Intussusception (Mala a a Bonang ka Thelesekoupo) mo Maseeng le mo Baneng ba ba Golang: Go Goa ga Mangole go ya kwa Sehubeng ka Dikgaotso le Mantle a Jelly a Currant¶

Intussusception ke selo se se tlwaelegileng thata se se bakang thibanyo ya mala mo maseeng le mo baneng ba ba santseng ba gola ba ba fa gare ga dikgwedi di le 3 le dikgwedi di le 36: boemo jwa tshoganyetso jwa mala jo bo ka tsenyang botshelo mo kotsing jo mo go jone karolo e le nngwe ya mala (mo e ka nnang ka metlha e le ileum e e felelang ya mala a mannye) e relelang mo letlhakoreng le le kwa tlase le fela jaaka thelesekoupo e e phuthegang, e gogela ditshika tsa yone tsa madi le mesentery mo mosakong o o gagametseng. Fa lebota la mala le le tshwaregileng le ruruga, kelelo ya madi mo ditshikaneng e a boela kwa godimo mme go dikologa ga madi mo ditshikaneng go a kgangwa, go ntsha modikologo o o tlhomolang pelo wa go goa ka tshoganyetso, go go sa gomotsegeng ga paroxysmal mo ngwana a gogang mangole ka bobedi ka thata mo sehubeng metsotso mengwe le mengwe e le 15 go ya go e le 20, ka metsotso mengwe le mengwe e le 15 go ya go e le 20, sile . go lapa, kgotsa go lapa go go tseneletseng ga methapo**, go go latelang moragonyana ke go kgwa le mantle a a bohibidu jo bontsho, a a tlhakaneng le mamina "currant jelly". Fa lesea kgotsa ngwana yo monnye a bontsha go goa ka tshoganyetso, a gogela mangole a gagwe kwa mpeng, a nna le diphoso tse di sa tlwaelegang kgotsa go nna thata go tsoga fa gare ga ditiragalo, a tlhatsa bile e tala, kgotsa a fetisa madi mo diapereng tsa gagwe, leletsa . dinomoro tsa tshoganyetso ka bonako. Fa o ntse o letetse dipalangwa, sekaseka kaelo e e amanang le seno mo go go thibana ga mala, hernia e e kgamilweng, le volvulus, appendicitis le setlhabi sa karolo e e kwa tlase ya moja, le go tsenwa ke botlhole jwa dijo, gastroenteritis le go felelwa ke metsi mo mmeleng.

Ka gonne lebota la mala fa a simolola go tsenngwa ga mala le sa ntse le tshela, diperesente di feta 85 go ya go di le 90 tsa bana ba ba alafiwang ka bonako kwa bookelong ka radioloji ya bana ba ka kgona go kgoromelediwa mala a bone ka thelesekoupu ka iketlo go boela mo mannong a one mo metsotsong e se kae fela ba dirisa ultrasound- kgotsa fluorostaide-gust (sa) enema, go tila gotlhelele go ariwa mo mpeng. Ho fapana le hoo, ho leta lapeng hore "mantle a jelly ya currant" a hlahe (letshwao la morao la necrosis ya mucosal) ho dumella mala a kgamilweng ho phunya, ho baka peritonitis e bolayang le ho tshoha ha septic.

