Intestinal intestinal invagination in a child is a pathology in which a separate section of the intestine is immersed in another. This is one of the most common causes of bowel obstruction, which is diagnosed mainly in infancy. In this article, we will analyze the main causes, symptoms, as well as methods for diagnosing and treating intestinal invagination in a child.
general information
This pathology in almost 90% of cases is observed in infants. The peak of intestinal invagination in a child occurs at the age of six months, when complementary foods begin to appear in the diet. The intestine is not always able to adequately rebuild and adapt to new food. Statistics show that per 1000 people there are about 4 cases of intestinal invagination in a child. It should be noted that in boys the disease is more common.
As for the young age, in this case the disease is quite rare, pathology is more often observed in the older group, in particular, in people aged 45 to 60 years.
Kinds
Types of this disease in which intestinal obstruction in children is formed include:
- Primary intussusception or idiopathic. The reasons have not yet been clarified.
- Secondary, which is a consequence of various intestinal diseases.
Depending on which specific areas in the gastrointestinal tract have invaded each other, the disease is also divided into the following types: colonic, small intestinal, small intestinal, small intestinal, intussusception of the intestinal loop through natural fistulous passages or stomas.
If the introduction of the intestinal section occurs in the direction of peristaltic contractions of the wall, then it is commonly called isoperistaltic. In the event that intussusception is directed against intestinal fibers, then it is fixed as antiperistaltic. Two separate sections of the intestine, or several at once, can participate in such a process.
Varieties of the course of the disease
We continue to consider the types of disease in which intestinal obstruction occurs in children. By type of course, intussusception can be of the following types:
- recurrent;
- spicy;
- chronic
Most often in practice it is the acute course of the disease, in almost 95% of cases. Often the consequence of such a disease may be necrosis of a fragment of the intestinal loop.
The relapsing course of the disease is diagnosed mainly in infants, after conservative methods have been used in therapy that are aimed at spreading the invaginate. Also, this form is often diagnosed in cases of immaturity of the intestines in children.
A recurring form of the disease may be early. In this case, it occurs during the first three days after reduction of the intussusception. If more than three days have passed, then invagination is called late.
The chronic form is a periodic, minor introduction of a segment of the intestine into another segment. This form of the disease manifests itself with mild symptoms of intestinal obstruction.
Causes
What are the causes of bowel obstruction? As mentioned earlier, in most cases it is not possible to identify the root cause of this pathology. However, all possible factors for the development of the pathological process are divided into two groups: mechanical, as well as alimentary, that is, associated with the use of food.
As for children aged 0 to 3 years, then in this case it will be characteristic of nutritional factors in the development of intussusception or intestinal obstruction. The code for ICD-10 is K-56. Mechanical factors are characteristic of older children.
It is believed that in babies the following factors can be an impetus for the development of the disease:
- Incorrect feeding schedule.
- Unadapted diet.
- Too thick food.
- Food in pieces or coarse fiber.
Alimentary factors for the development of the disease are also characteristic of the adult part of patients. Sometimes people with symptoms of this disease come to the clinic after eating the usual food, for example, dumplings, dumplings, brown bread. Often, patients associated the development of intussusception with quick snacks when swallowing non-cooked pieces.
In addition, mechanical factors play a special role in the development of the disease among adults, which include cystic formations, polypous intestinal growths, meckel diverticula, which is an inborn protrusion of the ileum, pancreatic disease, and tumors of the intestine, both malignant and benign.
In addition, factors are identified that do not directly lead to bowel disease, but increase the risk of invagination. These include the intestinal form of allergies, cystic fibrosis, impaired motor activity, conditions after various surgical interventions on the organs of the gastrointestinal tract, intestinal viral infections, a family history of history, male gender. If you will go to the hospital, do not forget that the ICD-10 code for intestinal obstruction is K56.
Quite often, invagination can be a complication of specific diseases and conditions, which should include bacterial and viral lesions of the intestine, chronic, acute exacerbation of chronic inflammation of the mucous membranes in any part of the gastrointestinal tract, for example, enteritis, gastritis, colitis, other ailments of the large and small intestines , peritoneal tuberculosis, intestinal tuberculosis, enteroptosis. It is these ailments that are considered the causes of bowel obstruction.
Symptoms of a disease in a child
So, we have figured out what could be the possible reasons for the development of this unpleasant disease. However, you need to know the symptoms of the disease. It should be noted that signs, for example, of small intestinal intussusception and any other type will be almost the same. They are as follows:
- diarrhea;
- abdominal pain;
- bloating.
