Child Intussusception (Bowel Obstruction)

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Child Intussusception
Body Parts: Abdomen
Medical Subjects: Children's Health Digestive System
Overview

What Is The Intussusception?

Intussusception is the insertion of a portion of a length of bowel and its mesentery into the lumen of the intestine at its distal or proximal end. The intestinal wall is folded to form three cylinders, the inner layer and the middle cylinder are invaginated intestinal tubes, and the cylinder of the outer layer accommodates the invaginated intestinal tubes. The angle of the fold will gradually compress the originally smooth intestine and blood flow. Symptoms such as vomiting, abdominal pain, hematochezia and abdominal mass occurred after the intestinal tube was compressed.

Intussusception, common in children, usually occurs at 6 to 36 months of age and is a second common cause of acute abdominal pain in infants and preschool children, in addition to constipation.

Intussusception in adults is rare and most often occurs after other abdominal procedures.

Intussusception is mainly divided into the following types:

  • Small intestine invaginates large intestine (this type is the most common and relatively easy to treat).
  • The small intestine invaginates into the small intestine and then invaginates together into the large intestine (a difficult type of treatment that often has serious consequences).
  • Small intestine invaginated into cecum (this type of symptom is atypical and difficult to detect).

In addition, some intussusception can be untwisted by oneself, so there will be intussusception symptoms before, but the examination found normal.

Cause

What Is The Cause Of Intussusception?

Who are prone to intussusception?

Acute intussusception is a unique condition in infancy and is not uncommon.

80% of the sick child were within 2 years old, 60% of them were within 1 year old, and the most common cases within 1 year old were infants aged from 3 to 6 months. The incidence decreased with age after 2 years old, but it was rarely seen after 5 years old.

More boys than girls, healthy and obese infants are more likely to occur.

Which seasons are easy to cause intussusception?

Intussusception occurs all the year round, with the highest incidence in late spring and early summer, which may be related to viral infection. Diarrhea and cold are easy to induce intussusception.

What diseases can induce intussusception?

Seventy-five percent of intussusceptions are idiopathic, meaning that no specific disease can be identified as a trigger or predisposing factor. The remaining 25% of intussusception can be found to have a definite predisposing disease.

Among them, the most common cause is to stimulate the proliferation of small intestinal lymphoid tissue and induce intussusception after viral infection.

Intussusception can also be caused by conditions such as Meckel's diverticulum, intestinal polyps, tumors, hematomas, or vascular malformations.

Symptom

What Are The Symptoms Of Intussusception?

What are the manifestations of intussusception?

Typical symptoms of intussusception are abdominal pain, vomiting, bloody stools, and an abdominal mass.

For parents, if the baby has sudden/intermittent/severe abdominal pain with frequent vomiting or bloody stool, they should be alert to the occurrence of intussusception and take the baby to the hospital in time.

For babies, inability to express their abdominal pain usually manifests as an unpalatable crying disturbance and a posture in which the lower limbs flex toward the abdomen.

How to identify intussusception.

Typical symptoms are sudden, severe, intermittent abdominal colic in which the leg is involuntarily raised to relieve pain (curled up in pain even when the child is still unable to express) that can last for several minutes. After abdominal pain, the baby is usually quiet, has pale skin, sweats, and may temporarily return to normal activity. Abdominal B-scan should be performed in time at this time.

Why does abdominal pain occur during intussusception?

During intussusception, the intestinal lumen was blocked by the intestinal tube or mesangium, and the intestinal contents could not normally pass through during intestinal peristalsis. Each peristalsis of the intestinal tract would cause intestinal dilatation, and the traction reflex of the intestinal wall would cause abdominal pain. The abdominal pain was significantly relieved during the intermission of intestinal peristalsis, manifested as typical paroxysmal abdominal pain.

Why is there blood in the stool when intussusception occurs?

  • The blood vessel of normal bowel is relatively straight, turn very small.
  • When intussusception occurs, the partially folded blood vessels will be distorted and squeezed.
  • This results in severe local edema of the intussusception, which in turn aggravates venous compression, congestion, and blood stasis.
  • This in turn causes the swollen intussusception to discharge mucus and blood, often forming a classic red jam-like stool.

What happens when intussusception is serious?

If the intussusception cannot be reduced in time, congestion and pressure in the bowel increase, eventually leading to ischemic changes in the bowel and necrosis of the intussusception. Severe complications include obstruction (intestinal obstruction), bowel necrosis, septic shock, and even death.

Detect

How To Check For Intussusception?

What tests should be done for intussusception?

At present, ultrasonic examination is not only high in accuracy but also atraumatic, making it the first choice for the diagnosis of intussusception.

