1.What is intussusception?
The term “intussusception” comes from the Latin words “intus” in and “suuscipere” to hold, and is a part of the intestine and its ligament that is snapped into its distal The term “intussusception” comes from the Latin words “intus” in and “suuscipere” to hold. Intussusception is the second most common cause of acute abdominal pain in infants and preschool children, in addition to constipation.
2. What is the structure of intussusception?
Three cylinders of the intestinal wall, the inner and middle cylinders are the invaginated intestinal canal (intussusception), and the outer cylinder accommodates the invaginated intestinal canal (intussusception sheath).
3.What are the types of intussusception?
(1) Two general types are permanent (intussusception fixed, accounting for 80%) and temporary (can be reset by itself, accounting for 20%);
(2) Special type can be divided into idiopathic intussusception (no pathological trigger point, accounting for 95%), pathological trigger point (accounting for 4%) and postoperative intussusception (accounting for 1%);
(3) Anatomical types can be divided into ileocolic (85% of cases), ileo-ileocolic (10% of cases), appendicocolic, cecocolic, colonic (2.5% of cases), ileo-jejunal (2.5% of cases), jejunojejunal (2.5% of cases), and peritubular intussusception;
(4) Other types, including recurrent intussusception (5%).
4. Which type of intussusception is the most serious?
The severity of intussusception is related to the age and physical condition of the child, but it is mainly related to the time between the onset of the disease and the time of consultation. If the disease is detected in time (within 48 hours), it usually does not cause serious consequences and can be restored to normal after 1-2 days of successful rectification; failure to detect the disease in time may cause intestinal necrosis, which may lead to death in serious cases.
5, what children are prone to intussusception?
Acute intussusception is a unique disease in infancy, common within 1 year, accounting for 60% to 65% of infants aged 4 to 10 months, the incidence decreases with age after 2 years, and is rare at 5 years. The incidence of intussusception in infants and children is about 1/2000. more boys than girls, usually 2:1 or 3:2, especially in obese infants and children.
6.When is intussusception likely to occur?
Intussusception can occur throughout the year, with the highest incidence in late spring and early summer, and can be related to viral infections (respiratory and or gastrointestinal viruses), and is most likely to occur when there is recent diarrhea or a cold.
7.What are the manifestations of intussusception in children?
Two typical symptoms (abdominal pain, vomiting) and signs (abdominal mass, rectal bleeding) of intussusception help diagnose intussusception in infants or children, but a history of abdominal cramps is required for diagnosis, especially in infants. Other signs or symptoms usually help to confirm the diagnosis.
8.What diseases can be secondary to intussusception?
Intussusception is most often secondary to mesenteric lymphadenitis (most recent upper respiratory tract infections or gastrointestinal infections), diarrheal disease, Meckel’s diverticulum, intestinal polyps, allergic purpura, etc.
9.How to detect intussusception early?
The typical symptom is sudden, severe, intermittent abdominal cramps that can cause the thighs to lift and last for several minutes. After the abdominal pain, the infant is usually quiet, has pale skin, sweats, and can temporarily resume normal activities. At this time, ultrasound examination of the abdomen should be performed promptly.
10.Why is there abdominal pain when intussusception occurs?
When the intestinal cavity is blocked by the intestinal tube or ligament, the intestinal contents cannot pass normally when the intestine is peristaltic, and each time the intestine is peristaltic, it will cause the intestinal tube to expand, and the pulling and firing of the intestinal wall will cause abdominal pain, and the abdominal pain is obviously relieved during the interval of intestinal peristalsis, which is typical of paroxysmal abdominal pain.
11.Why is there bloody stool when intussusception?
At the onset of intussusception, the intestinal tube moves forward, and the proximal invaginated intestinal tube (intussusception sheath) carries the mesentery into the distal accommodating intestinal tube (intussusception sheath), and the mesenteric vessels are twisted into angles, squeezed and compressed between the intestinal tubes of the intussusception, which leads to severe local edema of the intussusception, which in turn causes venous compression, congestion and blood stasis, which in turn causes the swollen intussusception to discharge mucus and blood, often forming The typical red jam-like stool.
12.What happens when intussusception is serious?
If intussusception is not rectified in time, the intestinal tube will become more congested and the pressure will increase, which will eventually lead to ischemic changes in the intestinal tube and necrosis of the intussusception. In severe cases, it may lead to infectious shock and death.
13.When I suspect that I have intussusception, which hospital department should I go to?
Once the child is found to be abnormal and intussusception is suspected, in areas where there is a specialized hospital, the first choice is the general surgery department of children; if there is no specialized hospital for children, the general surgery department of a general hospital is preferred.
14, suspected of intussusception should do what tests?
At present, ultrasound examination is not only accurate but also non-invasive, which is the first choice for diagnosing intussusception. There are also a variety of tests (contrast enema, CT, magnetic resonance imaging), which are mainly used for intussusception with more complex clinical manifestations or atypical ultrasound manifestations.
15.Is it still possible to let the patient eat after the diagnosis of intussusception?
When your child is diagnosed with intussusception, you should not feed him/her (not even water), because he/she may vomit repeatedly, and if you force feed him/her, it may lead to accidental aspiration and aggravate the number of vomiting. The correct approach should be to go to the relevant departments in a timely manner, early radiological revision; if the child vomits frequently and dehydration is serious, you should first infuse fluids to supplement, wait for the general condition of the child to improve before performing radiological revision, which can increase the success rate of revision.
16.How to treat intussusception?
At present, radiological repositioning (liquid or air) is still the preferred treatment for intussusception, and the success rate of early intussusception is over 90%.
17.What kind of situation can choose radiological revision?
If the duration of the disease does not exceed 48 hours, the systemic condition is good, there is no obvious dehydration and electrolyte disorder, no obvious abdominal distension and peritonitis, the reset pressure is generally controlled at 60~100mmHg, and the pressure of diagnostic enema for infants under 3 months of age generally does not exceed 80mmHg.
18.What cases need surgical treatment?
Surgical treatment is indicated in cases of failed radiological correction; auxiliary examinations suggesting suspicion of intestinal disease (especially in older children); or children with multiple recurrences of intussusception; small intestinal intussusception; and cases where non-surgical treatment is contraindicated.
19.How is the enema examination of intussusception done?
Radiological correction (air enema for example) operation: first, we need to take a standing plain film to ensure that the child does not have intestinal necrosis or perforation; insert a special tube with an air bag into the rectum through the anus, inflate the air bag and fix it in the rectum; inflate the anus under the monitoring of the monitor to ensure that the inflation pressure is within a certain range and to prevent the pressure from rupture of the intestinal cavity; use the gas from the anus to inflate the intestinal cavity. The intestinal canal will be flushed out by the combination of the gas from the anus and the manipulation.
20.What do I need to do before radiological repositioning treatment of intussusception?
If the child vomits repeatedly before the radiological repositioning, a gastric tube is needed, and after gastrointestinal decompression, atropine is injected intramuscularly to reduce the occurrence of aspiration during the operation.
21.When is intussusception prone to recurrence?
The time interval of recurrence is mostly within 6 months, mostly 1 month to 1 year after the first attack. It is important to strengthen the care of the child during this period for early detection of intussusception, and the possibility of the disease should be considered when the child has paroxysmal crying.
22.Is there any way to reduce the recurrence of intussusception?
The recurrence of intussusception in children is mostly within five years of age, and there is no definite and effective way to prevent its recurrence. However, it is very important to reduce respiratory and gastrointestinal viral infections and to keep warm during sudden changes in weather, in addition, timely consultation is the key to reduce the risk of recurrence.
23.What should I do if I repeatedly get intussusception?
In children with one recurrence of intussusception, the incidence of pathological trigger points (secondary intussusception caused by organic lesions) is 4%, while the incidence of multiple recurrences is 14%, so it is necessary to perform ultrasound examination as early as possible and often, supplemented by intestinal imaging or enhanced CT examination if possible.
24.Does the recurrence of intussusception require surgery to remove the intestinal canal?
The symptoms and signs of recurrence are almost the same as those of the first time, so it is important to learn from the experience of the last episode of intussusception and shorten the time interval between the onset of symptoms and the hospital visit for the treatment of intussusception. The success rate of radiologic repositioning does not decrease when intussusception occurs again, and radiologic repositioning may still be preferred.