Intussusception is a segment of the intestine that is trapped in the lumen of the intestine to which it is attached and causes obstruction to the passage of intestinal contents. Intussusception accounts for 15% to 20% of intestinal obstruction. There are two types of intussusception, primary and secondary. Primary intussusception occurs mostly in infants and children, while secondary intussusception is mostly seen in adults. The vast majority of intussusception is the proximal intestine to the distal intestine into the set, reversible set is relatively rare, less than 10% of the total number of cases.
Clinical manifestations 1, mostly in infants and children, especially children under 2 years old.
2. Typical manifestations: abdominal pain, vomiting, blood in stool and abdominal mass.
3, adult intussusception clinical manifestations are not as typical as in young children, often manifested as chronic recurrent attacks, less often occurring bloody stools. In adults, intussusception is mostly associated with organic diseases (especially intestinal polyps and tumors).
Differential diagnosis 1, acute hemorrhagic enteritis Acute hemorrhagic enteritis has a rapid onset and begins with abdominal pain, mostly around the umbilicus or throughout the abdomen, as paroxysmal colic or persistent pain with paroxysmal aggravation. There is often chills and fever. Most of the patients have diarrhea, and 80% of them have bloody stools in the form of blood and water or jam, sometimes purple-black blood. 60% of them have nausea and vomiting. About 1/4 of the patients are in serious condition and can be accompanied by toxic shock. On physical examination, there are varying degrees of abdominal distension, abdominal muscle tension and tenderness, and bowel sounds are generally diminished. Sometimes a mass with pressure pain can be palpated. x-ray abdominal plain film examination can see the small intestine dilated, inflated and flattened with fluid, and the widening of the intestinal gap shows fluid in the abdominal cavity.
2, chronic abdominal pain due to other causes Adult intestinal loop often manifests as chronic recurrent episodes, less often occurring bloody stools. Mostly incomplete intestinal obstruction, the symptoms are mild, showing paroxysmal episodes of abdominal pain. It needs to be distinguished from other causes of chronic abdominal pain, such as chronic appendicitis.
Treatment 1, pediatric intussusception is mostly primary, can apply air or barium enema method reset. But suspected intestinal necrosis is contraindicated.
2, enema method can not be reset or suspected of intestinal necrosis, or secondary intussusception feasible surgical treatment. The specific surgical method should be decided according to the exploration situation. Without intestinal necrosis, surgical reset; with difficulty, cut the neck of the sheath to reset, and then repair the intestinal wall; with necrosis or combined with other organic diseases, intestinal resection anastomosis or fistulotomy is feasible.