Dira se jaanong¶

1. Eya kwa lephateng la tshoganyetso la bookelo le le gaufi ka bonako kgotsa leletsa nomoro ya tshoganyetso ya lefelo la gaeno. Letsa 911 kwa United States le Canada, 112 go ralala Yuropa, 999 kwa United Kingdom, 000 kwa Australia, kgotsa leba lenaane la rona la dinomoro tsa tshoganyetso. Fa go kgonega, ya ka tlhamalalo kwa Bookelong jwa Bana kgotsa kwa bookelong jo bo nang le bokgoni jwa go dira ultrasound ya bana le radiologic enema ya diura di le 24, kgotsa leletsa ambulense ka bonako fa ngwana a lapile, a le mosetlha, a le floppy, kgotsa a kgwa seedi se setala.
2. Boloka lesea kgotsa ngwana yo monnye a le nil ka molomo (NPO: GA GO na mashi, mashi a fomula, mashi a letswele, metsi, Pedialyte, kgotsa dijo tse di tiileng). Mala a ngwana a thibegile gotlhelele mme a ka tlhoka go fokodiwa ga enema ya radiologic/saline ka bonako ka fa tlase ga sedation kgotsa karo ya tshoganyetso ka fa tlase ga anesthesia ka kakaretso. Go tsenya diedi kgotsa dijo mo mpeng e e thibegileng go dira gore motho a tlhatse ka di-projectile, go atolosa mala a a kwa godimo ga boloko, mme go oketsa kotsi ya gore makgwafo a tlhotlhorege.
3. **O SE KE wa naya melemo ya ditlhabi, melemo e e lwantshang go feroga sebete, melemo e e lwantshang letshololo (loperamide/bismuth), kgotsa di-enema/di-laxator tsa kwa gae. mala ka phunya necrotic mala dinama tse nyenyane tse.
4. Nako ya ditiragalo tsa go goa mo founong ya gago mme o tlhalosetse mooki wa triage paterone ya "On-Off Switch". Go farologana le colic e e tlwaelegileng kgotsa tsebe e e botlhoko mo lesea le lelang ka tlhoafalo diura di le dintsi, go tsenelela ga mmele go latela makhubu a a nang le moribo a go ngotlega ga mala (peristalsis) a go tswa mo go robaleng: ngwana go goa ka mangole a gogetswe mo sehubeng le letlalo le le bosetlha metsotso e le 2 go ya go e le 5**, morago ga moo a bo a emisa go lela ka tshoganyetso fela jaaka a simolotse mme a nne mosetlha, a fufule, le go lapa metsotso e le 10 go ya go e le 30 pele ga lekhubu le le latelang le itaya.
5. Boloka diaper tsa ngwana tsa bosheng tse di leswe mo kgetsaneng ya polasetiki mme o tle le tsone kwa phaposing ya maemo a tshoganyetso. Le fa mantle a sa ntse a lebega jaaka madi a mahibidu a a galotseng kgotsa "jeli ya currant," go fitlha go diperesente di le 70 tsa di-diaper tse di mo tekong ya go tsenngwa mo mmeleng di supa gore di na le **madi a a sa bonaleng a a tswang mo lining, go naya ngaka ya maemo a tshoganyetso lesedi la ka bonako la fa thoko ga bolao.
6. Tlhagiso setlhopha sa maemo a tshoganyetso ka bonako fa ngwana a robetse ka tsela e e sa tlwaelegang, a le botlhofo, kgotsa a lebile fela a sa dire sepe ("Lethargic Intussusception"). Mo go fitlhang go diperesente di le 10 go ya go di le 20 tsa masea, dipeptide le di-cytokine tse di tshwanang le di-opioid tse di mo mmeleng tse di gololwang ke hypoprouruse ya mala e e nang le madi (floppiness), le go supa barutwana** pele ga go tlhagelela matshwao ape a mpa kgotsa mantle a a nang le madi, gantsi seno se dira gore dingaka di se ka tsa tlhatlhoba ngwana ka tsela e e sa siamang gore o na le bolwetse jwa meningitis, sepsis, go thuthumela morago ga go tshwarwa ke seterouku, kgotsa go ja diokobatsi ka phoso ntle le fa go dirwa ultrasound ya mpa.

Setlhare sa tshwetso: go sekaseka go goa ga lesea ka modikologo, go lapa, go kgwa ga bile, le go tsenwa ke madi¶

flowchart TD
    Start["Lesea kgotsa Ngwana (Segolobogolo wa Dikgwedi di le 3 go ya go di le 36) yo o Nang le Dipheko tsa go Goa ka Tshoganyetso, go Kgwa, go Lapa, Kgotsa Mantle a a Madi"] --> GreenVomit{"A ngwana o tlhatsa bile e e botala jo bo galotseng kgotsa e e botala jo bo serolwana (Bilious Vomiting), KGOTSA o bontsha mpa e e gagametseng e e atolositsweng kgotsa go tshoga?"}

    GreenVomit -->|"EE: GO KGOREGA KA KARO / VOLVULUS KGOTSA GO TSENA GA GO BOLA"| Emergency["KARO YA TSHOGANYETSO E E TSENYANG BOTSHELO KA BOTSHELO: Leletsa 911 / 112 / 999 Ka bonako, NPO ka tlhoafalo, Go Tsosolosa ka Seeledi sa IV le Karo ya Bana"]

    GreenVomit -->|"NNYAA: Tlhola Mokgwa wa go Goa wa Paroxysmal le go Lapa"| PatternCheck{"A ngwana o na le ditlhaselo tsa go goa tsa metsotso e le 2-5 tse di gogelang mangole mo sehubeng metsotso mengwe le mengwe e le 15-30, go lapa/go tlhotlhorega go go tseneletseng go go sa tlhalosiweng fa gare ga ditlhaselo, mpa e e kafa mojeng, KGOTSA madi/mamina mo mantleng?"}

    PatternCheck -->|"EE go letshwao lengwe le lengwe: GO BELAELWA GO TSENELA"| Ultrasound["Lefapha la Maemo a Tshoganyetso la Bookelo le le Potlakileng Triage: NPO e e gagametseng, Boloka diaper, Ultrasound ya ka bonako ya mpa ya fa thoko ga bolao (Batla Letshwao la Target / Bull's-Eye)"]

    PatternCheck -->|"NNYAA: Go tswelela go lela > diura di le 3 mo sedibeng lesea < dikgwedi di le 4, go nna kelotlhoko go go tlwaelegileng, mantle a a tlwaelegileng, go sa kgwa"| OtherCheck["Sekaseka Colic ya Masea, Tourniquet ya Moriri, Go Kgotlhega ga Lethapo, Otitis Media, kgotsa Hernia ya Inguinal e e Tshwerweng (Ka metlha ntsha leleiri go tlhola mokwatla.)"]

