Intestinal intussusception

Intussusception is the insertion of a section of the intestine (intussusception) into the lumen of an adjacent segment (intussusception), which leads to intestinal obstruction and sometimes its ischemia.

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What causes intussusception?

Intussusception usually occurs in children between 3 months and 3 years of age, with 65% of cases occurring in children under one year of age. It is the most common cause of bowel obstruction in children of this age, in whom it is usually idiopathic. In older children, there may be a precipitating factor, i.e., a mass or other bowel abnormality that contributes to intussusception; examples include polyps, lymphoma, Meckel's diverticulum, and Henoch-Schönlein disease. Cystic fibrosis is also a risk factor.

Intussusception results in the development of intestinal obstruction and necessarily disruption of local blood flow, which leads to the development of ischemia, gangrene and perforation.

Symptoms of Intussusception

The first clinical symptoms of intestinal intussusception are sharp colicky abdominal pains that recur every 15-20 minutes, often accompanied by vomiting. Between attacks, the child looks relatively well. Later, when intestinal ischemia develops, the pain becomes constant, the child is lethargic, hemorrhages in the mucous membrane are the cause of a positive reaction to the presence of blood in the feces during a rectal examination and sometimes spontaneous passage of stool in the form of "raspberry" jelly. Palpation sometimes reveals a sausage-shaped cord in the abdominal cavity. In case of perforation, symptoms of peritonitis appear, with severe pain and tension in the muscles of the anterior abdominal wall, the child spares the affected area. Shortness of breath, tachycardia may indicate the development of shock.

Diagnosis of intestinal intussusception

Examination and treatment should be carried out urgently, since survival and the likelihood of successful conservative treatment decrease significantly with the duration of the disease.

Barium x-ray contrast examination administered through the rectum was previously the method of choice for initial diagnosis, as it had a therapeutic effect in addition to its diagnostic value; the pressure of the barium often straightened the intussusception. However, barium sometimes enters the abdominal cavity through a perforation that was not clinically evident, causing severe peritonitis. Therefore, ultrasound should be preferred if possible. If the diagnosis of intussusception is confirmed, air injection into the rectum is used for disintussusception, which reduces the likelihood and consequences of perforation. Children are kept under observation for 12-24 hours to exclude perforation.

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Treatment of intestinal intussusception

Treatment of intussusception depends on clinical findings. Children in severe condition with signs of peritonitis require fluid replacement therapy, broad-spectrum antibiotics (eg, ampicillin, gentamicin, clindamycin), placement of a nasogastric tube, gastric lavage, and surgery. Other patients require radiographic and ultrasound examination to confirm the diagnosis of intussusception and treat the disease.

If conservative treatment of intestinal intussusception is unsuccessful, emergency surgery is required. The recurrence rate of the disease with conservative treatment is 10%.