Intussusception:

Outer tube: Inner tube: Most common : Most infantile cases:

 Intussuscipiens  Intussceptum  ilio colic type  Idiopathic

 Secondary causes: Meckets diverticulum Polyps/ carcinomas Duplication cysts Lipoma Purpura Lymphoma

 Intermittent colicky pain with screaming, vomiting with red currant jelly stools  Sausage shaped periumblica! mass  Commonest cause of intestinal obstruction in children: intussusception  Empty right iliac fossa (sign de dance)  Step ladder peristalsis  Initially hydrostatic reduction is done.  Laprotomy with reduction is done in complicated cases and those failing initially.

 X ray features show: Target sign Meniscus sign  Barium enema shows : Claw sign Coiled spring sign  USG Signs are: Target sign Bulls eye sign Pseudo kidney sign Hay fork and sandwich appearance.

 HIRSCHSPRUNG'S DISEASE HIRSCHSPRUNG'S DISEASE  There is absence of ganglion cells in the myenteric plexuses (both Auerbach's and Meissner's) of the most distal bowel and extending proximalty for a variable distance.  Aganglionosis involving only the rectum or rectosigmoid is often termed 'short segment Hirschsprung's disease and affects males five times more commonly than females.  'Long segment' Hirschsprung's disease, extending above the sigmoid

    

Associated congenital anomalies are Down syndrome , Warden burgs syndrome, Cartilage hair hypoplasia syndrome Usually the symptoms of Hirschsprung's disease are manifest within the first few days of life.  Failure to pass meconium within the first 24 h, abdominal distention, bile stained vomiting and reluctance to feed are the main symptoms.  Diarrhea may be the presenting feature of

Hirschsprung's enterocolitis, a devastating complication of the condition which has a high mortality.  A plain abdominal X-ray shows distended small and large bowel, sometimes with multiple fluid levels on an erect film. Distal segment is constricted, Proximal is dilated.  A barium enema is best carried out without a previous rectal examination as then the narrow aganglionic bowel with dilation proximally is demonstrated.  Definitive diagnosis is by rectal biopsy.

 Duodenal atresia:  Associated with Downs syndrome  Atresia at level of ampulla of vater  Double bubble sign on radiograph.  Me cause of acute intestinal obstruction in neonates  Duodeno jujenostomy is procedure of choice.