemerero Giturumbuka, Aruha, Agira Ubunebwe canke Amavyi Afise Amaraso"] --> GreenVomit{"Mbega umwana yoba ariko araruha ibara ry’icatsi kibisi canke ry’umuhondo-icatsi kibisi (Bilious Vomiting), CANKE yerekana inda ikomeye canke ihungabana?"}

    GreenVomit -->|"EGO: INTAMBARA Y'UKUBAGA / VOLVULUS CANKE INTUSSUSCEPTION NECROTIC"| Emergency["UBWO GUBAZWA BUHITA BUTERA UBUZIMA: Hamagara 911 / 112 / 999 Ubwo nyene, NPO, IV Fluid Resuscitation n'Ukubaga Abana"]

    GreenVomit -->|"OYA: Suzuma Induru n'Ubunebwe"| PatternCheck{"Umwana yoba afise ibitero vy’ugusemerera vy’iminota 2-5 bikwegera amavi mu gikiriza buri minota 15-30, ubunebwe bukomeye butasobanutse hagati y’ibitero, inda iri ku ruhande rw’iburyo, CANKE amaraso/umunyu mu mvyimba?"}

    PatternCheck -->|"EGO ku kimenyetso ico ari co cose: GUKEKA KURI INTUSSUSCEPTION"| Ultrasound["Ibitaro vyihutirwa Igisata c’Ivyihutirwa Gutoranya: NPO idasanzwe, Gukingira igitambaro co mu nda, Ubwo nyene gupima inda (Rondera ikimenyetso c’Iciyumviro / Ijisho ry’Inka)"]

    PatternCheck -->|"OYA: Gukomeza kurira > amasaha 3 mu mwana w'iriba < amezi 4, kuba maso bisanzwe, amavyi asanzwe, nta gutakara"| OtherCheck["Gusuzuma ko ata Colic y’abana bato, Tourniquet y’imisatsi, Abrasion y’amaso, Otitis Media, canke Hernie Inguinal Incarcerée (Igihe cose ukureho igitambaro kugira ngo usuzume igihimba c’irondoka.)"]

    Ultrasound --> Reduction["Intussusception yemejwe ata gutobora canke peritonite: IV Fluid Bolus + Radiologique Pneumatique (Air) canke Hydrostatique (Saline) Enema Reduction (85-90% Kuroranirwa Ata kubagwa)"]

Pathophysiology: ingene amara abona n’igituma aniga amaraso yayo bwite¶

Intussusception ibaho iyo igice co hafi c’inzira y’amara (citwa intussusceptum) gifashwe n’umupfunda w’ugutera kw’amara (peristalsis) kigasunikwa imbere imbere mu gice c’amara kiri hafi cane (citwa **intuscissupi).

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. Kubera iki abana b'inzoya b'amezi 3 gushika kuri 36 bafatwa n'indwara y'ibihaha (90% vy'abarwayi)¶

Mu 90 kw’ijana vy’ibibazo bishika hagati ya amezi 3 n’imyaka 3 (n’igihe gikomeye kiri hagati y’amezi 5 n’9), iyo telesikope ibera ku ileocecal valve aho ileum y’iherezo ry’umubiri ry’inyuma ry’umubiri rifatanya n’igihimba c’umubiri gikomeye cane n’igihimba c’umubiri gitera kiduga (**ileoco). - Ikibazo ca Viral "Peyer's Patch" Trigger: Kubera iki umwana w'amezi 7 afise amagara meza aca abona amara yiwe bukwi na bukwi? Uruhome rw’uruyoya rwuzuye ibice vy’umubiri vyitwa ibice vya Peyer. Inyuma gato y’aho indwara isanzwe iterwa n’umugera wo mu bihimba vy’impwemu vyo hejuru (adenovirus) canke indwara y’umugera yo mu nda (gastroenteritis), canke rimwe na rimwe mu misi 1 gushika ku misi 7 inyuma y’urukingo rwa mbere canke rwa kabiri rw’urucanco rwa rotavirus rwo mu kanwa, ivyo bihimba vya Peyer biravyimba imbere mu ruhome rw’umugera gushika ku. - Uko umutsi w'amaraso uvyimba ukora nk'"Ikirongo c'Imbere": Imiraba y'uruhinja y'uruhinja ikora amakosa y'uruyoya ifata igice ca Peyer gisohotse kandi kivyimvye nk'igihimba c'ibifungurwa maze igerageza kugisunika imbere kimanuka mu nzira y'ugufungura, igakwegera uruhome rwose rw'iherezo ry'iburyo ry'umubiri ry'umubiri ry'umubiri ry'umubiri ry'umubiri ry'umubiri ry'umubiri ry'umubiri ry'umubiri ry'umubiri ry'umubiri.

