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Intussusception is a pathological condition in which part of one section of the intestine moves into another, usually that part of the small intestine enters the large intestine. The most common site of intussusception is around the caecum. Intussusception is the most common cause of mechanical obstruction of the gastrointestinal tract in infants.
Intussusceptionoccurs most often ininfants , especially in boys who are several months old. The peak incidence is observed between the sixth and twenty-fourth month of life. It rarely occurs after the age of two.
Causes of intussusception
Intussusception is fostered by congenital factors - anomalies in the anatomyof the gastrointestinal tract , e.g. too long intestinal mesentery, obstacles to digestive passage (diverticula and polyps), abnormal structure and contractility the muscles of the intestine. In the vast majority of children, the cause of the intussusception cannot be found. In many people, intussusception is associated with gastrointestinal infection, Meckel's diverticulitis, lymphoma, also with a respiratory tract infection, and sometimes a change from a liquid diet to a more concentrated one.
Symptoms of intussusception
In the first stage of intussusception, there is severe colic abdominal pain associated with vomiting. The child's condition deteriorates rapidly, becomes weaker, tired, pale and sleepy. Bouts of pain lasting several minutes are alternated with periods of apathy and sleepiness. The child may pass meager amounts of stool with an admixture of blood and mucus (resembling raspberry or currant jelly). After a period of clear, strong symptoms, there may be an oligosymptomatic period, in which resistance from the invaginated intestine is sometimes palpable. The diagnosis is based mainly on the clinical picture and imaging tests, mainly ultrasound.
Intussusception treatment
The occurrence of the first symptoms requires immediate medical intervention. Longer-lasting intussusception may lead to ischemic necrosis of the incarcerated intestine, which in turn may result in peritonitis. The method of treatment depends largely on how much time has passed since the onset of the disease. There are two options: conservative treatment and surgical treatment. Conservative treatmentit is usually used within 24 hours of the first symptoms. They are performed only in children who do not show symptoms that indicate gastrointestinal perforation or peritonitis. There are three methods of non-surgical treatment of intussusception:
» Rectal contrast infusion (from a barite suspension) under X-ray control is most often performed. The treatment is very effective (55-90 percent). The infusion causes the recessed section of the intestine to be pushed back, which returns to its place; , 14-2.8 percent);» rectal saline infusion - an equally effective method with the lowest complication rate.
ImportantIntussusception surgery
It consists in removing the damaged part of the intestine and fusing both ends together so that the continuity of the gastrointestinal tract is maintained. Note: Recurrences of intussusception are possible, although slight. They are observed in about 2-4 percent. children treated conservatively and 1-2 percent. treated surgically.