Intussusception is a segment of the intestine with its mesentery snapping into the lumen of the intestine to which it is attached and causing obstruction to the passage of intestinal contents. Intussusception accounts for 15% to 20% of intestinal obstruction. There are two types: primary and secondary. Most pediatric intussusceptions are primary. A few of them are secondary to Meckel’s diverticulum, allergic purpura, lymphoma, etc.
Pediatric intussusception occurs in infants and children aged 6 months to 2 years, spring and autumn days, fat children, and boys. The onset is often preceded by a history of upper respiratory tract infection or diarrhea.
The most common pathological type is ileocecal (i.e., the ileocecal part acts as the head of intestinal entrapment, leading the end of the ileum into the ascending colon, and the cecum and appendix are also turned into the colon), accounting for about 50%-60% of the total; the ileocecal type takes the second place (i.e., the ileum starts from a few centimeters from the ileocecal valve, sets into the very end of the ileum, and crosses the ileocecal valve into the colon), accounting for about 30%; the set-in part continues to advance with As the intestinal peristalsis continues to advance, the intestinal tube and its mesentery are also sheathed together, and the neck bundle cannot be withdrawn automatically, resulting in circulatory disorders in the sheathed intestinal tube due to continuous spasm of the sheathed intestinal tube, initial venous reflux obstruction, tissue congestion and edema, varicose veins, increased mucosal reflux disorder, arterial involvement, insufficient blood supply, resulting in intestinal wall necrosis and systemic toxic symptoms, which can be complicated by intestinal perforation and Peritonitis, toxic shock.
What are the clinical manifestations of intussusception?
1, paroxysmal crying: the early symptoms, characterized by a healthy infant, without any cause and sudden onset of violent and regular paroxysmal crying (abdominal pain). The child shows paroxysmal crying and restlessness, leg flexion and pallor. Each attack lasts about 10-20 minutes, then the child falls asleep quietly, or plays as usual, and then suddenly attacks again after an interval of tens of minutes, with the same symptoms as before.
After repeatedly doing so, the child becomes mentally ill, fatigued and pale. This regular paroxysmal abdominal pain is caused by strong peristaltic waves pushing the intestinal tube forward and pulling the mesentery, while strong contractions occur in the sheaths of the sleeve. Individual small children do not cry violently, but only show bouts of restlessness and pallor, and then enter a state of shock, need to be particularly alert.
2. Vomiting: Reflex vomiting occurs soon after the onset of the disease, and the vomit is milk or food, and later there is bile or even fecal-like vomit, which is a serious manifestation of intestinal obstruction.
3, blood stool: mostly in 8 to 12 hours after the disease, is one of the characteristics of the disease, often dark red jam-like stool, can also be fresh blood stool or blood, generally no odor, when suspected of the disease and no blood in the stool can be rectal finger examination, if the finger test is stained with blood has the same diagnostic significance. The reason for the blood in the stool is the impaired blood circulation in the intestinal wall of the sleeve, resulting in mucosal blood leakage and intestinal mucus mixed together.
4, abdominal mass: the mass is mostly located in the right upper abdomen, upper abdomen or left abdomen, salami-like, smooth and not too hard, slightly elastic, slightly movable, with pressure pain.
5, general condition: early onset of the disease, the child’s general condition is still good, the body temperature is normal, only pale, poor spirit, loss of appetite or refusal to eat. With the prolongation of the onset, the general condition is gradually serious, showing depression, drowsiness, dehydration, fever, abdominal distension, and even toxic shock or signs of peritonitis.
How to diagnose intussusception?
Firstly, based on the above manifestations (i.e. paroxysmal abdominal pain, vomiting, blood in stool and presence of masses in all four) and medical history, secondly, ultrasonography shows the characteristic concentric circle-like masses of intussusception. Thirdly, an air or barium enema X-ray can be performed to make a correct diagnosis in time. Colon air or barium enema X-ray is a simple, safe and reliable diagnostic method, and the correct diagnosis can be made in time by seeing the “cupped” image as its characteristic, which is also a better treatment measure.
What diseases should be distinguished from pediatric intussusception?
1, bacterial dysentery: also seen in infants and young children, the onset of acute, paroxysmal abdominal pain, bloody stools, etc., may be confused with intussusception. However, dysentery has a large number of bowel movements, contains a lot of mucus and pus and blood stool, with urgency, early fever, abdominal pain is not as intense and regular as intussusception, and the abdomen is not palpable mass. A large number of pus cells can be seen in the stool routine, and the culture has the growth of Bacillus dysenteriae. Identification is often not difficult, but it is worth noting that on the basis of bacterial dysentery, due to intestinal motility disorders, can also be complicated by intussusception.
2, acute necrotizing enterocolitis: can be manifested as abdominal pain, vomiting and bloody stools, but the disease has a history of diarrhea, early can be manifested as abdominal distension, high fever and frequent vomiting, frequent stools, washed water-like, more volume, with a special fishy smell, the systemic condition deteriorates quickly, often showing severe dehydration, skin pattern and other signs of shock.
3, roundworm intestinal obstruction: mostly seen in older children, may have paroxysmal abdominal pain, vomiting, in the abdomen can be palpable roundworm mass, rather like a salami-like mass, but its surface is often striped, generally no blood stool. The onset of the disease is less acute than intussusception, and most of them have a history of roundworm discharge or improper deworming.
4, allergic purpura: most of the older children, most of them have fresh bleeding rash, accompanied by joint pain, sometimes accompanied by hematuria. These symptoms help to differentiate the disease from intussusception, which can sometimes be complicated by intussusception, and should be noticed and X-rayed if necessary.
How to treat intussusception?
Non-surgical treatment: Air or barium enema is preferred. The indications are primary intussusception within 48 hours, the child is in good general condition, no obvious dehydration, no obvious abdominal distension and soft abdomen. The indications of reset air enema see the air suddenly enter the end of ileum, pull out the anal tube that see the child expel a lot of foul gas; abdominal mass disappears; the general condition of the child improve, quiet, no longer cry; oral 0.5 ~ 1.0g of carbon end, 6 ~ 8 hours later can be excreted by the feces carbon end, that means the reset completely successful.
Surgical treatment: Late stage of the disease is more serious, uncooperative enema reset cases, or has been enema failed to reset cases, suspected of small intestine overlap; and reset up to more than 3 times must be surgical treatment. Pre-operative preparation should include correction of dehydration and electrolyte disorders, antibiotics, antipyretic and blood transfusion. During surgery, repositioning, intestinal resection and anastomosis, enterostomy, etc. should be performed according to the child’s condition and pathological changes.