Intussusception is a pathology in which one section of the intestine is introduced into another, causing obstruction of the gastrointestinal tract. This is the most common disease in the first years of a baby's life. As a rule, the child cannot yet speak, and therefore he whimpers, cries, screams, is naughty. If he screams for no apparent reason and draws his legs to his stomach, this may be the first sign of illness and a signal for parents. What is this disease, what are its symptoms, how to treat it and why is it dangerous for the he alth of the baby?
Terminology. General concepts of the disease
The disease is most often observed in infants (90% of all diagnosed cases). Code according to the international classification of diseases ICD:
Intussusception - K56.1
Most common in children aged 5-8 months. When complementary foods are introduced into the diet, their intestines have not yet rebuilt and adapted to the new food, as a result of which this pathology develops. The prevalence of the disease is1000 infants account for 3-4 cases of intussusception, and in boys it manifests itself much more often. Most episodes have been recorded in perfectly he althy children who are well fed. The next age group predisposed to the disease is 45-60 years old, young people suffer from intussusception quite rarely.
Facts about the disease
Invagination of the intestine is the introduction of one part of the organ into another.
- Pathology develops mainly in infants.
- Usually, the disease leads to intestinal obstruction.
- The main symptoms are vomiting and severe abdominal pain.
- Treatment and early diagnosis of the disease is important to save the intestines and life of the patient.
- Intussusception in children is very rare after age 6.
People call intussusception "volvulus" - this is the most common and most dangerous disease of the abdomen in infants. Leads to compression of the veins, edema and intestinal obstruction. Most cases of intussusception occur in the area where the small intestine becomes large.
If the disease is left to chance, the condition will worsen and endanger the life of the child. Timely diagnosis and treatment almost always correct the situation.
Disease types
Intussusception can be of the following types:
- Primary - the reasons for its occurrence have not yet been clarified.
- Secondary - develops inthe result of various bowel diseases.
Depending on where the disease develops, they are distinguished:
- invagination of the small intestine;
- colon;
- mixed type (small-colonic and small-intestinal-gastric).
Intussusception can involve two or more parts of the intestine.
According to the course of the disease, acute, recurrent and chronic forms are distinguished. In this case, the acute form occurs most often, but its consequence is necrosis of the intestinal loop.
Reasons
Explain why one segment of the intestine is introduced into another, many doctors find it difficult. In the scientific literature, all causes of intussusception are divided into two groups: nutritional and mechanical. As a rule, for children under 3 years of age, the causes of the disease associated with food intake are characteristic, and for children a little older - with mechanical factors.
Dietary or nutritional factors:
- Incorrect introduction of complementary foods.
- Failure to follow the baby's diet (feeding out of hours, alternating too long intervals between feedings).
- Food too thick.
- Coarse fiber food.
- Hurry eating.
- Swallowing food in large unchewed pieces.
Mechanical factors include:
- Intestinal polyps.
- Cystic formations.
- Atypical location of the pancreas.
- Intestinal tumors.
Increase the risk of pathology:
- Intestinal allergy.
- Surgical intervention.
- Viral intestinal infections.
- Male.
- Genetic predisposition.
Intussusception often develops as a complication of the following diseases:
- Bacterial and viral damage to the intestines.
- Colitis, gastritis, enteritis.
- Tuberculosis of the intestine or peritoneum.
- Pathology in the form of prolapse of the small intestine.
How the disease progresses
Whatever the causes of the disease, it is directly provoked by a violation of the perist altic activity of the intestine. Peristalsis manifests itself chaotically, one section of the intestine, as it were, “bumps” into the neighboring one and is introduced into it.
The intruded area does not return to its original position due to compression of the intestinal wall, as a result of which it changes, that is, tissue edema that occurs due to stagnation of lymph, arterial and venous blood. This swelling does not allow the segment to straighten out.
Due to the fact that the arteries are pinched, the blood begins to circulate worse, the tissues do not receive oxygen, they starve. This, in turn, leads to necrosis of the intestinal wall. Gastrointestinal bleeding of varying intensity may develop.
If medical assistance is not provided, then intestinal perforation is possible at the site of necrosis, which will lead to peritonitis, which, in turn,turn, may end in the death of the patient.
Symptoms
Symptoms of intussusception in children are very similar to those of gastric intussusception. The following symptoms are usually observed:
- Children have sudden intermittent spasms. The pain progresses, the baby screams inconsolably and bends the legs to the tummy. Attacks occur at intervals of 20-25 minutes, but over time they become more frequent and more severe.
- Vomiting may be observed, in which, over time, impurities of bile appear, and it becomes yellow or green.
- The child may behave normally between pain attacks, which is why the initial symptoms may be confused with gastroenteritis.
Common signs of the disease are:
- Stools with mucus and blood (this is a sign of the beginning of tissue death), feces resemble currant jelly.
- Child wants to go to the toilet all the time but can't.
- A lump is felt in the stomach.
- Pressure drops sharply.
- Tachycardia appears.
- Lethargy, drowsiness.
