Intussusception

Introduction: Intussusception is a common condition that present with abdominal colic and is usually diagnosed by ultrasonography with appearance of (Target Sign). Material and method: Over the last 35 years we have noticed a new phenomenon that mimic intussusception both clinically and radiologically but is not cause by bowel intussusception but by impacted stool at he terminal ileum. Whereas intussusceptions an emergency that require urgent attention to reduce either by air, saline or Barium and my need urgent exploration , Gohary’s phenomenon if recognized can be treated by simple fleet enema. We have encountered 56 cases between 1983 and 2018 , their age varied from 9 months and 7 years They have the common features of 1- Severe abdominal colic that is not responding to analgesic or antispasmodics 2- US feature suggestive of ileo-colic intussusception 3- No red current jelly stool .intussusception 4- Good response to fleet enemas Conclusion: More recently we have encountered a subgroup pf patients that have genuine intussusception on radiological examination but not causing complete bowel obstruction and still associated with had srool in the large bowel and still needs simple fleet enema to cure.We hope by highlighting this new phenomenon to avoid unnecessary radiological investigation and unnecessary abdominal exploration. During the period 1992-2000, 124 boys with 149 impalpable testes were managed both by diagnostic and operative laparoscopy at Mafraq Hospital, Abu Dhabi. Forty-one of them were managed by one stage laparoscopy assisted orchidopexy and 31 by 2 stage Fowler-Stephens procedures. Of particular interest are a group of 6 boys with 7 impalpable testes in whom the testes were sub-renal in position. Five of them were right sided and one bilateral. Five of the 6 right sided testes had associated contralateral palpable undescended testes and one had associated opened internal ring with normal descended testes. Two stage Fowler-Stephens procedure was attempted in all of them. Two testes were lost, one was removed accidentally during laparoscopic dissection and the other atrophied 6 months after testicular fixation. The rest have achieved clinical satisfactory position and size, 6 months to 4 years post operatively. The purpose of this study is to increase awareness of this particular group of high non-descended abdominal testes and avoid the potential risk of future complications. The fact that we have achieved satisfactory result in 5 out of 7 cases demonstrates that this group of high sub renal testicles is salvageable. Between 1993-2018 we used both diagnostic and operative laparoscopy in the management of 10 cases of persistent mullerian duct syndrome (BMDS). Two siblings from two different families accounted for four of the cases. They presented with cryptorchidism and inguinal hernias. The diagnosis was established during diagnostic laparoscopy. The impalpable testes were on the left in 6, on the right in 2 and bilateral in 2. One of the bilateral cases had been managed previously in another hospital by an open technique, and the diagnosis was missed. Transverse testicular ectopia was present in two unrelated boys. Two of the 10 cases were referred from overseas from further management at out institution. All the cases were managed by splitting the uterus in the midline and then bringing the testis with the vas and attached uterine tissue into the scrotum. 8of the 10 cases were managed laparoscopically. Follow-up of 3 months to 10 years showed satisfactory results in 6 of the 10 cases. We had small testis in one of bilateral cases and high testes in the other bilateral case. Conclusion: Diagnostic laparoscopy fpr impalpable testis can be rewarded by the findings of PMDS which cab me mannered laparoscopically in the majority of cases.

Author(s): Amin Gohary

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