Abdominal diseases are the most common problems in the first 2 years of a child's life. Babies cannot verbally communicate with their parents and therefore use signs such as whimpering and screaming. If a baby cries for no apparent reason, this may be the first sign of illness. Diseases of the stomach and other organs of the gastrointestinal tract in this case are most likely. Intestinal intussusception cannot be ruled out.
Abdominal diseases are the most common problems in the first 2 years of a child's life. Babies cannot verbally communicate with their parents and therefore use signs such as whimpering and screaming.
If a baby cries for no apparent reason, this may be the first sign of illness. Intestinal intussusception cannot be ruled out.
What is intussusception?
Intussusception Facts:
- Intestinal intussusception is the introduction (telescoping) of one organ segment into another.
- Intussusception usually results in a blockage of the intestine.
- Intussusception occurs mainly in infants, but can also occur in adults and older children.
- The main symptoms of intussusception are abdominal pain and vomiting.
- Early diagnosis and treatment of intussusception is essential to save the bowel and the patient.
Intussusception is the most common cause of intestinal obstruction in children from six months to three years. Intestinal intussusception in children is rare before the age of 3 months and after 6 years.
Studies have shown that the average annual incidence of intussusception is 38, 31 and 26 cases per 100,000 children in the first, second and third years of life. Then it drops to half of that in older children. Most episodes occur in healthy and well-nourished children.
Studies have shown that intussusception is predominant in boys, with the ratio of boys to girls affected being approximately 3: 2.
Intestinal intussusception (popularly called "volvulus") is the most common of the most dangerous abdominal diseases in young children. This leads to compression of the veins, which provokes edema and becomes the cause of obstruction. This is followed by a decrease in blood flow to the affected area of the intestine. Most cases involve the area of the intestine where the small intestine becomes the large intestine.
If intussusception is not corrected, the condition can worsen and become life-threatening. But if the disease is detected early, it can almost always be corrected.
Intestinal intussusception symptoms
The symptoms of intestinal intussusception are almost identical with signs of intussusception of the stomach:
- in children, intestinal intussusception usually begins with sudden, intermittent, violent spasms. Progressive pain in the abdomen is accompanied by an inconsolable cry of the baby and pulling the legs up to the tummy. Episodes usually occur at intervals of 15 to 20 minutes. They become more frequent and severe over time;
- abdominal pain may be accompanied by vomiting. Initially, vomiting is not bile in nature, that is, it does not have a yellow or green color. But over time, if the obstruction (obstruction) progresses, there are impurities of bile;
- between painful episodes, the child may behave relatively normally and not feel pain. As a result, the initial symptoms may be confused with gastroenteritis.
Other common signs of intussusception include:
- stools with blood and mucus. Feces resemble currant jelly due to its appearance;
- a lump in the abdomen, detected by feeling (palpation);
- lethargy;
- diarrhea;
- fever.
Not all symptoms can be seen in a child. Some babies have no obvious pain, others have no blood in the stool or a palpable mass in the abdomen. Some older children have pain but no other symptoms.
After a few hours, the baby may show signs of dehydration. Sunken eyes, dry or sticky mouth, and lack of urination will indicate this.
The sooner the condition is diagnosed, the better. Intussusception of the intestines and stomach is an emergency that requires qualified medical attention. It won't go away on its own.
Causes of intussusception
In most cases, doctors do not know what is causing an intussusception.
Most Important causes of intussusception in infants are as follows:
- the presence of gastroenteritis or stomach flu. It is difficult to understand how viruses get in. This may be due to bottle feeding and untreated water;
- viruses that are transmitted through the upper respiratory tract;
- bacterial gastrointestinal infections that affect lymphatic tissue.
Bacterial or viral gastrointestinal infections often cause swelling of the lymphatic tissue that lines the intestines. This can lead to the fact that one part of the intestine will be drawn into another;
- in children younger than 3 months and older than 5 years, intussusception is more likely to occur due to conditions such as swollen lymph nodes, tumors, or an abnormality in the structure or function of the blood vessels in the intestine.