    Ultrasound --> Reduction["Go Tsenngwa ga Seledi go go Netefaditsweng Kwantle ga go Phunyega kgotsa go Tshwarwa ke Peritonitis: Bolus ya Seeledi sa IV + Phokotso ya Enema ya Radiologic ya Pneuma (Mowa) kgotsa ya Hydrostatic (Saline) (Katlego ya 85-90% Kwantle ga Karo)"]

Pathophysiology: kafa mala a kgonang go bona ka gone le gore ke eng fa a kgamela madi a one¶

Go tsena ga mala go diragala fa karolo e e gaufi ya tsela ya mala (e e bidiwang intussusceptum) e tshwarwa ke lekhubu la go ngotlega ga mala (peristalsis) mme e kgarametswa kwa pele mo teng ga lumen ya karolo e e bapileng le yone e e kgakala ya mala (e e bidiwang **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. Goreng masea a dikgwedi di le 3 go ya go di le 36 a tsenwa ke go tsenwa ke madi a a "Idiopathic" (90% ya dikgetse)¶

Mo diperesenteng di le 90 tsa dikgetse tse di diragalang fa gare ga dikgwedi di le 3 le dingwaga di le 3 (ka tlhora ya ditiragalo fa gare ga dikgwedi di le 5 le di le 9), go bona ka thelesekoupu go diragala kwa belefong ya ileocecal kwa ileum e e tshesane e e felelang e kopanang le cecum e e bulegileng le in**susceplic e e tlhatlogang (**ileoco). - Trigger ya "Peyer's Patch" ya Viral: Ke eng fa ngwana yo o itekanetseng wa dikgwedi di le 7 a tshoganyetsa go bona mala a gagwe ka thelesekoupo? Lebota la ileum e e felelang ya lesea le tletse ka mabala a dithishu tsa lymphoid tsa mucosal tse di bidiwang mabala a ga Peyer. Ka bonako fela morago ga tshwaetsego e e tlwaelegileng ya mohemo o o kwa godimo wa mogare (adenovirus) kgotsa khukhwana ya mala e e bakiwang ke mogare (gastroenteritis), kgotsa ka dinako tse dingwe mo malatsing a le 1 go ya go a le 7 morago ga selekanyo sa ntlha kgotsa sa bobedi sa kenti ya rotavirus e e nowang ka molomo, diphatsa tseno tsa ga Peyer di ruruga mo teng ga mogare go ya kwa leboteng la mala. - Kafa lymph node e e rurugileng e dirang ka gone jaaka "Lead Point": Makhubu a peristaltic a lesea a a nang le morethetho a dira phoso ya gore lebala la Peyer le le tlhagelelang, le le rurugileng ke legogo la dijo mme a leka go le kgoromeletsa kwa pele go ya kwa tlase mo tseleng ya tshilo ya dijo, a gogela lebota lotlhe la ileum ya valcal mo letlhakoreng le le siameng go tsena mo ilece mmogo le lone.

2. Fa "Ntlha ya Ketapele ya Bolwetse" ya nnete e le molato (Bana < 3 months or > Dingwaga di le 3 go ya go di le 5)¶

Fa go tsena mo maleng go diragala kwa ntle ga fensetere ya dingwaga tsa dikgwedi di le 3 go ya go di le 36 (bogolo jang mo baneng ba ba fetang dingwaga di le 3 go ya go di le 5 kgotsa ba ba kwa tlase ga dikgwedi di le 3), kgotsa fa go ipoeletsa makgetlo a le mantsi, dingaka di batla go tsena ga mala mo sebopegong sa Pathologic Lead Point (PLP): - Diverticulum ya ga Meckel (ntlha ya #1 ya popego mo baneng, go tswa ga mala a mannye ka tlholego), - Purpura ya Henoch-Schonlein (IgA Vasculitis) e e bakang hematoma e e kafa tlase ga legogo mo leboteng la mala a mannye (gantsi go tsena ga mala a mannye eleo-ileal; bona Pupura ya Henoch-Schonlein le bolwetse jwa methapo ya IgA), - Dipolyp tsa mala (dipolyp tsa bana kgotsa bolwetse jwa Peutz-Jeghers), - Lymphoma ya mala (Burkitt lymphoma) mo baneng ba ba fetang dingwaga di le 5 go ya go di le 6, - Cystic fibrosis (dipolaka tsa meconium/mantle tse dikima, tse di tshetsweng mo ileum e e felelang), kgotsa di-cyst tsa go ipoeletsa ga mala.

3. Dikgato di le 4 tsa go kgangwa ga ditshika¶

Fa mala a a kafa teng (intussusceptum) a sena go gogelwa mo teng ga letsogo le le kwa ntle (intussuscipiens), letlhare la one la ditshika tsa madi le le bopegileng jaaka fene (mesentery) le a gogelwa mo teng le go menaganngwa ka thata fa gare ga mabota a mabedi a mala: 1. Kgato 1 - Go Thibana ga Lymphatic le Venous (Diura 1 go ya go 12): Ka gonne ditshika le lymphatics di na le mabota a masesane, a a nang le kgatelelo e e kwa tlase, di pitlaganngwa pele. Madi a ditshika ga a kgone go tswa mo maleng a a bonwang ka thelesekoupo, mme seno se baka go ruruga go gogolo le go ruruga (edema) go go lotlelang thelesekoupo thata mo e leng gore ga e tlhole e kgona go tswa ka boyone. 2. Kgato 2 - Go Tshologela ga Mamina a Disele tsa Goblet + Go Tshologa ga Madi a Di-Capillary ("Currant Jelly"): Fa kgatelelo ya ditshika e ntse e tlhatloga, disele tsa goblet mo letlalong la mala le le hupetsang di tshologela mamina a a bokima a a phepa fa di-capillary tsa mucosal tse di tletseng di thubega le go tswa madi mo lumeneng. E tlhakantswe mmogo le go kgoromelediwa kwa ntle ga rectum, madi ano a mahibidu a a fifetseng le mamina a gelatinous a bopa mantle a "jelly ya currant" a bogologolo. 3. Kgato ya 3 - Ischemia ya Ditshika & Mucosal Necrosis (Diura 12 go ya go 36): Go ruruga go tlhatlogela kwa godimo ga kgatelelo ya madi a ditshika, go kgaola okosejene e e foreshe go ya kwa leboteng la mala. 4. Kgato ya 4 - Gangrene e e fetang mo mpeng, Go phunyega, & Go tshoga ga mala (Diura di le 24 go ya go 72): Lebota la mala a a suleng le a thunya, le tshololela dibakateria tsa mantle mo lerobeng la mpa (peritonitis), go baka go tshoga ga hypovolemic le septic.

