Intussusception is a condition in which a part of the intestinal canal and its ligament enter the adjacent intestinal cavity, a condition specific to infancy and childhood, and one of the most common acute abdominal conditions. The incidence of intussusception in China is high, accounting for the first place of intestinal obstruction in infants, and 80% occurs in children under 2 years old. The main manifestations are abdominal pain, vomiting, bloody stools and abdominal masses. This disease belongs to the category of “vomiting” and “abdominal pain” in Chinese medicine. So, what are the causes of intussusception?
The cause of intussusception is divided into primary and secondary two.
1, primary intussusception 90% of intussusception belongs to the primary, set into the intestinal segment and surrounding tissue without significant organic lesions. Intussusception can have a starting point, with intestinal peristalsis, its proximal intestine into the distal intestinal lumen. Intraoperative enlargement of the lymph nodes of the intestinal wall at the head of the looped intestinal segment can be found in almost every patient. Intussusception usually occurs after upper respiratory tract infection or gastroenteritis, and more than 50% are associated with adenovirus and rotavirus infection, which explains the enlarged Peyer’s collection lymph nodes, and the enlarged Peyer’s collection lymph nodes protruding into the intestinal cavity may be the trigger for intussusception.
2, secondary intussusception The starting point of intussusception with clear pathological abnormalities accounts for 2% to 12%, including: Meckel’s diverticulum, appendix, polyps, tumors, submucosal bleeding due to allergic purpura, non-Hodgkin’s lymphoma, foreign body, ectopic pancreas or gastric mucus, intestinal duplication malformation, etc., among which Meckel’s diverticulum is most common. The older the child is at presentation, the greater the likelihood of the presence of secondary intussusception.
Patients with cystic fibrosis are prone to intussusception and may have recurrent episodes, so multiple repositioning is required. The possible causes are the concentration of intestinal secretions and the formation of fecal stones, mostly in children aged 9 to 12 years.
How to distinguish between intestinal distention and intussusception?
Flatulence is much less serious than intussusception and is caused by intestinal dysfunction, sometimes accompanied by abdominal pain. It can be effectively relieved by eating easily digestible food, hot compresses and massage, and taking digestive drugs. However, antibiotics (anti-inflammatory drugs) should not be used indiscriminately to avoid dysbiosis leading to further intestinal dysfunction. Intussusception is mostly seen in infants aged 4-6 months, and is characterized by paroxysmal crying, abdominal masses felt, bloody stools, and in some cases, vomiting. The so-called paroxysmal episodes are basically once every few minutes or ten minutes and are very frequent; the masses are mostly in the right lower abdomen, i.e., at the junction of the ileum and cecum; and the bloody stools often appear a few hours after the onset of intussusception and are more jam-like in nature. Since intestinal entrapment can cause bleeding in the intestinal mucosa and impaired blood circulation in the intestinal tube, the deeper and longer the entrapment, the greater the risk. If the patient is seen as soon as possible, 90% of the cases do not require surgery and can be reset with a low-pressure air enema. However, if a certain period of time has passed without medical attention, surgery is usually required.