Intussusception is a type of intestinal obstruction caused by a segment of the intestine entering the adjacent intestine. Pediatric intussusception is one of the most common emergencies in pediatric surgery. It is more frequent in late spring and early summer. The incidence is higher in boys than in women. It is most common in infants within 1 year of age, with the most frequent occurrence at 4-7 months of age, and decreases with age after 2 years of age, and is very rare after 5 years of age.
The etiology of intussusception is still not well understood. At present, the factors associated with the development of intussusception are recognized at home and abroad: dietary changes and food stimulation, local anatomical factors of the intestine, disorders of the vegetative nervous system, intestinal spasm, viral infection, immune response factors, etc.
Pathology: small intestine, colon, ileocolic, ileocecal, ileo-cecum, ileo-ileal, and polycystic type. Pediatric intussusception is most common in the ileocolic type, accounting for about 70% to 80%.
Clinical manifestations】 1 abdominal pain for the earliest symptoms, often sudden onset, crying and restless. The child’s fists are clenched and moved around, the legs are flexed and curled, the face is pale, and he refuses to eat. The abdominal pain is paroxysmal and lasts for several minutes each time. After the attack, the whole body is relaxed and quiet, and can even fall asleep, but after an interval of 10 to 20 minutes, the attack is repeated again; so repeatedly that the child finally becomes exhausted and can only moan, and enters a semi-sleepy state of powerless struggle. The abdominal pain of intussusception occurs in about 90% or more of the cases.
2 Vomiting About 80% of the sick children vomit, vomiting milk, milk lumps or other food. The vomiting is infrequent, with gradual vomiting of bile (yellowish-green), which may contain feces in the later stages.
3 Bloody stools are usually passed 8 to 12 hours after the onset of the disease, and the contents are sticky jam-colored stools or jelly-like stools mixed with blood and mucus. Sometimes it is dark red blood, which indicates serious damage to the intestinal wall, and special caution should be exercised when non-surgical repositioning.
4 abdominal manifestations About 75% of children can find a sausage-shaped swelling, slightly hard and tough. The child has discomfort when the mass is touched, and sometimes the abdominal muscles are reactive and tense.
After 24 hours, the condition gradually deteriorates as the symptoms worsen. The child is indifferent, depressed, drowsy, pale, and severely dehydrated. The body temperature often rises above 39°C and the pulse rate increases. 48 hours later, the diaphragm is elevated due to severe abdominal distension, which affects breathing. After the occurrence of intestinal necrosis, signs of peritoneal irritation and abdominal muscle tension appear. The child’s systemic symptoms of poisoning are increasing, the pulse rate is fine and rapid, the fever is above 40℃, coma, shock, failure and even death.
Diagnosis】It is not difficult to diagnose when there is abdominal pain, vomiting, blood in stool and masses, especially when there is blood with abdominal salami-like masses. In some children, the early symptoms are not clear, the signs are not obvious, and the diagnosis is often difficult when the medical history is unknown or when the intestinal loop is secondary to other diseases. The most common misdiagnosis is diarrhea, dysentery or other intestinal diseases. If there is any doubt about the diagnosis, abdominal ultrasound, barium or air enema must be used to clarify the diagnosis.
Air enema] Air enema is both a diagnostic method and the preferred treatment for intestinal loop. Indications: Good general condition, normal body temperature, pulse and respiration. No significant fluid level in the intestinal cavity under fluoroscopy. No significant abdominal distension and no signs of peritoneal irritation. The onset of disease is within 24 hours.
Methods: Using an air enema machine, performed by a pediatric surgeon in collaboration with a radiologist. Main steps: application of antispasmodic sedative, insertion of balloon anal tube, colonic air injection under X-ray fluoroscopy.
Notes on reset: After successful reset, abdominal signs, bowel movements and temperature changes should be observed, and attention should be paid to preventing recurrence of intussusception and complications. Soft abdomen, gradual yellow color of stool and normal body temperature are signs of improvement.
Surgical treatment】Surgery is recommended for those who have failed air enema, or late combined with other intestinal disorders, repeated recurrence, or habitual intussusception. Before surgery, adequate preparation should be made, and those with serious conditions should first correct dehydration and acidosis, transfuse blood or plasma if necessary, and control the body temperature. Otherwise, hyperthermic convulsions and high mortality rate are likely to occur after surgery.