Go lemoga go tsenelela ga mmele kgatlhanong le bolwetse jwa mala, colic ya masea, le meningitis¶

Ka gonne gantsi go tsena mo mpeng go latela serame se se bakiwang ke megare kgotsa khukhwana ya mala mme go simolola ka go lela le go kgwa ka dinako tse di rileng pele ga madi ape a tlhagelela mo mantle, ke nngwe ya maemo a tshoganyetso a a sa lemogiweng sentle gantsi mo kalafing ya bana.

Lenaneo la papiso la kalafi: Go tsenngwa mo mmeleng kgatlhanong le Gastroenteritis e e bakiwang ke megare kgatlhanong le Colic ya masea kgatlhanong le Hernia e e mo kgolegelong¶

Serai sa "Lesea le le Lapileng / le le Nang le Bolwetse jwa Boboko" (Ke ka ntlha yang fa go tsenngwa mo mmeleng go etsisa Meningitis kgotsa Go nwa selekanyo se se feteletseng)¶

Nngwe ya diperela tse di botlhokwa thata tsa kalafi mo kalafing ya maemo a tshoganyetso a bana ke gore go fitlha go diperesente di le 10 go ya go di le 20 tsa masea a a nang le go tsenwa ke mmele a a leng teng ka "Go Tsenngwa ga Mmele go go Senang Botlhoko kgotsa go go Lapileng": - Fa mala a lesea a nna le ischemic, mala a golola morwalela o mogolo wa di-endorphin tse di mo teng (di-peptide tsa opioid) le di-cytokine tse di bakang go ruruga mo mading. - Mo leseeng la dikgwedi di le 5 go ya go di le 10, di-opioid tseno tse di mo teng ga mmele di dira ka tlhamalalo mo bobokong jaaka selekanyo sa morphine: lesea le goroga mo phaposing ya maemo a tshoganyetso le tlhotsa (hypotonic), le le bosetlha, le robala (go thata go le tsoga), le na le dipupi tse di tlhomameng kgotsa tse di bonya le go hema go go seng boteng pele ga go hema go go seng boteng ga ao, go lela go a lemogwa. - Dingaka gantsi di dira diphunya tsa mokwatla (dipompo tsa lerapo la mokwatla) fa go belaelwa gore o na le bolwetse jwa meningitis, di laela gore go dirwe di-CT tsa tlhogo fa go belaelwa gore o utlwile botlhoko mo tlhogong, kgotsa di mo naya naloxone fa go belaelwa gore o na le botlhole jwa opioid pele ga di lemoga gore tota lesea le na le mala a a bonwang ka thelesekoupo. Lesea lengwe le lengwe le le nang le letsapa le le sa tlhalosiweng, seemo se se fetogileng sa tlhaloganyo, kgotsa go nna mohibidu ka tshoganyetso le tshwanetse go dira ultrasound ya mpa ya metsotso e le 2 fa thoko ga bolao.

Temogo ya bookelo: "Letshwao le le Ikaeletsweng" la ultrasound (98% go ya go 100% ya go nepagala)¶

Fa o goroga kwa lephateng la maemo a tshoganyetso, teko ya maemo a gauta ya go tlhatlhoba go tsenwa ke Ultrasound ya Mpa e e bonako, e e senang botlhoko, e e senang marang:

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)

• Ke ka ntlha yang fa di-X-ray tse di tlwaelegileng tsa mpa di SA lekana: Di-X-ray tse di tlwaelegileng tsa mpa di tlwaelegile mo go fitlhang go diperesente di le 25 go ya go di le 50 tsa dikgetse tsa go tsenwa ke mpa ka bonako. Di-X-ray tse di tlwaelegileng di laelwa thata fa ngaka e belaela mowa o o sa duelelweng mo teng ga mpeng (go phunyega) pele ga e leka go fokotsa enema.
• Se ultrasound e se bolelelang ngaka ya marapo le ngaka e e arang:
• E tlhomamisa Letshwao la Seikaelelo / Leitlho la Poo (gantsi > 2.5 cm ka molagare wa kwa ntle mo mpeng e e kafa mojeng, fa e bapisiwa le < 1.5 cm mo di-intussusceptions tsa nakwana tse di seng kotsi tsa mala a mannye go ya kwa maleng a mannye tse di rarabologa ka botsone fela).
• E tlhola Kelelo ya madi ya Color Doppler mo teng ga lebota la mala le le bonwang ka thelesekoupu mme e batla seeledi se se tshwaregileng fa gare ga diring kgotsa seeledi sa mahala sa peritoneal.