Diagnosis and treatment of intestinal intussusception in children
During the visit, the doctor will ask about the child's health, any medications he is taking, and any allergies the child may have.
The doctor will then examine the baby, paying particular attention to the abdomen, which may be bloated or tender to the touch. Sometimes the doctor can find the part of the intestine that is blocked.
If the doctor suspects intussusception, the child can be sent to the emergency room. Usually there they immediately turn to a pediatric surgeon.
The doctor may order an abdominal ultrasound or x-ray, which often helps detect a bowel obstruction.
If the child looks very ill and there is suspicion of bowel damage, the surgeon will immediately refer the child to the operating room to immediately begin treatment for the bowel obstruction.
Enemas
Two types of enemas (air enema and barium enema) can simultaneously diagnose and treat intussusception.
In an air enema, a small, soft tube is placed in the rectum through which air is passed. It enters the intestines and outlines it on x-rays. If intussusception is present, the doctor will see the damaged part. At the same time, air pressure unfolds those parts of the intestine that have been turned inside out, and neutralizes the obstruction.
Barium, a liquid mixture sometimes used instead of air to correct blockages, works in a similar way.
Both enemas are safe and children usually feel good after them.
It is important to remember, however, that intussusception can return in 1 in 10 cases. This usually happens within three days after the procedure.
Operation
Surgery is necessary for intussusception that cannot be treated with a barium enema, or when the child is too ill to undergo this diagnostic procedure. Under anesthesia, the surgeon will make an incision in the abdomen, locate the intussusception and replace the affected areas.
The intestines will be examined for damage, if any areas do not function properly, they will be removed.
If there is damage to the intestine and the removed section is small, the two sections of healthy intestine will be sewn together.
In extremely rare cases, if the damaged part of the intestine is large, a significant volume of the intestine can be removed. Its parts that remain after the removal of this area cannot be surgically attached to each other. And so that the digestive process can continue, an ileostomy will be performed.
This is an operation in which the two remaining healthy ends of the intestine are removed through openings in the abdominal cavity. The stool is passed through an opening (called a stoma) and then into a collection bag. Ileostomy can be temporary or, in extremely rare cases, permanent. It depends on the size of the damaged intestine that needs to be removed.
After treatment, the child will stay in the hospital and receive parenteral nutrition (the introduction of nutrient solutions and fluids through a vein) until he can eat on his own. Doctors will monitor the baby closely to make sure the intussusception does not return. Some children may also need antibiotics to prevent infection.
Forecast
The prognosis for children with intussusception is encouraging if the condition is diagnosed and treated early. Otherwise, serious complications and even death are possible.
With treatment, most babies recover completely within 24 hours. The recurrence rate of intussusception after non-surgical repair is usually less than 10%, but can be as high as 15%.
Most relapses appear within 72 hours of correction. However, there have been cases of recurrence after 36 months. The onset of a relapse is usually accompanied by the appearance of the same symptoms as in the initial event.
The recurrence rates after air or barium enema are 4% and 10%, respectively. As a rule, 95% of recurrent cases are recorded after non-operative correction.
Complications associated with intestinal intussusception:
- perforation (loss of integrity) of the intestine with non-surgical treatment;
- internal hernias and adhesions causing intestinal obstruction;
- sepsis from undiagnosed peritonitis;
- intestinal bleeding;
- intestinal necrosis.
Memo to parents:
- It is always recommended to seek professional help as soon as possible after symptoms are identified. The sooner, the better.
- If left untreated, intussusception can lead to severe tissue damage, bowel perforation, abdominal infection, and even death.
- Do not give your child any over-the-counter medications to treat symptoms until a doctor has seen and prescribed treatment. Do not feed your baby if you see any signs or symptoms of intussusception. See a doctor immediately.
With early diagnosis, adequate resuscitation and therapy, the mortality rate from intussusception in children is less than 1%. If this condition is not treated in a timely manner, death occurs within 2 to 5 days.
The long-term prognosis depends on the degree of bowel damage (if any). Children who have had a damaged part removed may have delayed consequences. When most of the intestines are removed, it can interfere with the digestion process.
