Surgery in refractory metabolic derangements: Report of a case

Abstract

The problems associated with emergency surgery in infants are multifaceted, especially in the presence of inanition and fluid/electrolyte disturbances. These include the high energy requirements of the infant, the delicate physiology of their total blood voume1, and the synergism between inanition and sepsis. This could easily result in a vicious cycle if management is delayed. Therefore careful attention must be paid to patients energy and fluid/electrolyte status, and derangements promptly corrected . The underlying pathology which in this case was ileocolic intussusception should be treated without delay . Cuschieri has described intussusception as the mechanism of a catastrophic vascular accident. It is more than a mere telescoping of a segment of intestine into the adjacent segment. The vascular supply of the inner layers of the intussusception is most liable to be impaired resulting in gangrenous bowel, with its ominous consequences of dehydration, electrolyte disturbances, hypoglycaemia (sirs) and even death if prompt surgical intervention is not initiated.