Kalafi e e tlhomameng ya kwa bookelong: Go Fokotsa Enema ya Pneumatic kgotsa Hydrostatic e e sa dirisiweng karo¶

Pele ga maiteko ape a go fokotsa a simolola, setlhopha sa maemo a tshoganyetso se baya mola wa tshika (IV), se goga dilaboratori tsa motheo, se naya bolus ya seeledi sa isotonic se se tsenngwang mo tshikeng (20 mL/kg ya 0.9% Normal Saline kgotsa Lactated Ringer's) go baakanya go tlhoka metsi mo sebakeng sa boraro, e ntsha kgatelelo mo mpeng ka tšhupu ya nasogastric fa ngwana a kgwa, le go tsibosa setlhopha sa karo ya bana go ema fa thoko.

1. Tlhola ditshupo tse 3 tse di feletseng tsa go fokotsa enema¶

Enema ya radiologic e tshwanetse go GA E KE ya dirwa fa e le gore go na le matshwao ape a mararo a a latelang (bana bano ba ya ka tlhamalalo kwa phaposing ya karo go ya go dira laparotomy ya karo): 1. Pneumoperitoneum (Mowa o o gololesegileng mo mpeng mo X-ray): E supa gore mala a setse a phunyegile. 2. Clinical Peritonitis: Mpa e e gagametseng, e e tshwanang le boto, e e bonolo thata e e supang mala a a suleng/a a phunyegileng. 3. Septic kgotsa Hypovolemic Shock e e sa tlhomamang e e sa tlhomamang ka bonako ka go tsosolosa seeledi sa tshika sa ntlha.

2. Ka fao Phokotso ya Enema e e sa arweng e dirang ka teng (85% go ya go 90% ya seelo sa katlego)¶

Fa go se na go phunyega kgotsa peritonitis, ngaka ya marapo ya bana e dira kalafi ya Phokotso ya Enema ya Ileocolic mo setlhopheng sa fluoroscopy kgotsa sa ultrasound: - Go tsenngwa tšhupu e e bonolo ka bonolo mo mpeng ya ngwana mme marago a bofiwa mmogo go dira sekano se se bonolo. - Mokgwa A - Enema ya Pneumatic (Mowa) ka fa tlase ga Fluoroscopy: Mowa o o laolwang wa kalafi o tsenngwa ka bonolo mo lelapeng le legolo fa ngaka ya marapo e lebile mo fluoroscopy ya X-ray ya selekanyo se se kwa tlase ya nako ya mmatota, e sa letle kgatelelo ya mo teng ga lela le legolo go feta 80 go ya go 120 mmHg. Mosamo wa mowa o kgoromeletsa ileum e e bonwang ka thelesekoupu ka iketlo kwa morago ka mala a mannye a a kgabaganyang le a a tlhatlogang go fitlha e thunya gotlhe kwa morago ka belefo ya ileocecal go tsena mo ileum e e felelang (e e netefadiwang ka go bona mowa o boela morago ka kgololesego mo maleng a mannye). - Mokgwa B - Hydrostatic (Letswai le le Bothitho kgotsa Pharologanyo e e Nyokologang mo Metsing) Enema ka fa tlase ga Ultrasound: Saline e e bothitho e e tlwaelegileng e e lepeletseng kwa bogodimong jwa 3 feet (90 go ya go 100 cm) fa godimo ga tafole e elela ka bonolo mo kholong ka fa tlase ga pono e e tswelelang ya nako ya mmatota ya ultrasound (marang a lefela) go fitlha belofo ya ileocecal go tsena mo ileum e e felelang. - Go tweng fa maiteko a ntlha a tsamaisa mala fela ka bontlhabongwe? Fa ngwana a nna a tlhomame mo kalafing kwantle ga peritonitis mme enema ya ntlha e fokotsa go tsenelela ga mala ka bontlhabongwe, dikaelo di akantsha maiteko a go boeletsa enema a a diegileng (go leta metsotso e le 30 go ya go diura di le 2 gore mala a ruruge mo letlhakoreng le le kwa tlase la boraro), e namola bana ba le bantsi ka pabalesego gore ba se ka ba tlhoka go ariwa.

3. Fa go tlhokega phokotso ya karo (Laparoscopy kgotsa Laparotomy) (10% go ya go 15% ya dikgetse)¶

Fa go fokodiwa ga enema ka radiologic go sa letlelelwa kgotsa go sa kgone go kgarameletsa mala kwa morago gotlhelele ka belofo ya ileocecal, ngaka e e arang ya bana e isa ngwana kwa phaposing ya karo: - Phokotso ka Seatla (Thekeniki ya ga Cope): Ka go sega go le gonnye ga quadrant e e kwa tlase ya moja kgotsa ka laparoscope, ngaka e e arang e tlhotlhora ("gama") ka bonolo ntlha e e kgakala ya intussusception go ya kwa morago go tswa kwa ntle (ga e ke e goga mo ileum e e gaufi, e e neng e tla gagola mala a a bokoa). - Go Kgaolwa ga Mala: Fa mala a a bonweng ka thelesekoupu a fitlhelwa a na le gangrenous/necrotic, a phunyegile, kgotsa a bakilwe ke ntlha ya lloto ya bolwetse jwa popego (jaaka diverticulum ya Meckel kgotsa polyp), ngaka e e arang e tlosa karolo e e senyegileng mme e golaganye gape dintlha tse di itekanetseng.

