General introduction: Acute intussusception is a common condition unique to pediatric patients and is almost never seen in adults. The diagnosis of acute intussusception in pediatric patients is not difficult, and early treatment is relatively simple. Acute intussusception has a high incidence and is a common pediatric disease. Zhengzhou Children’s Hospital sees children with intussusception every day, with a maximum of a dozen intussusceptions a day. As acute intussusception is a common disease in infants and young children, early treatment is effective, and timely diagnosis is especially important to avoid serious consequences of delayed diagnosis! All infants and children with unexplained crying, vomiting and blood in the stool should be highly alert to the occurrence of intussusception.
Etiology: Intussusception is a kind of intestinal obstruction in which a part of the intestinal tube and its nearby ligament are snapped into the adjacent intestinal cavity. The age of onset of this disease is most common in infants and children under 2 years of age, especially in infants aged 4-10 months. The etiology and pathogenesis of this disease may be due to the disturbance of intestinal peristaltic rhythm and alteration of intestinal tube dynamics, leading to the occurrence of intussusception. The incidence of intussusception is higher in spring, but it is also thought to be related to pediatric respiratory infections and adenovirus infections. The causes of intussusception include enteritis, diarrhea, dietary changes such as the addition of complementary foods, and hyperthermia.
Clinical symptoms: Intussusception often occurs in obese healthy children. Four major symptoms of acute intussusception: (1) paroxysmal crying. Crying occurs due to abdominal pain caused by increased peristalsis of the obstructed intestine, which is paroxysmal, and the timing of the attack is consistent with the wave of peristalsis. Intussusception of crying violent, painful expression, not easy to soothe, quiet for a while and then cry, and so repeatedly. (2) Vomiting. Vomiting occurs soon after the onset of pain. The vomiting is reflexive at first, and the vomit is milk or other food, and after 1-2 days the vomit is yellow-green liquid due to obstruction. (3) Blood in the stool. Blood in the stool appears 6-12 hours later, due to the entrapment of the mesentery, which causes the blood circulation of the intestinal tube to be impaired and affects the venous reflux, resulting in blood oozing from the intestinal mucosa and the discharge of “jelly-like stool” mixed with mucus in the intestinal lumen. Blood in the stool is an important symptom of intestinal entrapment, and is often misdiagnosed as bacillary dysentery. (4) Abdominal mass. A “salami-like mass” can be palpated in the right upper abdomen when the child is quiet.
Treatment: There are two types of treatment for intussusception, air enema and surgery. Air enema can be used for children who have been in good general condition for less than 48 hours. Air enema is a simple and effective treatment that can be cured in 90% of early cases. Air enema is performed under X-ray using an air enema machine with pressure display and is sometimes used as a diagnosis of intussusception. If the onset is long, the general condition is poor, and the air enema fails, surgical treatment is performed. The surgical procedures are simple repositioning, intestinal resection and anastomosis, and enterostomy.
Typical cases 1. The child, male, 7 months. He had paroxysmal crying for one day with vomiting, which was yellow-green liquid. Blood in stool twice, as dark red jam-like stool. A mass could be palpated in the right upper abdomen on abdominal palpation. Ultrasound report: “sleeve sign” and “concentric circles” signs were detected in the right upper abdomen. Diagnosis: acute intussusception. Treatment: Air enema was performed in the outpatient clinic. He was cured and went home after intussusception was rectified.
2.Child, female, 10 months. She had paroxysmal crying for 6 days, abdominal distension for 3 days, with high fever, poor mental health, little urination, and no stool for 2 days. Physical examination: poor mental response, confusion, pale face. The abdomen was highly distended with full abdominal pressure pain and disappearance of bowel sounds. Ultrasound report: intussusception. Abdominal plain film report: intestinal obstruction. Diagnosis: intussusception with intestinal necrosis and infectious shock. Intraoperatively, the small intestine was found to be significantly dilated, and the terminal ileum, cecum and ascending colon were necrotic, about 25 cm in length, and intestinal resection and enterostomy were performed. During hospitalization, he was treated with surgery, anti-shock and anti-infection, and was hospitalized for 12 days. He was cured by shutting down the fistula 5 months after the operation.