Intussusception – causes, symptoms, treatment, complications

Proven content

Intussusception is the pathological insertion of one section of the intestine (most often the small intestine) into another. It is one of the most common causes of intestinal obstruction and ischemia in children. The disease usually occurs in infants aged 3-12 months, more often in boys. Intestine is manifested by colic abdominal pain and a general poor general condition. Quick intervention allows you to avoid surgical treatment.

What is intussusception?

Intussusception is a pathological condition in which part of the intestine (usually the small intestine) slides into the second part of the intestine (usually the large intestine). The invagination usually occurs around the caecum. Intussusception results in food passage obstruction (obstruction) and intestinal ischemia. Venous stasis and mucosal ischemia cause the child to bleed and release excess mucus, and to pass stool resembling raspberry jelly. Intussusception is most common in infants aged 3-12 months, more often in boys than in girls (the frequency of intussusception is 1,5–2,5 per 1000 live births). The disease very rarely occurs after the age of 2.

The structure of the intestines

The intestines are part of the gastrointestinal tract with a tubular structure. Due to their tortuous structure, they come upon themselves and other organs located in the abdominal cavity. The intestine can be thin and thick – the thin one connects to the large one, and there is a Bauhin valve at their junction. The first (thin) is divided into:

1. jejunum,
2. ileum,
3. duodenum.

In turn, the large intestine is divided into:

1. rectum,
2. ascender,
3. descendant,
4. crossbar,
5. I will rise

The causes of intussusception

Intussusception usually involves the opening of the small intestine into the caecum. It appears as a result of abnormalities in the anatomy of the gastrointestinal tract (too long intestinal mesentery), obstacles in the passage of food (diverticula and polyps), and defective structure and contractility of the intestinal muscles. Unfortunately, in a large number of children it is impossible to find the cause of this ailment (sometimes it is also referred to as a family history of the disease). Intussusception is often associated with lymphoma, a gastrointestinal infection, or a respiratory infection. However, there are also diseases that can lead to a thickening of the intestinal wall:

1. hemophilia,
2. familial polyposis,
3. celiac disease,
4. cystic fibrosis.

In adults, intussusception usually occurs as a complication of abdominal surgery.

Intussusception – symptoms

Symptoms of intussusception include severe colic abdominal pain and deterioration of your general condition, sometimes vomiting. Bouts of pain lasting several minutes are alternated with periods of apathy and sleepiness. Your child may pass meager amounts of stool with an admixture of blood and mucus (which looks like raspberry or currant jelly). The pain in the course of intussusception is sudden and has a colic character (as mentioned above). It usually appears after feeding. Then the baby curls his legs up and cries, he is restless. Additionally, the abdomen is hard and difficult to examine, although sometimes you can feel a lump in the abdomen under the fingers. After the attack of pain in the child’s epigastric pain subsides, one can feel a sausage-like structure, i.e. a dimpled fragment of the intestine, with its absence in the lower abdomen.

The occurrence of such symptoms requires immediate medical intervention. Longer lasting intussusception may result in ischemic necrosis of the incarcerated intestine and lead to peritonitis. If conservative treatment is unsuccessful, surgical removal of the affected part of the intestine may be necessary.

Note: The symptoms of intussusception closely resemble infant colic.

Intussusception and diagnosis

Intussusception may be suspected at the first clinical signs. Then the child should be referred to a specialist who will confirm or rule out the initial diagnosis using various methods. For diagnostic purposes, radiological or ultrasound examinations of the abdomen are performed, during which the image of the shooting target is visible, i.e. the cross-sectional visualization of two overlapping layers of the intestine. In patients who cannot be XNUMX% sure of the ultrasound examination, computed tomography is additionally performed. However, it is not often recommended because it is associated with high costs and a much longer waiting time for the result than in the case of ultrasound.

How to treat intussusception?

The type of treatment that is given depends on how long has elapsed since the onset of the disease. Treatment can be conservative or operative. The first is implemented within XNUMX hours of the appearance of the first symptoms of intussusception in children who do not show symptoms that may indicate peritonitis or gastrointestinal perforation. The following is performed then:

1. rectal infusion of saline;
2. rectal air injection – a relatively effective method, unfortunately causing complications, such as perforation of the intestine;
3. X-ray contrast-controlled rectal infusion – a highly effective method; the infusion pushes out the recessed part of the intestine, thanks to which it returns to its place.

In turn, surgical treatment of intussusception is based on the removal of the damaged part of the intestine, and then joining its ends in a way that allows the continuity of the gastrointestinal tract. Of course, recurrences of intussusception are possible (rarely).

Complications of intussusception

Long-term intussusception may lead to ischemia and necrosis of the invaginated portion of the intestine. The cause of these complications is the continuous pressure of the invaginated fragment by another part of the intestine, which prevents blood from reaching it. Some patients may develop a perforation of the intestine, which in turn causes peritonitis that can even be fatal (if not addressed immediately).

The best gastroenterologist