Lenaanenetefatso la tshekatsheko ya fa thoko ga bolao la batsadi le bathusi ba kalafi: go sekaseka go felelwa ke metsi mo mmeleng, go tshelwa madi, le matshwao a mpa¶

Fa ba tsamaisa lesea kgotsa ngwana yo monnye yo go belaelwang gore o tsenwe ke madi kwa lephateng la maemo a tshoganyetso la bookelo, bathusi ba kalafi le batsadi ba tshwanetse go ela tlhoko ka thulaganyo seemo sa go tsamaya ga madi a ngwana le go tswelela pele ga mpa kwantle ga go gatelela mpa ka tsela e e sa siamang:

• Lekola Nako ya go Tlatsa Capillary le go Tshelwa ga Letlalo: Tobetsa ka bonolo mo gare ga lerapo la sehuba la ngwana (sternum) kgotsa phatla metsotswana e le 5 mme o e golole. Mmala o tshwanetse go boa mo ka fa tlase ga metsotswana e le 2. Go tladiwa ga di-capillary go go diegileng ga metsotswana e le 3 kgotsa go feta, dintlha tse di tsidifetseng tse di nang le marontho, kgotsa letlalo le le bosetlha/le le molora go supa gore mala a a kgoreleditsweng a lela dibolumo tse dikgolo tsa polasema ("third-spacing") mo leboteng la mala le mo lerobeng la mpa, go baka shockhypovole ya pele.
• Lekola Seelo sa Pelo le Mokgwa wa go Hema: Seelo sa pelo sa go ikhutsa se se kwa godimo ga 160 go ya go 180 ka motsotso mo leseeng (le fa gare ga dinako tsa go lela fa lesea le robetse ka tidimalo) ke letshwao le le botlhokwa la tlhagiso la go latlhegelwa ke dieledi, go tlhoka madi mo maleng, kgotsa go nna le sepsis.
• Tlhatlhoba Mmala wa Matlhatsa mo Letseleng le Lesweu: Ka metlha tshwara kgotsa tlhatlhoba matlhatsa kgatlhanong le taulo e tshweu kgotsa pampiri.
• Mašwi/dijo tse di tlhotlhoregileng tse di tshweu, tse di phepa, kgotsa tse di serolwana: Go kgwa go go tlwaelegileng ga reflex ya pele go go tlhotlhelediwang ke go otlolla ga tshika ya vagal fa mesentery e gogelwa mo intussusception.
• Seedi se se botala jo bo galotseng jwa kalaka kgotsa se se botala jo bontsho jwa sepinashe (Go Kgwa ga Bilious): Go supa go thibana ga mala go go feletseng ka metšhini ka fa tlase ga ampulla ya Vater; tsibosa mooki wa triage ka bonako fa a goroga.
• Tlhola Lapere mme o Bala Dilepere tse di Metsi mo Diureng di le 12 tse di Fetileng: Tlosa lelepe gotlhelele ka nako ya tlhatlhobo, ka bobedi go tlhatlhoba mantle go bona gore a go na le madi a a sa bonaleng kgotsa mamina a mahibidu a a fifetseng a "jeli ya currant", le go **tlhatlhoba dikhuti tsa mokwatla le dikhuti tse di sa tlhomamang tsa mokwatla/labia go go etsisa go tsenngwa ga mmele.
• Batla Letshwao la Tantshe le Botlalo jwa Kwadrante e e kwa Godimo ya Moja: Fa lesea le iketla fa gare ga go tlhotlhorega go go goang, ngaka e e tshwaraganang ka bonolo mo mpeng gantsi e utlwa silintara e e tiileng, e e bonolo go sekae, e e kobegileng **"e e bopegileng jaaka boroso" e le mo letlhakoreng la telescope mo kwadrante e e kwa godimo ya moja kgotsa mo gare ga ilescope the telescope colon), e patilwe ke maikutlo a a lolea, a a senang sepe mo karolong e e kwa tlase e e kafa mojeng (Letshwao la Dance) ka gonne cecum le ileocecal valve di gogetswe kwa godimo go tswa mo boemong jwa tsone jo bo tlwaelegileng.

Dinomoro tsa maemo a tshoganyetso tsa kgaolo le diporothokholo tsa boemedi¶

Go belaelwa gore go tsena mo mmeleng ke boemo jwa tshoganyetso jwa karo ya bana le jwa marapo jo bo tlhokang nako e ntsi:

