Invagination of the intestine in a child is a pathology in which a separate section of the intestine is immersed in another. This is one of the most common causes of intestinal blockage, which is diagnosed mainly in infancy. In this article, we will analyze the main causes, symptoms, as well as methods for diagnosing and treating intestinal intussusception in a child.
General information
This pathology is observed in almost 90% of cases in infants. The peak occurrence of intussusception in a child occurs at the age of six months, when complementary foods begin to appear in the diet. The intestines are not always capable of adequately rebuilding and adapting to new food. Statistics show that there are about 4 cases of intestinal intussusception in a child per 1000 people. It should be noted that the disease is more common in boys.
As for young age, in this casethe disease is quite rare, the pathology is more often observed in the older group, in particular, in people aged 45 to 60 years.
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Kinds of this disease that causes intestinal obstruction in children include:
- Primary or idiopathic intussusception. The reasons are still not clear.
- Secondary, which is a consequence of various intestinal diseases.
Depending on which specific areas in the gastrointestinal tract have invaded each other, the disease is also divided into the following types: large intestine, small intestine, small intestine-gastric, small-colon, intussusception of the intestinal loop through natural fistulous passages or stoma.
If the introduction of the intestinal section occurs in the direction of the perist altic contractions of the wall, then it is commonly called isoperist altic. In the event that the invagination is directed against the intestinal fibers, then it is fixed as anti-perist altic. Two separate sections of the intestine, or several at once, can participate in such a process.
Varieties of the course of the disease
We continue to consider the varieties of the disease in which intestinal obstruction occurs in children. According to the type of flow, intussusception can be of the following types:
- recurrent;
- spicy;
- chronic.
The most common in practice is the acute course of the disease, almost 95%cases. Often the consequence of such a disease may be necrosis of a fragment of the intestinal loop.
The recurrent course of the disease is diagnosed mainly in infants, after conservative methods have been used in therapy, which are aimed at straightening the intussusceptum. Also, this form is often diagnosed in cases of intestinal immaturity in children.
Recurrent form of the disease may be early. In this case, it occurs during the first three days after the reduction of the invaginate. If more than three days have passed, then intussusception is called late.
The chronic form is a periodic, slight penetration of a segment of the intestine into another segment. This form of the disease manifests itself with moderate symptoms of intestinal obstruction.
Reasons
What are the causes of intestinal obstruction? As mentioned earlier, in most cases it is not possible to identify the underlying cause of this pathology. However, all possible factors in the development of the pathological process are divided into two groups: mechanical, as well as alimentary, that is, associated with the use of food.
As for children aged 0 to 3 years, in this case, the alimentary factors in the development of intussusception or intestinal obstruction will be characteristic. ICD-10 code - K-56. Mechanical factors are common in older children.
It is believed that the following factors may be the impetus for the development of the disease in babies:
- Wrong feeding schedule.
- Unadjusted modesupply.
- Food too thick.
- Food in chunks or coarse fiber.
Alimentary factors in the development of the disease are also characteristic of the adult part of patients. Sometimes people with symptoms of this disease come to the clinic after they have consumed the usual food, for example, dumplings, dumplings, black bread. Often, patients associated the development of intussusception with quick snacks when they swallowed unchewed pieces.
In addition, a special role in the development of the disease among adults is given to mechanical factors, which include cystic formations, polypous growths of the intestine, Meckel's diverticula, which is a congenital protrusion of the walls of the ileum, pancreatic diseases, intestinal tumors, as malignant, and benign.
In addition, there are factors that do not directly lead to bowel disease, but increase the risk of intussusception. These include the intestinal form of allergy, cystic fibrosis, impaired motor activity, conditions after various surgical interventions on the organs of the gastrointestinal tract, intestinal viral infections, family history, aggravated male sex. If you go to the hospital, do not forget that the ICD-10 code for intestinal obstruction is K56.
Very often, intussusception can be a complication of specific diseases and conditions, which should include bacterial and viral damage to the intestines, chronic, acute exacerbation of chronic inflammation of the mucous membranes in any part of the gastrointestinal tract, for example,enteritis, gastritis, colitis, other ailments of the large and small intestines, peritoneal tuberculosis, tuberculosis of the intestine, enteroptosis. It is these ailments that are considered the causes of intestinal obstruction.
Symptoms of illness in a child
So, we figured out what the possible reasons for the development of this unpleasant disease may be. However, you need to know the symptoms of the disease. It should be noted that the signs of, for example, small bowel intussusception and any other type will be almost the same. They are as follows:
- diarrhea;
- abdominal pain;
- bloating.
