Acute Intussusception, Early Diagnosis vs. Acute Intussusception, Late Diagnosis
Left picture: The operative findings correspond to an acute intussusception which has been recognized quickly and operated on immediately following an unsuccessful trial of reduction of the intussusception with air. Notice that the cecum and the appendix are not visible, because the invagination of the small intestine in the colon has included partially the cecum and the appendix, too (= so-called ileocecal invagination). Right picture: Here, an acute intussusception is present which has been recognized and operated too late, meaning more than 24 to 36 hours after the beginning of the clinical presentation. Now an obstructive ileus and a peritonitis are present due to an irreversible damage of the invaginated wall of the small intestine. The intussusception has been reduced on admission in spite of the progressed stage of invagination, which was only partially possible. The progressed stage of the surgical abdomen or of the intussusception could have been recognized due to the length of the history and the clinical presentation.
Left picture: Operative findings in an infant with surgical abdomen: Sudden onset of crying which is intermittently repeated, and vomiting at the beginning. Right picture: Operative findings in an infant with acute abdominal emergency; currently repeated vomiting, large belly, and severe and continual pain while the child cannot be quietened.