• United States le Canada: Letsa 911 kgotsa tswelela ka bonako kwa Lefapheng la Tshoganyetso la Bana / Bookelong jwa Bana jo bo gaufi (ka gonne mafelo a tlhokomelo ya potlako a baagi le di-ER tse dintsi tse di ikemetseng tsa bagolo fela ga di na ngaka ya marapo ya bana mo lefelong go dira phokotso ya enema/sa). E laolwa ka fa tlase ga dikaelo tsa kalafi tsa Sekolo sa Kalafi ya Bana sa Amerika (AAP) le Mokgatlho wa Karo ya Bana wa Amerika (APSA).
• United Kingdom: Letsa 999 kgotsa o ye ka tlhamalalo kwa bookelong Lefapha la Maemo a Tshoganyetso a Bana (A&E). Ka fa tlase ga diporothokholo tsa NICE Acute Abdominal Pain le Kholetšhe ya Bogosi ya Dingaka tsa go Ara / BSPED, masea a a nang le go kgwa ga bili kgotsa go belaelwa gore a na le go kgwa mo mpeng a dirwa karo ya bana ka bonako le go tlhatlhobiwa ka radioloji.
• Kopano ya Yuropa: Letsa 112. E laolwa ka fa tlase ga dikaelo tsa Mokgatlho wa Yuropa wa Radioloji ya Bana (ESPR) le Mokgatlho wa Dingaka tsa Bana tsa Yuropa (EUPSA).
• Australia le New Zealand: Letsa 000 kwa Australia kgotsa 111 kwa New Zealand. E laolwa ka fa tlase ga Dikaelo tsa Tiriso ya Kalafi ya Bookelo jwa Bana jwa Bogosi jwa Melbourne (RCH) jwa go Tsenngwa ga Mmele.
• India le Asia-Pacific: Letsa 112 (kgotsa 108 kwa India), 995 kwa Singapore, 119 kwa Japane le Korea Borwa, kgotsa 999 kwa Malaysia le Hong Kong. Tswelela kwa bookelong jwa maemo a a kwa godimo jo bo nang le ultrasound ya bana ya diura di le 24 le karo ya bana.

Dipotso tse di bodiwang kgapetsakgapetsa¶

Ke ka ntlha yang fa lesea le le nang le intussusception le goa metsotso mengwe le mengwe e le 15 go ya go e le 20 mme morago ga moo le dire jaaka le didimetse gotlhelele kgotsa le robetse fa gare ga nako eo?¶

Mala a mannye a motho a ngotlega ka moribo ka makhubu (peristalsis) metsotso mengwe le mengwe e le 15 go ya go e le 20 go isa dijo kwa pele. Mo intussusception, nako le nako fa lekhubu la peristaltic le itaya karolo ya mala e e bonwang ka thelesekoupo, le tlhotlhora mala a a tshwaregileng ka maatla mme le goga mesentery ya lone e e humileng ka methapo, le baka metsotso e le 2 go ya go e le 5 ya botlhoko jo bo botlhoko jwa colicky moo lesea le goang le go gogela mangole ka bobedi mo sehubeng sa lone. Fa lekhubu la go ngotlega le feta, botlhoko bo ema ka nakwana, bo tlogela lesea le le mosetlha, le mofufutso, e bile le lapile kgotsa le lapile thata go fitlha lekhubu le le latelang la peristaltic le goroga metsotso e le 15 moragonyana.

Ke eng fa go tsenngwa ga ngwana mo mmeleng go ka dira gore go lebege e kete o na le bolwetse jwa meningitis kgotsa bothata jwa boboko?¶

Mo diperesenteng di le 10 go ya go di le 20 tsa dikgetsi, lebota la mala le le bolawang ke tlala ya okosejene, le le gateletsweng le golola di- peptide tse dintsi tse di tshwanang le di- opioid (di- endorphin) le di- cytokine tse di bakang go ruruga mo mading a lesea. Di-opioid tseno tsa tlholego di dira mo bobokong jwa lesea go baka go lapa go go tseneletseng, mesifa e e tlhotsang (floppiness), go leba ka leitlho le le sa reng sepe, le matlho a mannye, ka dinako tse dingwe pele ga lesea le ka fetisa madi mo mantleng a lone kgotsa le bontsha botlhoko jo bo bonalang mo mpeng. Dingaka di bitsa seno "go tsena ga mala go go sa siamang kgotsa go go lapileng," mme ultrasound e e bonako ya mo mpeng e e dirwang fa thoko ga bolao e senola ka bonako go thibana ga mala go go fitlhegileng.

"Mantle a jelly ya currant" a lebega jang, mme a masea otlhe a a nang le intussusception a na le one?¶

Currant gela mantle shebahala joaloka lefifi bofubelu kapa maroon gelatinous jeme tsoakane ka lesela. E bopega fa go pitlagana ga ditshika mo teng ga mala a a bonwang ka thelesekoupo go dira gore letlalo la legogo le tlhotlhorege mme le tswe madi go nna ditsholo tse dikima tsa lero le le tswang mo diseleng tsa goblet tsa mala. Lefa go ntse jalo, masea a a kwa tlase ga diperesente di le 25 go ya go di le 50 a na le mantle a a bonalang a jeli ya currant fa a goroga la ntlha kwa phaposing ya maemo a tshoganyetso ka gonne ke letshwao la morago ga nako la go tlhoka madi mo legogong; o se ka wa leta go bona madi mo diapereng pele ga o ya kwa bookelong.