2. Iyo "Iciyumviro c'Indwara" nyakuri ari co gitera (Abana < 3 months or > Imyaka 3 gushika kuri 5)¶

Iyo intussusception ibaye hanze y’idirisha ry’imyaka ry’amezi 3 gushika kuri 36 (na cane cane ku bana barengeje imyaka 3 gushika kuri 5 canke bakiri munsi y’amezi 3), canke iyo igarutse incuro nyinshi, abaganga barondera Pathologic Lead Point the wewel in (PLP) pu - Meckel's diverticulum (igihimba ca mbere c'imiterere y'abana, ni ukuvuka gusohoka kw'amara mato), - Indwara y’imitsi y’amaraso (IgA Vasculitis) itera amaraso yo munsi y’amaraso mu ruhome rw’amara mato (kenshi na kenshi ileo-ileal intussusception; raba Henoki-Shonlein n'indwara y'imitsi y'amaraso), - Ibivyimba vyo mu mara (ibivyimba vyo mu mara canke indwara ya Peutz-Jeghers), - Indwara y’amaraso (Burkitt lymphoma) mu bana barengeje imyaka 5 gushika ku myaka 6, - Cystic fibrosis (ibihimba vy’umubiri bikomeye, bipfutse amazi y’umubiri mu gice c’umubiri citwa ileum terminal), canke ibihimba vy’umubiri vy’umubiri vy’umubiri.

3. Intambwe 4 z'ugunyiganyiga kw'imitsi¶

Iyo amara y’imbere (intussusceptum) amaze gukwegwa imbere mu gipfukisho c’inyuma (intussuscipiens), urupapuro rwayo rw’imitsi y’amaraso rumeze nk’umuyaga (mesentery) rurakururwamwo maze rugapfungwa cane hagati y’inkuta zibiri z’amara: 1. Intambwe ya mbere - Uguhagarara kw’imitsi n’imitsi (Amasaha ya 1 gushika ku 12): Kubera ko imitsi n’imitsi y’amaraso bifise inkuta zitoyi kandi zifise umuvuduko muto, zica zibanza gupfungwa. Amaraso y’imitsi ntashobora guhunga amara akoresheje telesikope, bigatuma umuntu agira ububabare bwinshi n’ukuvyimba (edema) bifunga cane telesikope ku buryo atashobora gusubira gusohoka ubwayo. 2. Intambwe ya 2 - Gusuka amaraso y'ibikombe + Gusohoka amaraso mu mitsi ("Currant Jelly"): Uko umuvuduko w'imitsi ugenda uraduga, utugingo ngengabuzima turi mu ruhu rw'amara rupfutse dusuka umunyu mwinshi ugaragara neza mu gihe imitsi y'amaraso yuzuye imeneka igasohoka amaraso mu gitereko. Iyo zivanzwe hamwe zigasunikwa hanze y'umubiri, ayo maraso atukura cane n'umunyu w'umukara bica bihingura "currant jelly" y'umubiri. 3. Intambwe ya 3 - Ischemie artérielle & Mucose Necrose (Amasaha 12 gushika 36): Ukuvyimba kuraduga hejuru y’umuvuduko w’amaraso mu mitsi, bikagabanya umwuka mushasha uja mu ruhome rw’amara. 4. Intambwe ya 4 - Gangrene Transmural, Gutobora, & Septic Shock (Amasaha 24 gushika ku 72): Uruhome rw’amara rwapfuye ruraturika, rugasesa imigera y’amavyi mu nda (peritonitis), bigatuma umuntu agira hypovolemic n’uguhungabana kw’amaraso.

