Invagination of the intestine

Invagination - is the introduction of the intestine (invaginate) into the lumen of a nearby segment (invaginant), which leads to bowel obstruction and sometimes its ischemia.

[1], [2], [3], [4], [5], [6], [7]

What causes intussusception?

Invagination of the intestine usually occurs in children aged 3 months to 3 years, with 65% of cases occurring in children under one year old. This 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 provoking factor, i.e., volumetric formation or other abnormality of the intestine, which contributes to intussusception; examples can be polyps, lymphoma, Meckelian diverticulum, Shenlaine-Henoch disease. Also a risk factor is cystic fibrosis.

When intussusception occurs, the development of intestinal obstruction and necessarily violation of local blood flow, which leads to the development of ischemia, gangrene and perforation.

Symptoms of intussusception of the intestine

The first clinical symptoms of intussusception of the intestine are sharp colicky pains in the abdomen, which recur after 15-20 minutes, often accompanied by vomiting. In the intervals between attacks, the child looks relatively good. Later, when ischemia of the intestine develops, the pain becomes permanent, the child - sluggish, hemorrhages in the mucous membrane cause a positive reaction to the presence of blood in the fecal masses during rectal examination and sometimes self-withdrawal of the stool in the form of "crimson" jelly. When palpation is sometimes found sosiskoobrazny chest in the abdominal cavity. When the perforation appears, the symptoms of peritonitis, with severe soreness and muscle tension of the anterior abdominal wall, the child spares the affected area. Shortness of breath, tachycardia can indicate the development of shock.

Diagnosis of intussusception of the intestine

Examination and treatment should be carried out urgently, since the survival rate and the likelihood of success of conservative treatment are significantly reduced with the duration of the disease.

Radiopaque examination with barium administered through the rectum was previously a preferred method for initial diagnosis, since, in addition to the diagnostic value, it also had a therapeutic effect; The pressure of barium often spreads the invaginate. However, sometimes barium enters the abdominal cavity through perforation, which is not clinically manifested, and causes severe peritonitis. Therefore, if there is a possibility, you should prefer ultrasound. When confirming the diagnosis of intussusception, disinvagination is used to inject air into the rectum, which reduces the likelihood and consequences of perforation. Children are left under observation for 12-24 hours to exclude perforation.

[8], [9], [10], [11]

Treatment of intussusception of the intestine

Treatment of intussusception of the intestine depends on the clinical data. Children in serious condition with signs of peritonitis require infusion therapy to recover fluids, broad-spectrum antibiotics (eg, ampicillin, gentamicin, clindamycin), nasogastric tube placement, gastric lavage and surgical intervention. The rest of the patients are shown X-ray and ultrasound examination to confirm the diagnosis of "intussusception" and treatment of the disease.

If conservative treatment of intussusception of the intestine is unsuccessful, an emergency operation is required. The frequency of recurrence of the disease with conservative treatment is 10%.