For the intussusception with more complicated clinical manifestations or atypical ultrasonic manifestations, there can also be multiple examinations such as contrast enema, CT, and magnetic resonance imaging, and the intussusception with automatic reduction can be found to be normal during the examination.

Prevention

How To Prevent Intussusception?

How to prevent recurrence of intussusception.

The recurrence of intussusception in children is usually within five years old, and there is currently no very exact and effective way to prevent its recurrence. It should be noted that:

  • Usually reduce respiratory tract and gastrointestinal virus infection.
  • It is very important to keep warm when the weather changes suddenly.
  • Prompt treatment once recurrence is suspected is the key to harm reduction.
Treatment

How To Treat Intussusception?

What clinic should be selected for intussusception?

Once an abnormality is found in a child and intussusception is suspected, general pediatric surgery and gastrointestinal surgery are preferred in areas with specialist hospitals. If there is no special hospital for children, general surgery and gastrointestinal surgery from the general hospital will be selected.

Can intussusception patients eat?

After the diagnosis of intussusception is established, never take food, including water, again at this time. At this time, the child will present with repeated vomiting, which may lead to aspiration and aggravation of the child's vomiting times if forced feeding is performed.

The correct approach should be to visit relevant departments in time and carry out radiological reduction in an early stage (in X-ray examination, liquid or air is injected into the intestinal tract through the anus, and the sleeved intestines are washed away by certain pressure).

If the child suffers from frequent vomiting and severe dehydration, infusion should be supplemented first, and radiological reduction should be performed after the general condition of the child is improved. This can increase the success rate of reduction.

How to treat intussusception?

At present, radiographic reduction is still the first choice for the treatment of intussusception.

The success rate of reduction of early intussusception is over 90%. For children who cannot be successfully reduced, surgical reduction is adopted and the intestinal tube is resected if necessary.

Under what circumstances can I choose radiological reduction to treat intussusception?

If the course of the disease is not more than 48 hours, the child will generally have a good response and a good general condition, with no obvious dehydration, no obvious electrolyte disorder, and not very severe abdominal distension as well as no manifestation of muscle tension when touching the belly.

When does intussusception need surgery?

If radiological reduction cannot be performed, the abdomen can only be opened for manual reduction, i.e., surgical treatment. Applicable to:

  • Radiologic reset failed.
  • An ancillary examination revealed a suspicious bowel condition (especially in older children).
  • Or children with multiple relapses of intussusception.
  • Small intussusception.

Radiological reduction (in the case of air enema) operating procedures:

  • First, a standing plain film is needed to ensure that no intestinal necrosis or perforation occurs in the child at this time.
  • A special pipeline with a balloon was inserted into the rectum through the anus, and the balloon was inflated and fixed in the rectum.
  • Under the supervision of the X-ray display, inflate the anus to ensure the inflation pressure is within a certain range and prevent the intestinal cavity rupture caused by excessive pressure.
  • The intussuscepted bowel was washed open using gas filled from the anus in combination with manipulation.

What should be done before radiological reduction treatment?

Before radiological reduction, if the child vomits repeatedly, a gastric tube needs to be connected, and after gastrointestinal decompression, atropine is intramuscularly injected, so as to reduce the occurrence of aspiration during operation.

What are the serious adverse consequences of intussusception?

The severity of the injury caused by intussusception is related to age and physical condition, but is mainly closely related to the onset and treatment time.

  • If found in time (within 48 hours), generally will not cause serious consequences, after the success of the reset observation 1 ~ 2 days can be back to normal.
  • Failure to detect it in time may result in bowel necrosis and, in severe cases, death.

What should you do if the intussusception recurs?

For children who have had a recurrence of intussusception, the incidence of secondary intussusception caused by obvious lesions in the intestine itself is 4% and that of multiple recurrences is 14%. Ultrasound examination needs to be performed as early as possible and frequently. Intestinal angiography or enhanced CT examination may also be required to find the problem.

The intussusception has recurred, do you need to surgically remove the intestine?

Not necessarily. The symptoms and signs of children with recurrent intussusception are generally almost the same as those when the intussusception occurred for the first time. After the last intussusception attack, the children have more experience and understand the importance of seeing a doctor in the hospital as early as possible for the treatment of intussusception.

The success rate of radiological reduction for recurrent intussusception will not decrease, and radiological reduction is still preferred.

In case of prompt treatment, there is no severe compression or necrosis of the bowel, and surgery is generally not required.

Life

What Should Patients With Intussusception Pay Attention To In Life?

Will the intussusception recur?

Intussusception may recur. The time interval for recurrence of intussusception in children is usually within six months, and it is mainly within one month to one year after the first attack. It is very important to be vigilant during this period for early detection of intussusception. The possibility of paroxysmal crying in children should be considered immediately.

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