Kumenya indwara y’ibihaha n’indwara y’ibihaha, indwara y’ibihaha y’abana, n’indwara y’ibihaha¶

Kubera ko intussusception akenshi ikurikira umusonga w’umugera canke igikoko co mu nda kandi igatangura no kurira no gukorora bimwe bimwe imbere y’uko amaraso yose aboneka mu mva, ni kimwe mu bibazo vyihutirwa bikunda gufatwa nabi mu buvuzi bw’abana.

Imbonerahamwe y'ukugereranya ubuvuzi: Intussusception n'Indwara y'Inda n'Indwara y'Inda n'Indwara y'Umwana n'Indwara y'Igifu¶

Umutego w'"Umwana w'uruyoya afise ubunebwe / afise ubumuga bwo mu bwonko" (Kubera iki intussusception yigana Meningitis canke Overdose)¶

Kimwe mu bintu bihambaye cane mu buvuzi bw'abana vyihutirwa ni uko ibice 10 gushika kuri 20 kw'ijana vy'abana batoyi bafise indwara y'umutima bafise "Indwara y'umutima idatera ububabare canke idatera ububabare": - Iyo amara y’uruyoya ahindutse ischemie, amara arekura umwuzure munini w’ibinyabuzima bita endorphines (opioïdes peptides) n’ibinyabuzima bita cytokines bitera umururumba** mu maraso. - Mu mwana w’amezi 5 gushika ku 10, izo opioïdes zikora ataco zihinduye ku bwonko nk’urugero rwa morphine: umwana ashika mu cumba c’ubuvuzi bw’ivyihutirwa acitse intege (hypotonic), aracitse intege, arasinziriye (bigoye kuvyuka), afise amaso y’abanyeshure agaragara neza canke agenda arabura n’uguhema gutari kure cane imbere y’aho avio, kurira biraboneka. - Abaganga barakunda gutobora mu rubavu (spinal taps) kubera bakeka ko afise indwara ya meningitis, bagategeka ko bamupima umutwe kugira ngo bamenye ko afise ububabare bwo mu mutwe, canke bagatanga umuti witwa naloxone kubera ko bakeka ko afise ubumara bw’imiti y’ibitera ubwoba imbere y’uko bamenya ko mu vy’ukuri umwana afise amara ashobora gufatwa n’iteleskope. Uruyoya rwose rufise ubunebwe bukomeye butasobanutse, ruhindutse mu mutwe, canke rufise ububabare butunguranye rukwiye gupimwa mu nda mu minota 2.

Igipimo c'ibitaro: igipimo c'amajwi "Ikimenyetso c'Iciyumviro" (98% gushika ku 100% vy'ukuri)¶

Iyo ushitse mu bitaro vy’ibiza, ikizame co gupima indwara y’umutima gikoreshwa n’inzahabu ni ikizame gica vuba, kitagira ububabare, kitagira imishwarara Ultrasound y’inda:

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)

• Kubera iki imishwarara y’inda isanzwe ITAHAGIJE: Imishwarara y’inda isanzwe ni ibisanzwe mu bice bishika kuri 25 gushika kuri 50 kw’ijana vy’abantu bafatwa n’indwara y’umutima mbere y’igihe. Ivyuma vy’imirasire y’izuba bitegekwa cane cane iyo umuganga akeka ko hariho umuyaga wo mu nda (perforation) imbere y’uko agerageza kugabanya enema.
• Ivyo ultrasound ibwira umuganga w'amaradiyo n'umuganga w'abaganga:
• Yemeza Ikimenyetso c'Iciyumviro / Ijisho ry'Inka (mu bisanzwe > 2.5 cm mu gipimo c’inyuma mu nda y’iburyo, ugereranyije n’ < 1.5 cm mu bihimba vy’umubiri biva ku mara mato bishika ku mara mato biva ku mara mato bigenda birakira, bikaba bihera ubwavyo).
• Igenzura Color Doppler blood flow imbere mu ruhome rw’amara rwo gukoresha telescope maze irondera amazi afashwe hagati y’ibizingiti canke amazi yo mu nda ataco akora.