Enema ya mowa kgotsa ya letswai e baakanya jang mala a a bonwang ka thelesekoupo kwantle ga go ariwa?¶

Ka nako ya go fokotsa enema e e kaelwang ke ultrasound kgotsa X-ray, ngaka ya marapo ya bana e tsenya tšhupu e e boleta mo mpeng ya ngwana mme e tsenya ka bonolo mowa o o laotsweng wa kalafi (enema ya mowa) kgotsa metsi a a bothitho a letswai (enema ya hydrostatic) mo maleng a magolo. Kholomo e e bonolo ya mowa kgotsa metsi e kgoromeletsa ntlha ya mala a mannye a a bonwang ka thelesekoupo jaaka piston, e phutholola thelesekoupo go boela kwa morago ka mala a magolo go fitlha e thunya gape mo boemong jwa yone jo bo tlwaelegileng. Mokgwa ono o o sa ariweng o atlega mo diperesenteng di le 85 go ya go di le 90 tsa bana fa o dirwa go sa le gale.

A go enta rotavirus kgotsa mogare o o tlwaelegileng wa serame go ka baka go tsena ga mmele?¶

Bontsi jwa dikgetse tsa go tsena ga masea mo mmeleng di tlhotlhelediwa ke tshwaetsego e e tlwaelegileng ya megare e e kwa godimo ya go hema (jaaka adenovirus) kgotsa mogare wa mala o o dirang gore di-lymph node tse di tlwaelegileng mo teng ga lebota la mala a mannye (di-patch tsa Peyer) di ruruge mme di dire jaaka "ntlha e e eteletseng pele" ya mmele e e gogelwang mo mala a magolo. Dikenti tsa rotavirus tse di nowang ka molomo di na le kotsi e nnye thata (mo e ka nnang dikgetse di le 1 go ya go di le 5 tse di oketsegileng mo maseeng a le 100 000 a a kentilweng, bogolosegolo mo malatsing a ntlha a le 7 morago ga selekanyo sa ntlha kgotsa sa bobedi), fa ka nako e le nngwe di thibela diketekete tsa go robadiwa kwa bookelong ka ntlha ya go felelwa ke metsi mo mmeleng ka ntlha ya rotavirus e e tshosetsang botshelo; batsadi ba gakololwa fela go ela tlhoko go lela ga mangole go ya kwa sehubeng go go dikologang mo bekeng e e latelang go enta.

A go tsena ga mmele go ka diragala gape fa go sena go baakanngwa?¶

Ee. Intussusception e boela gape mo diperesenteng di ka nna 8 go ya go di le 12 tsa bana morago ga go fokotsa enema ya mowa kgotsa ya letswai ka katlego, mme mo e ka nnang halofo ya go boela gape goo go diragala mo diureng tsa ntlha di le 24 go ya go di le 72 fa thishu e e rurugileng ya lymphoid mo leboteng la mala e sa ntse e kokobela. Fa go goa ga modikologo, go ema ka mangole go ya kwa sehubeng, go kgwa, kgotsa go lapa go boela, go boela ka tlhamalalo kwa lephateng la maemo a tshoganyetso, dikgetse tse di ipoeletsang gantsi di ka fokodiwa gape ka enema e nngwe, le fa go ipoeletsa gantsi go dira gore go dirwe tshekatsheko ya ntlha e e eteletseng pele ya popego jaaka divertilum ya Meckel.

Metswedi le kaelo ya semmuso¶

• Sekolo sa Kalafi ya Bana sa Amerika (AAP) & Mokgatlho wa Karo ya Bana wa Amerika (APSA, United States): Dikaelo tsa Tiriso ya Kalafi le Dipholo tsa Karo ya go Tsenngwa ga Bana ka Ileocolic.
• Bookelo jwa Bana jwa Bogosi (RCH) Melbourne (Australia): Kaelo ya Tiriso ya Kalafi: Go Tsenngwa ga Mmele, Tlhatlhobo ya Maemo a Tshoganyetso, Letshwao la Setlhogo sa Ultrasound, le go Fokotsa Enema ya Moya.
• Mokgatlho wa Lefatshe Lotlhe wa Boitekanelo (WHO): Go Tsena mo Maseeng le mo Baneng: Ditiragalo, Tlhagiso ya Kalafi le Botsamaisi, Pono ya Lefatshe Lotlhe.
• Setheo sa Bosetšhaba sa Boitekanelo le Tlhokomelo ya Boleng jo bo kwa Godimo (NICE) & Kholetšhe ya Segosi ya Kalafi ya Bana le Boitekanelo jwa Bana (RCPCH, United Kingdom): Go Lemoga le go Tlhaola go Thibana ga Mala a Bana a a Bogale le go Kgwa ga Bilious.
• Mokgatlho wa Yuropa wa Radioloji ya Bana (ESPR): Dikaelo tsa go Tlhatlhoba Ultrasound le go Fokotsa go Tsenngwa ga Bana ka go Kaelwa ke Ditshwantsho.

Dikaedi tse di tsamaelanang¶

• Go thibana ga mala, hernia e e kgamilweng, le matshwao a tshoganyetso a volvulus
• Pupura ya ga Henoch-Schonlein (bolwetse jwa ditshika tsa IgA), purpura e e kgonang go tshwarwa, le go tlhaola go tsena ga madi mo mmeleng
• Go pitlagana ga pyloric, go kgwa go go seng ga bile, le alkalosis ya metaboliki
• Bolwetse jwa mametlelelo, mametlelelo e e thubegileng, peritonitis, le setlhabi mo karolong e e kwa tlase ya kafa mojeng
• Go tsenwa ke botlhole jwa dijo, gastroenteritis e e tseneletseng, le go felelwa ke metsi mo mmeleng