Waugh Syndrome (Ileocolic Intussusception +Malrotation): A Case Report and Discussion

A. Maria Menaka¹, V. Gayathri devi², I. Ruby³, S.J. Sonya Mercy Anbu⁴

Department of Nursing, maa kauvery, Trichy, Tamil Nadu

Case Presentation

A 4-year-old female child got admitted to hospital with the complaints of vomiting 1 day (6-7 episodes) not blood stained, non-bilious, contents of food particles. History of vomiting immediately after feed.

H/O

Blood stained stool 1-2 episode passed.

Abdominal distension present for 2 days

Irritable cry, sleep disturbance present

Baby was delivered by LSCS, Immunized till date

There is no past medical and surgical history

Baby attained developmental milestone at appropriate age.

Blood Investigations

Haemoglobin	10.9 g/dl
Total WBC	11510 cells/cumm
Platelet	556000 cells/ml
CRP	5.1
Na	131
K	5.29
Urea	23
Creatinine	0.25
INR	1.10
PT	12.4 /11.3

Viral Serology: Non-Reactive

Physical Examination

Abdomen – Soft, distended, sluggish bowel sounds present.

USG Abdomen

Ileo colic Intussusception

Floating Internal echoes in urinary Bladder-Likely cystitis

Treatment process: (Surgery Notes)

Under GA parts painted and draped under aseptic precautions

Incision and muscle cutting – right SUT incision

Operation Findings

Ileocolic intussusception
Ladd’s bands were present

DJ over the spine, free fluid present. Dupodino colic isthmus widened, Intussusception reduced manually, Ladd’s bands released, duodenum straightened, Duodino colic isthmus widened.

Appendectomy done, small bowel placed on the right, large bowel on the left, wound closed in layers and dressing applied.

Post-Operative orders & Progress of child

Kept NPO for 48 hr
Given IV fluids ½ DNS 25 ml/hr
Monitored Abdominal girth every 4^th hourly
Monitored vital signs every hourly
Monitored intake output chart
On the third day of surgery child was started on clear liquids followed by soft diet which the baby tolerated well.
Surgical site looks healthy
Bowels opened normally

Pharmacological treatment

Inj. Cefotaxime, Inj, Paracetamol, Inj. Amikacin, Inj. Piptaz, Syp. Cefixime, Syp. P120 (Paracetamol 120)

Nursing Management

Pain management was done and comfort care with analgesia given
Took care of personal hygiene.
Wound care given and followed SSI bundle care.
Care of tube and drains followed as per HIC protocol.
Intake and Output monitored and maintained, prevented dehydration and shock.
High protein and fiber diet.
Emotional and psychological Support: Provided emotional support and counseling to the patient’s family members (parents) believing that it can help them to cope with the changes to their body image and life style.

Condition at Discharge

Child stable, afebrile, Hydration adequate, Urine output adequate, Vitals stable, Systems normal.

Advice On Discharge

Diet as advised
Daily bath with soap & water
Pediatric surgeon review
Advised the parents: If baby has excessive dullness, continuous cough, cold, high grade fever, fast breathing, difficulty in breathing, excessive diarrhea, vomiting, reduced urine output.
Wound care education

Discharge Medication

Drug Name	Generic name /Strength	Frequency			Route of administration	Relationship with meal	Days
		M	A	N
Syp. Cefixime	Cefixime (50mg/5ml)	3.5ml	0	3.5ml	Oral	After food	3 days
Syp. P120	Paracetamol				Oral	After food	5ml sos for fever
T bact ointment		1	1	1	local application		1 week

Discussion

Iliocolic Intussusception

Waugh’s syndrome is a rare condition characterized by the association of intussusceptions and acute appendicitis in pediatric patients. It was first described by George Waugh in 1911.

Key features

Typically occurs in children
Intussusception is a condition where one part of the intestine telescopes into another, leading to obstruction.
Acute appendicitis is inflammation of the appendix, which can lead to perforation if untreated.
The combination of both conditions is rare but clinically significant because symptoms can overlap

Intussusception

It is defined as the invagination of one segment of the bowel into an immediately adjacent segments of the bowel.

Idiopathic ileocolic intussusceptions are the most common form in children and is typically managed with non operative reduction

This is most commonly seen in infants and young children (especially between 6 month and 3 years) and often presents with abdominal pain, vomiting and currant jelly stools (mucus and blood), lethargy, abdominal distention, signs of dehydration requiring prompt diagnosis and treatment.

Clinical Manifestations

Elevated temperature, elevated WBC count
Signs of severe peritonitis, such as rebound tenderness and guarding
Three failed reduction attempts
New or Persistant symptoms after successful reduction

Treatment of choice

Surgical intervention is usually required because of the dual pathology.

Pneumatic (air enema) and hydro static (contrast or saline) reduction: For stable patients without signs of bowel perforation non operative measures such as pneumatic (air enema) and hydro static (contrast or saline) reduction may be used. These are performed under ultrasound or fluoroscopic guidance. Appendectomy and bowel reduction/resection: this may be needed in severe cases.

Prognosis

Early diagnosis and treatment lead to good outcomes.

Delayed recognition can lead to complications such as bowel perforation and peritonitis.

Waugh Syndrome (Ileocolic Intussusception +Malrotation): A Case Report and Discussion

Waugh Syndrome (Ileocolic Intussusception +Malrotation): A Case Report and Discussion

A. Maria Menaka1, V. Gayathri devi2, I. Ruby3, S.J. Sonya Mercy Anbu4

Nightingale Journals

A. Maria Menaka¹, V. Gayathri devi², I. Ruby³, S.J. Sonya Mercy Anbu⁴