What is intussusception?
Intussusception is one of the common abdominal emergencies in pediatrics. 80% of the cases are within 1 year of age, especially 5-9 months old, and more often in male than female infants. Intussusception refers to a segment of intestinal tube together with its attached mesentery snapped into its connected intestinal cavity, which not only causes impaired blood supply to the snapped intestine, but also abnormal intestinal peristalsis and leads to intestinal obstruction. In children, intussusception accounts for 15% to 20% of the causes of intestinal obstruction. Because the digestive system of infants is not well developed, the end of the small intestine is easily embedded in the large intestine, leading to intussusception. 90% of intussusceptions cannot be found for a specific reason and are called “idiopathic.
It has been observed that intussusception is associated with diarrhea, constipation, medications, upper respiratory tract infections, and intestinal allergies. Some seasonal periods of high incidence may be associated with the prevalence of certain viruses or diarrhea. The danger of intestinal entrapment is that when intestinal entrapment occurs, the intestinal vessels will be pressurized and the blood and lymphatic fluid will accumulate, causing the intestinal wall to swell, resulting in tighter and tighter intestinal entrapment. Because of this, intussusception is an acute abdominal disease that requires timely treatment. Many parents do not understand this knowledge and do not detect abnormalities in the early stages of intussusception, and do not treat their babies until serious symptoms appear.
How to detect it early?
The typical symptoms of intussusception include: paroxysmal crying, vomiting and jam-like bloody stools.
1. Paroxysmal crying is mainly caused by abdominal pain.
After the occurrence of intussusception, the intestinal tract is blocked, intestinal peristalsis becomes very strong, and paroxysmal abdominal cramps occur, often combined with vomiting. While older babies can express their tummy pain, younger babies are usually unable to express their feelings accurately and usually appear restless, cry in paroxysms, bend their legs and do not allow their tummies to be touched. When the bouts of crying (pain) are over and the baby appears to be “quieter”, he or she may appear to be in poor spirits, pale or have cold sweats. Parents should not think that their baby is fine because he or she is quiet. If the overlap is not lifted, the next bout of abdominal pain will soon appear.
2, jam-like bloody stools: generally 8 hours after the onset of paroxysmal abdominal pain, the baby can be solved jam-like bloody stools. This is due to the intestinal tube after trapping, intestinal wall bleeding mixed with intestinal mucus caused by bloody stools, at this time, if not sent to the doctor in time, it is easy to cause intestinal necrosis, and even peritonitis. Of course, these symptoms may also be caused by other reasons, such as gastroenteritis, constipation, etc. Therefore, parents should take their babies to the hospital for examination when they have bouts of crying and vomiting. Don’t treat it as “gastroenteritis”. The common gastroenteritis in infants can also occur with vomiting, usually with fever and diarrhea as the main symptom, while intussusception usually occurs with vomiting before jam-like stools and less fever. However, intussusception can also be caused by diarrhea following gastroenteritis.
An experienced doctor will check the baby for the possibility of intussusception, typically a sausage-like mass can be felt in the lower abdomen, and a blood-sticky stool can be seen on the glove during an anal examination. In addition, CT examinations can also detect intussusception. Parents should keep an eye on their baby’s symptoms, and also think about whether intussusception may have occurred after sending them to the doctor, to give the doctor a heads up as well. Once intussusception is suspected, the pediatrician will perform an air or saline enema under X-ray fluoroscopy or ultrasound to diagnose and treat the problem at the same time. Air or saline is slowly poured into the large intestine through the anus at a certain pressure to push the intestinal tube back into place.
Children who have been successfully repositioned by enema still need to be hospitalized for 24 hours for observation to make sure they are okay before being discharged.
Parents should be reminded that there is a 2% to 4% chance of recurrence in children with intussusception. The success rate of air enema treatment for intussusception in the early stage is about 80% to 90%, but the longer it is delayed, the more difficult it is to reset successfully, and if it cannot be recovered, it must be operated. If intussusception is found late, if it has been more than 24 hours (the intestine may be ischemic and necrotic) or if intestinal necrosis or peritonitis is suspected, there is a risk of intestinal rupture by enema, and emergency surgery is needed.
If the intestine is not necrotic, the intestine can be squeezed back from the distal end to the proximal end like milk to recover the overlapped large and small intestine. If the treatment is timely, the patient can be discharged successfully in 2 to 3 days after surgery. If the intestine is necrotic, the necrotic intestine will be removed and the patient will be discharged from the hospital at least 6-7 days after surgery. If there are more necrotic intestines, short bowel syndrome may occur after surgery, affecting the child’s nutrition and normal development. Therefore, timely detection of intussusception is very important. For babies who have frequent bouts of crying (especially when they appear to not let their stomachs be touched) and vomiting at the same time, not only doctors should pay attention, but also parents should think that intussusception may occur and confirm the diagnosis in time so as not to delay the treatment.