Operative Treatment (Intussusception)

Example of operative findings in a laparotomy due to an idiopathic intussusception. There is an intestinal loop running from the right to the left and disappearing in the distally located ileocecum. From the picture the impression arises that the surgeon tries to reduce the invagination by traction on the small intestine which is localized proximally to the intussusception. This proceedig is obsolete; rather, the invagination must be milked out carefully in a proximal direction. Thereafter, the vitality of the reduced invagination must be tested and if necessary, an intestinal segment must be resected. In the presented case the intestinal wall is involved but vital. Changes of this kind and a starting peritonitis explain the incidence of some percent of obstructive ileus due to postoperative adhesions.