Ubuvuzi bw'ibitaro butomoye: Gugabanya Enema y'Umuyaga canke y'Amazi ata kubagwa¶

Imbere y’uko habaho ukugerageza kwose kwo kugabanya, umugwi w’abaganga bashiramwo umurongo wo mu mutsi (IV), bagacapura ama laboratwari y’ishimikiro, bagatanga umuti w’amazi y’isotonic bolus (20 mL/kg ya 0.9% Normal Saline canke Lactated Ringer’s) kugira ngo akosore ukubura amazi mu kibanza ca gatatu, akuraho amazi mu nda akoresheje umurongo w’amazi iyo umwana ariko araruha, kandi akamenyesha umugwi w’abaganga babaga abana ngo bahagarare aho.

1. Suzuma ibintu 3 bishobora gutuma umuntu adashobora kugabanya enema¶

Enema radiologique NTIWIGEZE itegerezwa gukorwa iyo hari kimwe muri ibi bimenyetso bitatu bikurikira (abo bana baja bagororotse mu cumba co kubagiramwo kugira ngo babazwe): 1. Pneumoperitoneum (Umuyaga w’ubuntu mu nda ku bipimo vya X): Bigaragaza ko amara amaze gutoboka. 2. Clinical Peritonitis: Inda ikomeye, imeze nk’urubaho, iteye igomwe cane yerekana ko amara yapfuye/yatobotse. 3. Igihunga c’amaraso kidashikamye canke gitera amaraso make kidahagarara ningoga iyo umuntu abanza gusubiza ubuzima mu mutsi.

2. Uko Enema Reduction idakoreshwa mu kubagwa ikora (85% gushika kuri 90% vy’uguterimbere)¶

Iyo ata n’umwe atoboye canke afise ubumuga bwo mu mutwe, umuganga w’abana akora ubuvuzi Ileocolic Enema Reduction mu gice c’ivyuma bifata amajwi canke mu bipimo vy’amajwi: - Umwana ashiramwo igikoresho citwa catheter giteye igomwe mu nzira y’amaraso y’umwana, hanyuma amatako agafatanywa kugira ngo haboneke ikidodo giteye igomwe. - Uburyo A - Pneumatic (Air) Enema under Fluoroscopy: Umuyaga w’ubuvuzi utunganijwe ushirwa mu nzira y’amaraso mu gihe umuganga w’ivy’amaradiyo ariko araba ku gihe nyaco c’imishwarara y’imirasire y’izuba, nta na rimwe yemera ko umuvuduko wo mu maraso urenga 80 gushika kuri 120 mmHg. Igipfukisho c’umuyaga gisunika ileum igereranijwe n’iteleskope kigasubira inyuma buhoro buhoro biciye mu nzira y’amaraso y’imbere n’inyuma gushika aho isubira inyuma yose biciye mu nzira y’amaraso y’imbere y’umubiri (ileocecal valve) ikaja mu nzira y’amaraso y’inyuma (vyemezwa no kubona umuyaga usubira inyuma ataco widegemvya mu mara mato). - Uburyo B - Hydrostatic (Umunyu ushushe canke Uwushobora gusenyuka mu mazi) Enema munsi y’ijwi ry’umubiri: Umunyu usanzwe ushushe umanitswe ku burebure bwa amafuti 3 (90 gushika kuri 100 cm) hejuru y’imeza utemba buhoro buhoro mu gitereko c’umubiri mu gihe nyaco c’umunyu w’umubiri (zero ma radiation) gushika ileocecal mu nzira y’amaraso y’iherezo. - Bimeze gute iyo ukugerageza kwa mbere gutuma amara agenda gusa igice? Iyo umwana aguma ameze neza ata peritonite afise kandi enema ya mbere igabanura igice c’intussusception, amabwirizwa asaba ugusubiramwo enema attempts (kurindira iminota 30 gushika ku masaha 2 kugira ngo amara avyimbe ku ruhande rwa kabiri canke enema ya kabiri), irakiza abana benshi ata nkomanzi ntibakeneye kubagwa.

