Intussusception is one of the most common pediatric acute abdominal conditions in clinical practice. It occurs most often within 1 year of age, with peak age of onset at 4 to 10 months, but it also occurs at 2 or 3 years of age or older. It is more common in obese children. The disease can be seen throughout the year, with the highest incidence in winter and spring. The onset of the disease may be related to changes in dietary habits, food irritation, intestinal dysfunction due to various causes, intestinal spasm and viral infections, but also secondary to organic lesions such as ileal wandering, lymph node enlargement, intestinal tumors or Merkel’s diverticulum. In addition, intussusception caused by allergic purpura is not uncommon.
(a) Abdominal pain is the most common and earliest clinical manifestation of pediatric intussusception. Infants and children cannot describe themselves and often show paroxysmal episodes of crying. 10 to 20 minutes, the child is quiet between episodes and can even sleep. Some children do not cry, but show pale, agitated and uncomfortable expressions of paroxysmal attacks.
(B) Vomiting is quite common in infants and young children. Early vomiting is the stomach contents, which is a neuroreflex vomiting caused by the irritation of the mesentery. As the disease progresses, bile-like material can be vomited, and in the late stage, even fecal-like material can be vomited, which is caused by complete intestinal obstruction.
(c) Bloody stools are also more common, usually appearing several hours after the onset of the disease. Due to intussusception caused by intestinal blood flow disorders, which is equivalent to strangulated intestinal obstruction, as the cause of bloody stools. Most of them are jam-like stools, and some of them have a large amount of bleeding and may pass red blood stools. Occasionally, there are intermittent episodes of intussusception or more relaxed intussusception, the onset of a long period of time without the appearance of bloody stools. If the child has not had a bowel movement for a few hours after the onset of the disease, the rectal-anal examination can be used to understand the nature of the stool as early as possible.
(d) In most children, the abdominal mass formed by intussusception can be palpated, usually along the colonic frame, and can be in various locations, but most often in the right upper abdomen, while the right lower abdomen has a hollow feeling on palpation. In very few children with severe disease, the intestinal canal may come out of the anus, which needs to be distinguished from rectal prolapse. Early in the course of the disease, vomiting can lead to a decrease in abdominal intestinal tube inflation and a flat abdomen. The abdominal distension gradually appears with the prolongation of the disease, and when the distension is severe, the diaphragm may be elevated, affecting breathing. If there are signs of peritoneal irritation such as redness of the abdominal wall, abdominal pressure and muscle tension, it suggests that intestinal necrosis may have occurred.
(E) Early onset of the child’s general condition is still good, with the prolongation of the disease, the child’s condition gradually worsens, appearing signs such as depression, pallor, dehydration, etc., may also be accompanied by a fine pulse, body temperature, etc., and even develop into shock and systemic failure.
(f) Ultrasound examination: ring target sign, pseudorenal sign, etc.
(ix) The disease should be differentiated from bacterial dysentery, acute necrotizing enterocolitis, allergic purpura, rectal prolapse, ascaris intestinal obstruction, intestinal polyps, and other diseases.