At an early stage of the development of the disease, pain manifests itself as an attack, the duration of which is about 7 minutes. The time difference between attacks is from 10 to 30 minutes. In this case, you should pay attention to the fact that the onset of the attack will be acute. The intensity of the pain is very strong. During seizures, the child becomes very restless, cries out, cries, tightens his legs to his stomach. Breasts at the same time refuse a nipple or a breast. The skin becomes cold to the touch, covered with a sticky cold sweat. The completion of an attack is as acute as its beginning.
Symptoms of the disease in an adult
But what are the symptoms of the development of the disease in an adult patient? First of all, the patient has a strong pain in the abdomen. In parallel with this, vomiting appears. Often it is accompanied by tachycardia, pallor of the skin, cold sweat and other signs of shock.
A few hours after the onset of the attack, bloody discharge is observed in the feces. In the case of further development of the disease and necrosis of the intestinal walls, symptoms of intestinal bleeding can also be observed: weakness, blood in the stool, dizziness. Strongly swollen belly, absent stool. A person feels cramping sharp pains, from which he can even lose consciousness. Unpleasant sensations of such intensity often lead to confused consciousness and delirium. In an effort to alleviate pain, a man presses his legs to his stomach and takes the pose of "embryo". Another important symptom of intussusception is vomiting. It begins due to the fact that intoxication begins in the intestine.
Possible complications
If the therapeutic algorithm, the placement of the vent tube or even the operation is not scheduled in time, then various kinds of complications may arise. The most common of these are intestinal obstruction, intestinal bleeding, peritonitis, perforation of the intestinal wall due to necrosis, the appearance of an internal hernia. To avoid all this, it is necessary, when the first symptoms appear, immediately seek the help of a specialist, and then adhere to all clinical recommendations for intestinal invagination in children.
Diagnostics
Complaints that come from the patient with this disease can not be called characteristic only for this ailment, therefore, to confirm the diagnosis, instrumental, physical, as well as laboratory studies should be performed. Physical examination involves examination, tapping, probing, as well as examination with an endoscope.
During the inspection, the following symptoms are revealed:
- At the initial stage of the development of the disease, the tongue is ordinary, but then a white coating appears on it.
- The abdomen swells, the front walls are tense. This symptom suggests that intestinal obstruction develops.
To confirm the diagnosis, instrumental methods are also used, which include fluoroscopy, radiography with contrast, ultrasound, computed tomography. The specialist also studies the general analysis of blood and feces under a microscope.
Treatment features
If the diagnosis has been confirmed, then surgery is prescribed for bowel obstruction. However, babies, whose age is from 3 months to 3 years, can be cured of this disease using conservative therapy. However, attention should be paid to the fact that avoiding pediatric emergency surgery is possible only if no more than 10 hours have passed from the onset of the development of the disease, and also no complications have appeared.
Conservative therapy involves the introduction of air into the intestines using a special balloon. Air is pumped until the invaginate has recovered. After this, the gas outlet tube is set up according to the algorithm. The effectiveness of this treatment is very high. After the procedure, a control x-ray examination is carried out, and the surgeon closely monitors the condition of the baby. In other situations, surgery is performed.
So, if a child has a stomach ache, what to do, we sorted out. But how will surgery be carried out? First of all, a qualitative audit of the entire gastrointestinal tract should be carried out, since there may be several invaginates. After that, an examination is done in the affected area to determine the vital activity of the intestine. In the absence of changes in the walls of the intestine, one segment is carefully removed from the other. If pronounced changes are detected, then the changed area is deleted.
Postoperative period
It doesn’t matter what type of disease the pneumatic disinagination was carried out - conservative treatment should always be carried out after surgery. It includes antibiotic therapy as well as intravenous infusion therapy to supplement the volume of circulating blood. This is necessary in cases where the patient has been diagnosed with bleeding inside the intestine.
Prevention
Everyone knows that any disease is easier to prevent than to treat it later. Especially when it comes to such an unpleasant ailment as intestinal invagination, which almost always requires surgical treatment. As preventive measures, it is necessary to introduce complementary foods to children according to the schedule. This means that the first products are introduced into the diet no earlier than the baby’s six-month-old age. The appearance of new dishes on the menu should be phased. Gradually, the amount of food consumed should also increase. It is best to use pureed dishes from one component for complementary feeding.
As for prevention in adults, they need to follow the diet and diet, exclude too coarse foods from their daily menu. In addition, during lunch or dinner, you should carefully chew food. Another mandatory preventive measure is the timely diagnosis and treatment of neoplasms in the intestine.
Disease prognosis
If the patient is hospitalized in a timely manner, and the diagnosis and treatment of such an unpleasant disease as intestinal invagination is carried out properly, then the prognosis will be very favorable. However, in some cases, various relapses occur. The prognosis for the development of certain complications of intussusception will be ambiguous. They can also appear at an early stage of the development of the disease. Every hour is important for the patient’s life, so you should not hesitate if you notice the first symptoms of bowel obstruction in yourself or your baby.