At an early stage of the development of the disease, pain manifests itself as an attack, the duration of which is about 7 minutes. The time difference between attacks is 10 to 30 minutes. In this case, attention should be paid to the fact that the onset of the attack will be acute. In terms of intensity, the pain is very strong. During seizures, the child becomes very restless, screams, cries, draws his legs to his stomach. Babies at the same time refuse nipples or breasts. The skin becomes cold to the touch, covered with sticky cold sweat. The end of an attack is as sharp as its beginning.
Symptoms of the disease in an adult
And what are the symptoms of the development of the disease in an adult patient? First of all, the patient develops severe pain in the abdomen. In parallel with this, vomiting appears. Often it is accompanied by tachycardia, pallor of the skin,cold sweat and other signs of shock.
A few hours after the onset of the attack, bloody discharge is observed in the stool. In case of further development of the disease and necrosis of the intestinal walls, symptoms of intestinal bleeding may also be observed: weakness, blood in the stool, dizziness. The abdomen is strongly swollen, there is no stool. A person feels cramping sharp pains, from which he can even lose consciousness. Unpleasant sensations of such intensity often lead to confusion and delirium. In an effort to relieve pain, a person presses his legs to his stomach and assumes a fetal position. Another important symptom of intussusception is vomiting. It begins due to the fact that intoxication begins in the intestines.
Possible Complications
If a therapeutic algorithm is not appointed in time, the installation of a gas outlet tube or even an operation, various complications may arise. The most common of these are intestinal obstruction, intestinal bleeding, peritonitis, perforation of the intestinal wall due to necrosis, the appearance of an internal hernia. To avoid all this, it is necessary to immediately seek help from a specialist when the first symptoms appear, and then follow all clinical recommendations for intestinal intussusception in children.
Diagnostics
Complaints that come from a patient with this disease cannot be called characteristic only for this disease, therefore, in order to confirm the diagnosis, instrumental, physical, as well aslaboratory research. Physical examination includes inspection, tapping, palpation, and examination with an endoscope.
During the examination, the following signs are revealed:
- At the initial stage of the development of the disease, the tongue is normal, but then a white coating appears on it.
- The abdomen is swollen, the front walls are tense. This sign indicates that intestinal obstruction is developing.
To confirm the diagnosis, instrumental methods are also used, which include fluoroscopy, radiography with contrast, ultrasound, computed tomography. The specialist also examines the general analysis of blood and feces under a microscope.
Features of treatment
If the diagnosis was confirmed, then an operation is prescribed for intestinal obstruction. However, babies, whose age is from 3 months to 3 years, can be cured of this disease with the help of conservative therapy. However, you should pay attention to the fact that pediatric emergency surgery can only be avoided if no more than 10 hours have passed since the onset of the disease, and no complication has appeared.
Conservative therapy involves the introduction of air into the intestines using a special balloon. Air is pumped until the intussusception clears up. After that, the gas outlet tube is installed according to the algorithm. The effectiveness of this treatment is very high. After the procedure is carried outcontrol X-ray examination, and the surgeon closely monitors the condition of the baby. In other situations, surgical intervention is performed.
So, if a child has a stomach ache, what to do, we sorted it out. But how will the surgery be carried out? First of all, a qualitative revision of the entire gastrointestinal tract should be carried out, since there may be several invaginates. After that, an examination is done in the affected area to determine the vital activity of the intestine. In the absence of changes in the walls of the intestine, one segment is carefully removed from the other. If pronounced changes are detected, then the modified area is deleted.
Post-operative period
It doesn't matter what specific type of disease has been pneumatically disinvaginated - after surgery, conservative treatment should always be carried out. It includes antibiotic therapy, as well as intravenous fluid therapy to replenish the volume of circulating blood. This is necessary in cases where the patient has been diagnosed with bleeding inside the intestine.
Prevention
Everyone knows that any disease is easier to prevent than to treat it later. Especially when it comes to such an unpleasant disease as intussusception, which almost always requires surgical treatment. As a preventive measure, it is necessary to introduce complementary foods to children according to the schedule. This means that the first products are introduced into the diet no earlier than six months of age of the baby. Appearance inthe menu of new dishes should be phased. Gradually, the amount of food consumed should also increase. It is best to use pureed dishes from one ingredient for complementary foods.
As for prevention in adults, they need to follow the diet and diet, exclude too coarse food from their daily menu. In addition, during lunch or dinner, you should chew food thoroughly. Another mandatory preventive measure is the timely diagnosis and treatment of neoplasms in the intestinal area.
Disease prognosis
If the patient is hospitalized in a timely manner, and the diagnosis and treatment of such an unpleasant disease as intussusception is carried out properly, then the prognosis will be very favorable. However, in some cases there are various kinds of relapses. The prognosis will be ambiguous in the development of certain complications of invagination. They can also appear at an early stage in the development of the disease. Every hour is important for the life of the patient, so you should not hesitate if you notice the first symptoms of intestinal obstruction in yourself or your baby.