3. Iyo bikenewe ko umuntu abagwa (Laparoscopie canke Laparotomy) (10% gushika kuri 15% vy’abarwayi)¶

Iyo ukugabanya enema y’amaradiyo bibujijwe canke bidashobora gusunika amara yose inyuma biciye mu nzira y’amaraso y’umubiri (ileocecal valve), umuganga w’abana ajana umwana mu cumba co kubagiramwo: - Gugabanya n'amaboko (Ubuhinga bwa Cope): Biciye mu guca mu gice gitoyi c'iburyo co hasi canke mu gikoresho citwa laparoscope, umuganga abaga afata ("amata") umutwe w'inyuma w'igihimba c'umubiri gisubira inyuma avuye hanze (ntiyigere akura ku gice c'imbere c'umubiri, ivyo bikaba vyoshobora gutabura amara ashobora gusenyuka). - Guca amara: Iyo amara akoresheje telesikope abonetse ko ari gangrene/necrotic, atoboye, canke atewe n’ikintu gitera indwara (nk’igihimba c’umubiri citwa Meckel’s diverticulum canke polype), umuganga akuraho ico gice cononekaye maze agasubira gufatanya iherezo ry’umubiri rifise amagara meza.

Urutonde rw'isuzuma ry'igitanda ku bavyeyi n'abaganga: gusuzuma ukubura amazi, gutera amaraso, n'ibimenyetso vyo mu nda¶

Igihe abaganga n’abavyeyi batwara uruyoya canke umwana mutoyi akekwa ko afise ubumuga bwo mu mutwe mu bitaro, bakwiye gukurikirana neza ingene amaraso y’umwana agenda be n’ingene inda yiwe itera imbere ata gukanda cane ku nda:

• Suzuma igihe co kwuzuza amaraso n’ingene urukoba rutera: Kanda buhoro buhoro hagati y’igufa ry’ibere ry’umwana (sternum) canke mu ruhanga rwiwe mu masegonda 5 hanyuma urekure. Ibara rikwiye kugaruka mu munsi y'amasegonda 2. Igihe umuntu atevye kwuzuza amaraso mu maraso amasegonda 3 canke arenga, amahembe akonje afise amabara, canke urukoba rwuzuye ibara ry’agahama, vyerekana ko amara yazibiye ariko ararira amaraso menshi cane ("third-spacing") mu ruhome rw’amara no mu mfuruka y’inda, bikaba bituma shockhypovole igira vuba.
• Suzuma Umutima n’Uko Uhumeka: Umutima wo kuruhuka utera hejuru ya 160 gushika ku 180 ku munota mu mwana w’uruhinja (mbere no hagati y’ibihe vyo kurira iyo umwana aryamye bucece) ni ikimenyetso gikomeye co kugabisha ko umuntu ashobora gutakaza amazi, ko afise ubumuga bwo mu mara, canke ko afise indwara y’ibicurane.
• Suzuma Ibara ry’Iruse ku Mutambaro Wera: Imisi yose ufate canke usuzume uruse ku mpuzu canke ku mpuzu yera.
• Amata/ibifungurwa vyera, bigaragara canke vy’umuhondo: Guruka kw’umubiri gusanzwe guterwa n’ugukura kw’umutsi w’umubiri uko umutsi w’umubiri ukwegwakwegwa mu gitereko.
• Amazi y’icatsi kibisi c’umukara canke y’icatsi kibisi c’umukara (Bilious Vomiting): Bigaragaza ko amara ashobora guhagarara neza mu buryo bw’ubuhinga munsi y’ampulla ya Vater; n’umenyeshe umuforoma w’ivy’ugutoranya ubwo nyene ushitse.
• Suzuma igitambaro c'abana maze uharure igitambaro c'abana gitose mu masaha 12 aheze: Kura igitambaro cose mu gihe c'ikibazo, kugira ngo usuzume ko ata maraso yihishije canke ko hari umunyu w'umutuku w'agahama, no kugira ngo **usuzume ko ata n'ibara ry'umuhondo ry'imbere n'iry'imbere ry'ibere kwigana ukuntu umuntu agira umutima.
• Rondera Ikimenyetso c'Umuvyino n'Ukwuzura kw'Igice co Hejuru c'Iburyo: Iyo umwana aruhutse hagati y'ugusemerera, umuganga akorakora mu nda mu bugwaneza kenshi yumva igihimba gikomeye, giteye igomwe gatoyi, gigoramye **"gifise ishusho y'isosi" mu gice co hejuru c'iburyo canke hagati y'igice c'imbere c'umubiri (telescope the telescope in the telescope colon), iherekejwe n’ukwiyumva ko hari umwobo, ubusa mu gice c’iburyo co hasi (Ikimenyetso ca Dance) kubera ko cecum na ileocecal valve vyakwezwe hejuru biva aho vyari bisanzwe.

