Feeding intolerance as a result of small-intestine intussusception in a child with major burns.
Feeding intolerance is common in critically ill children. We present an unusual case of jejunojejunal intussusception causing feeding intolerance in a child with major burns. An 18-month-old female was admitted to the intensive care unit after sustaining a 65% TBSA burn. Following a decompressive laparotomy for abdominal compartment syndrome, nasojejunal feeds were started immediately after surgery, which she did not tolerate. A plain abdominal radiograph revealed a collection of intraluminal air and an abdominal CT revealed a proximal jejunojejunal intussusception. The patient underwent laparotomy and an uncomplicated reduction of the small-bowel intussusception (SBI). Successful enteral feedings were commenced on hospital day 24, and the patient was discharged to home after approximately a 4.5-month hospitalization. The major learning point is that SBI can cause feeding intolerance in the child with major burns. Despite the low incidence of SBI in critically ill children, arriving at a timely diagnosis is essential because the consequences of a missed or delayed diagnosis include intestinal ischemia, necrosis, or perforation. Because SBI defies diagnosis by techniques traditionally used to diagnose intussusception involving the colon, clinical suspicion for intussusception is needed to facilitate the urgent diagnosis and correction of feeding intolerance caused by mechanical obstruction.
Kincaid
M Sean
MS
Departments of Anesthesiology, University of Washington, Seattle, USA.
Vavilala
Monica S
MS
Faucher
Lee
L
Zimmerman
Jerry
J
Heimbach
David
D
D002056:Burns / Q000150:complications* / Q000601:surgery*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007223:Infant; D007443:Intussusception / Q000209:etiology* / Q000601:surgery; D007579:Jejunal Diseases / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications