Sometimes when the child is playing well or quietly, he suddenly starts to cry and suffer, even with clenched fists and curled body, sometimes accompanied by vomiting, and does not eat milk or other food. You can’t coax them. After a while, they are quiet again or start playing as if nothing has happened. After 15-20 minutes or so, the above performance appears again. At this time, parents should be alert to the possibility that the child has the most common acute abdominal disease in infants, “intussusception”. It is especially prevalent in children under 2 years old. The best age to develop it is from 5 to 9 months. It should be taken seriously and early consultation with a pediatric surgeon is recommended.
The following is an introduction to the development, diagnosis and treatment of intussusception and precautions.
What is intussusception? In layman’s terms, intestines are trapped in the intestines!
The disease was first identified by Barbette in the mid-17th century. The incidence is about 1.5 to 4 per 1,000 live births, 26 to 93.5 per 100,000 child-years, with varying reports around the world. The incidence differs between males and females, with boys more likely to have the disease, with a male:female ratio of about 1.5 to 3 to 1. It is mainly seen in infants under 1 year of age, and is most common from 5 to 9 months of age. The overall incidence is 60-65% under the age of 1 year and 85% under the age of 2 years. It varies around the world.
Etiology: 90% of pediatric cases are idiopathic, that is, there is no obvious cause. Secondary to intestinal pathology there are about 2-8%! In contrast, 80-90% of adults have organic pathology, that is, there is an obvious pathology of the intestinal tract that induces the cause of intussusception. It is generally believed to be related to adenovirus infection, intestinal dysfunction, and abnormalities in the development of the intestinal canal itself, especially in the ileocecal anatomy. The peristaltic movement of the intestine causes the edematous thickened or abnormal intestinal wall to move distally and lodge into the distal intestinal canal.
Classification: According to the location and mode of entrapment, it is classified as ileocecal, ileojunction, ileo-jejunct, small intestine, colon, multiple entrapment, etc.
Clinical manifestations.
Abdominal pain: it appears at the earliest, more than 90% of the children appear. It is often manifested as follows: the child is irritable, crying and restless, with painful expression, clenched fists, curled body, flexed lower limbs, pale face, refusal to eat. After repeated episodes, the child is tired and moans.
Vomiting: 80% of the children appear, vomiting not many times, initially the vomit is stomach contents, gradually vomit containing yellow bile, or even vomit in the form of stool.
Bloody stool: 8-12 hours after the onset of the disease, the stool is sticky red jam-like stool, sometimes in the form of blood and water, which indicates serious damage to the intestinal wall. 30% of the children resolve their own bloody stool, and 60% of the children can find bloody stool on anal finger examination!
Abdominal examination: 75% of children with abdominal examination can be seen salami-like masses, mostly located in the right upper abdomen or upper abdomen in the middle or to the right. In severe cases, a mass can be found on the left side of the abdomen, and even a mass can be seen prolapsing from the anus. The right lower abdomen is hollow. Late intestinal strangulation when peritonitis occurs, the abdominal muscles are tight, and the masses are not easily retrieved instead.
Systemic condition: at the beginning of the disease, the general condition is good, the abdomen is not distended, after 24 hours, the condition gradually worsens, the child’s expression is indifferent, drowsy, fever, body temperature is often above 39°C, the pulse rate is accelerated, after intestinal necrosis, peritonitis, abdominal muscle tension, systemic toxic symptoms are increasing, the body temperature is up to 40°C or more, coma, shock, failure, and even death.
Symptoms of intussusception in older children are not typical, but there is often recurrent abdominal pain. Relevant tests can be improved to further clarify the diagnosis.
Diagnosis: Typical children can be diagnosed according to their main manifestations such as paroxysmal abdominal pain, paroxysmal crying, vomiting, masses found in the abdominal wall, blood in the stool, etc.
For those with atypical manifestations and difficult diagnosis: further investigations such as abdominal ultrasonography, abdominal X-Ray, barium (other contrast agents can be used instead) enema, air enema are needed. Most of them can be diagnosed. If necessary, CT examination of the abdomen should be performed.
Differential diagnosis: There are many diseases that are associated with similar manifestations such as crying, vomiting and blood in stool in children.
Parents should not take the above symptoms lightly and should consult a pediatric surgeon as soon as possible.
Treatment: Non-surgical treatment and surgical treatment are available.
Non-surgical treatment: children with short onset time (within 48 hours of onset), good general condition and no contraindications to reset can be reset on a trial basis, such as air enema, saline enema reset under ultrasound surveillance. Most of them can be successfully reset in the early stage. The success rate is about 91%. The risks of resetting are: intestinal perforation, respiratory and cardiac arrest, bleeding, unsuccessful resetting, recurrence, etc.
Precautions after resetting: temporary fasting, rehydration, replenishment of water and electrolytes. Observe the child’s vital signs and clinical manifestations, and review the abdominal ultrasound to see if there is complete repositioning or whether there is re-collapse. Pay attention to whether there is any bleeding in the stool, abdominal condition, general condition, and whether there is any late perforation and bleeding. If there is any discomfort, consult the doctor promptly. If there is a recurrence of the condition of previous intussusception, it means that the condition may recur and needs to be seen early.
Surgical treatment: If the reset is not successful, surgical treatment is required; if the diagnosis is clear, there are contraindications to reset, and the condition is critical, air enema reset or saline enema reset treatment is not possible, and early surgical treatment is required.
After surgery, pay attention to observation, whether there is blood in the stool, recurrence, perforation, etc.
Recurrence rate: 3.4%~3.9% after surgery, 8.9%~12.7% after non-surgical recurrence