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

Intussusception yikekwa ni igihe gikomeye c’ubuvuzi bw’abana n’ivyihutirwa vy’amaradiyo:

• Leta Zunze Ubumwe za Amerika na Canada: Hamagara 911 canke ugende ubwo nyene ku Igisata c’Ivyihutirwa vy’Abana / Ibitaro vy’Abana biri hafi (kubera ko ibigo vy’ubuvuzi vyihutirwa vy’abanyagihugu n’ibitaro vyinshi vy’abantu bakuze gusa bikorera ku giti cabo bitagira umuganga w’abana aho hantu kugira ngo akore enema air/sa). Irongowe hakurikijwe Ishure ry’ubuvuzi bw’abana ryo muri Amerika (AAP) na Ishirahamwe ry’ubuvuzi bw’abana ryo muri Amerika (APSA) amabwirizwa y’ubuvuzi.
• Ubwongereza: Hamagara 999 canke ugende ubwo nyene mu bitaro Igisata c'ubuvuzi bw'abana (A&E). Mu mategeko ya NICE Acute Abdominal Pain n’Ishure ry’Abaganga b’Ubwami / BSPED, abana bato bafise ububabare bwo mu nda canke bakekwa ko bafise ububabare bwo mu nda, baca babagwa ubwo nyene n’ugusuzumwa n’abaganga.
• Ubumwe bw'Uburaya: Hamagara 112. Irongowe hakurikijwe amabwirizwa y’ishirahamwe ry’i Buraya ry’abaganga b’abana (ESPR) n’ishirahamwe ry’abaganga b’abana ryo mu Buraya (EUPSA).
• Ostraliya na Nouvelle-Zélande: Hamagara kuri 000 muri Australiya canke 111 muri Nouvelle-Zélande. Irongowe hakurikijwe Ibitaro vy’Ubwami vy’Abana (RCH) Melbourne Amabwirizwa y’Ibikorwa vy’Ubuvuzi ku bijanye n’Ugutera Inda.
• Ubuhindi na Aziya-Pasifike: Hamagara 112 (canke 108 mu Buhindi), 995 muri Singapore, 119 mu Buyapani na Koreya y’Epfo, canke 999 muri Maleziya na Hong Kong. Mugende mu bitaro vy’amashure yisumbuye bifise amasaha 24 y’ugupima abana n’ugubaga abana.

Ibibazo bikunda kubazwa¶

Ni kuki uruyoya rufise ubumuga bwo mu mutwe rusemerera buri minota 15 canke 20 hanyuma rugaca rukora nk’aho rucereje rwose canke rwo gusinzira hagati y’aho?¶

Amara mato y’umuntu arafatanya mu buryo bujanye n’imipfunda (peristalsis) buri minota 15 canke 20 kugira ngo ivyokurya bije imbere. Mu gihe c’intussusception, igihe cose umupfunda wa peristaltique uteye ku gice c’amara gifise telescope, urafyonda cane amara yafunzwe maze ugakwega ku mesentery yayo ifise imitsi myinshi, bigatuma umwana agira ububabare bubabaje cane mu minota 2 gushika ku 5 aho umwana asemerera maze agakwegera amavi yompi mu gikiriza. Iyo umupfunda w’ugukura uheze, ubwo bubabare burahagarara gatoyi, ugasiga uruyoya rufise ibara ry’agahama, rufise ivyuya, kandi rurushe canke rucitse intege cane gushika umupfunda ukurikira w’ugukura ushitse haciye iminota 15.

