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 the intestinal contents. The most common clinical condition is acute intussusception, which occurs between the ages of 5 months and 1.5 years, with 80% of cases occurring within 1 year of age, especially between the ages of 5 months and 9 months, with more male than female infants.
The main reason why intussusception almost always occurs in infants and children under 2 years old is that infants and children are not well developed.
Ninety percent of intussusceptions have no obvious cause and are called “idiopathic”. It has been observed that pediatric intussusception may be associated with diarrhea, constipation, medications, upper respiratory tract infections, gastrointestinal allergies and increased colonic motility. The incidence is highest in late spring and early summer and may be related to upper respiratory tract infections and viral infections.
In 75% of cases of pediatric intussusception, it occurs near the ileocecal valve, followed by the small intestine. If the intestine is edematous for a long time, the intestine will be clamped more tightly, and the arteries of the intestinal wall will be blocked, resulting in necrosis and rupture of the intestine, causing peritonitis.
Typical manifestations: intermittent abdominal pain (crying), vomiting, and jam-like stools.
Abdominal pain
The early symptoms of intussusception are characterized by the sudden onset of severe and regular paroxysmal abdominal pain (crying) in a normally healthy infant without any causative factors. The child shows paroxysmal crying, restlessness, leg flexion and pallor. Each attack lasts about 10-20 minutes, and then the child falls asleep quietly or plays as usual, and then has another sudden attack about tens of minutes later, with the same symptoms as before.
After repeatedly doing so, the child becomes mentally ill, fatigued and pale. This kind of regular paroxysmal abdominal pain (crying) is caused by the peristaltic movement of the intestine in bursts, and the stronger peristaltic waves push the intestinal tube forward, pulling the mesentery and causing strong contraction of the sheath. The smaller children do not cry violently, but show bouts of agitation and pallor, and then go into shock, which requires special vigilance.
Vomiting
Reflex vomiting occurs shortly after the onset of illness. This is due to the pulling of the mesentery, and the vomit is milk or food, and later it may be bile or even fecal matter, which is a sign of severe intestinal obstruction.
Bloody stool
This is one of the characteristics of the disease, often dark red jam-like stool, or fresh blood stool or blood water, usually without odor, when the disease is suspected and there is no blood in the stool, rectal finger examination, if the finger test is stained with blood, it has the same diagnostic significance. The reason for the blood in the stool is the obstruction of blood circulation in the intestinal wall of the socket, resulting in the mixing of mucosal blood and intestinal mucus.
Abdominal masses
The site of the mass depends on the point of entry and the degree of entry, and is usually located in the ascending, transverse and descending colon. In the early stage of the disease, the mass is mostly located in the right upper abdomen, which is salami-like, smooth and not too hard, slightly elastic, slightly movable, and with pressure pain. Later, with the progression of the stenosis, the mass may move to the left abdomen along the colon, and in severe cases, it may enter the rectum, and a cervical-like mass may be palpated on rectal finger examination.
Systemic condition
In the early stage of the disease, the general condition of the child is still good, the body temperature is normal, only pale, poor spirit, loss of appetite or refusal to eat. With the prolonged onset of the disease, the general condition gradually becomes severe, showing depression, drowsiness, dehydration, fever, abdominal distension, and even shock or signs of peritonitis.
Management of pediatric intussusception
Pediatric acute intussusception is treated with both non-surgical and surgical therapies.
Children are often unable to describe their symptoms clearly. Therefore, parents should learn to differentiate and be highly alert if they find typical manifestations of intestinal obstruction in their children to avoid delaying the disease. Intussusception is a disease that cannot be ignored, and its diagnosis and treatment are time-sensitive, as intestinal necrosis will result if intussusception cannot be reset.
Finally, we remind young parents that they should seek emergency medical attention as soon as possible if they notice symptoms such as sudden mental deterioration, paroxysmal alternating crying (alternating mental depression), jam-colored or dark red stools and vomiting in infants and children under 2 years old.