- Permanent obsessive thirst.
- Diarrhea.
- Fever, fever.
But not all symptoms are so obvious and can be observed in a child, some babies do not have obvious pain, others do not vomit, others do not have blood in the stool. Older children often have pain but no other symptoms.
A few hours after the first painful spasms, the child shows signs of dehydration: sunken eyes, dry mouth,sticky sweat on the forehead, prolonged lack of urination.
Invagination of the intestines or stomach is a dangerous condition that requires qualified medical attention. The sooner it is diagnosed, the better.
Symptoms of intussusception in adults are as follows:
- Abdominal pain.
- Single or repeated vomiting.
- Bleeding in stools.
- Dizziness, weakness.
- Bloating due to increased flatulence (wherein gas is difficult or impossible to pass).
- Bleeding.
The acute form of the disease usually occurs when the large intestine enters the small intestine. In this case, complete intestinal obstruction occurs. The chronic form is characteristic of colonic intussusception.
Complications
The most common complications of the disease are:
- Intestinal obstruction.
- Perforation of the intestinal walls.
- Peritonitis.
- Intestinal bleeding.
- Internal adhesions and hernias.
- Necrosis of the intestine.
Diagnosis
The symptoms of some diseases are very similar, so instrumental, physical and laboratory examinations are necessary to confirm the diagnosis.
Physical is examining, probing, tapping and listening to the abdomen with a phonendoscope.
Instrumental methods for diagnosing intestinal intussusception:
- Ultrasound examination (ultrasound) - the area is determined,where tissue compaction occurred.
- Computed tomography - reveals the causes of the development of intussusception.
Laboratory methods:
- Complete blood count.
- Coprogram (study of feces).
The doctor will definitely ask about the state of he alth, pay special attention to the stomach, which will be sensitive and swollen. He needs to know about allergies and drugs that the child takes on a regular basis.
If the doctor suspects intussusception, he sends the child to the emergency room to see a pediatric surgeon. You can confirm the diagnosis of "intussusception" on ultrasound.
If the child looks very sick, weak, and the doctor suspects damage to the intestine, then he immediately sends him to the operating room.
Treatment of intussusception
All patients with intussusception are admitted to the surgical department.
Small children under 3 years of age are treated with a conservative method, but this method is possible if no more than 10 hours have passed from the onset of the disease and there are no complications.
Conservative treatment consists of introducing air into the intestines using a Richardson balloon. Air is pumped until the intussusception clears up. After the child, a gas outlet tube is placed in order to remove this air from the intestines. The effectiveness of the method is 60% of all cases.
In other cases (both in children and adults), an operation is performed to treat intussusception. During it, a thorough revision of the intestine is carried out to excludeadditional pathologies. In the absence of necrosis, one segment is carefully removed from the other. If there are changes in the tissue of the intestinal walls, then the segment is removed, capturing he althy areas. During surgery, the appendix is also removed, even if it is he althy.
After surgery for intussusception, conservative treatment is performed. For the next 2-3 weeks from the moment of surgery, you need to be careful in order to notice possible complications in time:
- Diarrhea.
- Nausea.
- Temperature increase.
- Crying, anxiety, insomnia, irritability, apathy, lethargy.
- Vomiting.
After the operation, you need to take care of the suture: maintain hygiene, check if the wound has become infected: swelling of the tissues, an increase in temperature in this area, redness of the tissues, pain in this area.
Prevention
For the prevention of disease in children it is important:
- correctly and according to the schedule to introduce complementary foods (that is, not earlier than 6 months);
- introduce new dishes very carefully and gradually;
- slowly increase the volume of dishes;
- in the first year of life it is recommended to give food in the form of puree;
- if a child has acute intestinal infections, you need to see a doctor and start treating them;
- timely treat the child for worms;
- examine the baby (regularly) for adhesions or neoplasms in the intestines.
In adults preventive measuresare:
- Compliance with the diet.
- Exclusion from the diet of rough food.
- Thorough chewing.
- Periodic examination of the digestive organs.
Forecast
With timely treatment, the prognosis is favorable. Most babies recover within a day.
But in some cases relapses are possible. Their frequency is less than 10%. Most relapses occur within 72 hours, but recurrences have been reported several years later. Relapses, as a rule, are accompanied by the appearance of the same signs as in the primary nature of the disease.
Also, the prognosis is ambiguous in the event of complications, and the risk to the life of a small patient increases every hour.
Advice to parents
All diseases are much easier to prevent than to treat later. Recommended for parents:
- Always seek medical attention as soon as possible after the first symptoms appear.
- Don't give your child any medication.
- Don't force your baby to eat.
Instead of a conclusion
With early diagnosis, adequate timely treatment, the mortality rate in children with intestinal intussusception is less than 1%. But if this condition is not treated, the death of the baby can occur in 2-5 days.
This is a dangerous disease, the successful treatment of which depends on the he alth and full life of a small person. Children who have had the damaged part removed maylife to have digestive problems. But in most cases, timely treatment and surgery pass without consequences for the child.