Ni kuki intussusception ishobora gutuma umwana asa n’uwufise indwara ya meningitis canke ingorane yo mu bwonko?¶

Mu bihe bishika kuri 10 gushika kuri 20 kw’ijana, uruhome rw’amara rufise inzara y’umwuka w’ikirere kandi rufise ubushobozi bwo gukora, rurarekura ibintu vyinshi bimeze nk’imiti y’ibitera umururumba (endorphines) be n’ibintu bitera umururumba biva mu maraso y’umwana. Ivyo bihimba vy’umubiri bikora ku bwonko bw’uruyoya kugira ngo bimutere ubunebwe bukomeye, imitsi igira ubumuga (floppiness), abona ata co abona, n’amaso mato mato, rimwe na rimwe imbere y’uko umwana yigera arenga amaraso mu mva yiwe canke yerekane ububabare bugaragara mu nda. Abaganga ivyo babita “intussusception encephalopathique ou lethargique”, kandi iyo umuntu akoresheje ubuhinga bwo gupima inda yihuta iruhande y’igitanda, aca abona ko amara yihishije.

"Ivyimba vy'umukara" bisa gute, kandi abana bose bafise intussusception barabifise?¶

Ivyatsi vy’umukara vy’umukara bisa n’umutuku mwiza canke umutuku w’agahama uvanze n’umukara w’umukara. Ibaho iyo imitsi y’amaraso ipfutse imbere mu mara ibonwa n’iteleskope ituma uruzitiro rw’amaraso ruca rusenyuka maze rugaca ruva amaraso rugacika amaraso menshi cane ava mu turemangingo tw’amaraso. Ariko rero, abana batari munsi ya 25 gushika kuri 50 kw’ijana baragira amavyi aboneka nk’ay’umunyu w’umukara igihe bashika ubwa mbere mu cumba c’ubuvuzi bw’ibiza kubera ko ari ikimenyetso c’uko umuntu afise ubumuga bwo mu mubiri; ntuzokwigere urindira kubona amaraso mu gipfukisho imbere y’uko uja mu bitaro.

Ni gute enema y’umuyaga canke y’umunyu ikosora amara akoresheje telesikope ata kubagwa?¶

Mu gihe c’ugugabanya amaraso y’umwana akoresheje ubuhinga bwa ultrasound canke X-ray, umuganga w’abana ashira umurongo woroshe mu nzira y’amaraso y’umwana maze akayishiramwo mu bugwaneza umuyaga w’ubuvuzi utunganijwe (enema pneumatique) canke amazi asusurutse y’umunyu (enema hydrostatique) mu mara manini. Inkingi y’umuyaga canke amazi y’ubugwaneza isunika ku mpera y’insobe ntoyi ikoreshwa n’itelesikope nk’ipistoni, igafungura iyo telesikope isubira inyuma biciye mu nzira y’amaraso gushika igarutse mu kibanza cayo gisanzwe. Ubwo buryo butabagwa buraroranirwa ku bana 85 gushika ku 90 kw’ijana iyo bukoreshejwe hakiri kare.

Mbega urucanco rwa rotavirus canke umugera w’indwara y’umusonga usanzwe vyoshobora gutuma umuntu agira intusussus?¶

Ivyiyumviro vyinshi vy'ugutera imbere kw'uruyoya biterwa n'indwara isanzwe y'umugera wo mu bihimba vy'impwemu vyo hejuru (nk'umugera wa adenovirus) canke umugera wo mu nda utuma utugingo ngengabuzima dusanzwe turi mu ruhome rw'amara mato (ibihimba vya Peyer) tuvyimba maze tugakora nk'"inzira y'umubiri" ikwegera mu mara mato. Incanco z’umugera wa rotavirus zifatwa mu kanwa zifise ingorane nto cane (nk’umuntu 1 gushika ku 5 w’inyongera ku bana 100.000 baciwe incanco, ahanini mu misi 7 ya mbere inyuma y’urukingo rwa mbere canke rwa kabiri), mu gihe nyene zibuza abantu ibihumbi n’ibihumbi kuja mu bitaro kubera umugera wa rotavirus bishobora gutuma bapfa; abavyeyi barahanurirwa gusa kwitwararika ukurira kw’amavi gushika ku gikiriza mu ndwi ikurikira urucanco.

Mbega intussusception yoshobora gusubira kubaho iyo imaze gukosorwa?¶

Egome. Intussusception irasubira mu bana nka 8 gushika ku 12 kw’ijana bamaze kugabanya neza umuyaga canke umunyu, nk’igice c’ivyo bisubira mu masaha 24 gushika ku 72 ya mbere mu gihe utugingo ngengabuzima tw’amaraso twavyimvye mu ruhome rw’amara tukiriko turagabanuka. Iyo ivyiyumviro vy’ugusemerera, guhagarara amavi ku gikiriza, gukorora, canke gucika intege bigarutse, bisubira mu kigo c’ubuvuzi bw’ibihe vyihutirwa, ibibazo bisubira bishobora gusubira kugabanywa n’iyindi enema, naho nyene gusubira kenshi bituma hakorwa isuzuma ry’imiterere y’inzira nk’iya Meckel.

Amasoko n'ubuyobozi buzwi¶

• Ishure ry’ubuvuzi bw’abana ryo muri Amerika (AAP) & Ishirahamwe ry’abaganga b’abana ryo muri Amerika (APSA, Leta Zunze Ubumwe za Amerika): Imirongo ngenderwako y’ubuvuzi n’ingaruka z’ubuvuzi bw’abana bafise ubumuga bwo mu mutwe.
• Ibitaro vy’abana vy’Ubwami (RCH) Melbourne (Ostraliya): Ingingo ngenderwako y’ubuvuzi: Gutera umuti mu nda, Gusuzuma ivyihutirwa, Ikimenyetso c’intumbero y’amajwi, no kugabanya umuti w’umuyaga.
• Ishirahamwe mpuzamakungu ryitaho amagara y'abantu (OMS): Indwara y'umutima mu bana b'inzoya n'abana bato: Ingero, ukuntu igaragara n'ingene ivugwa, uburyo bwo kubona ibintu kw'isi yose.
• Ikigo c'Igihugu c'Ubuzima n'Ukwitwararika (NICE) & Ishure ry'Ubwami ry'Ubuvuzi bw'Abana n'Ubuzima bw'Abana (RCPCH, Ubwongereza): Kwemera no gutoranya ubumuga bw'amara y'abana bukomeye n'uguruka kw'amaraso.
• Ishirahamwe ry'Uburayi ry'Ivy'Ivyuma vy'Imitsi y'Abana (ESPR): Ingingo ngenderwako zo gupima indwara ziterwa n'amajwi n'amashusho yo kugabanya ububabare bwo mu nda mu bana.

Inyobora zifitaniye isano¶

• Ubuzibuzi bw'amara, ububabare bw'umubiri, n'ibimenyetso vyihutirwa vy'ububabare bw'umubiri
• Igikoko citwa Henoch-Schonlein (IgA vasculitis), igikoko gishobora gufatwa n’amaboko, n’ugutoranya imitsi y’umubiri
• Pyloric stenosis, ugutakara kw'ibitero bitagira amaraso, n'ivyuma bita alkalosis
• Indwara y’umusonga, umusonga wacitse, peritonite, n’ububabare bwo mu gice c’iburyo co hasi
• Ubumara bw’ibifungurwa, indwara y’ibihaha, n’ukubura amazi mu mubiri