Intestinal invagination is a pathology in which one part of the intestine is introduced into another, due to which there is obstruction of the gastrointestinal tract. This is the most common disease in the first years of a baby's life. As a rule, the child still cannot speak, and therefore he whimpers, cries, screams, and is capricious. If he screams for no apparent reason and presses his legs to his stomach, this may be the first sign of illness and a signal for parents. What kind of disease is it, what are its symptoms, how to treat it and how is it dangerous for the baby’s health?
Terminology. General concepts of the disease
The disease is most often observed in infants (90% of all diagnosed cases). Code for the international classification of diseases of the ICD:
- Intestinal Intestination - K56.1
Most often observed in children whose age is 5-8 months. When complementary foods are introduced into the diet, their intestines have not yet been rebuilt and have not adapted to new food, as a result of which this pathology develops. The prevalence of the disease - 3-4 cases of the development of intussusception occur in 1000 infants, and more often in boys. Most episodes were recorded in absolutely healthy children who eat well. The next age group predisposed to the disease is 45-60 years old, young people suffer from intussusception quite rarely.
Disease Facts
Intestinal invagination is the introduction of one organ site into another.
- Pathology develops mainly in infants.
- Usually the disease leads to intestinal obstruction.
- The main symptoms are vomiting and severe abdominal pain.
- Treatment and early diagnosis of the disease are important to save the intestines and the life of the patient.
- Intestinal invagination in children is very rare after 6 years.
In people, invagination is called "intestinal torsion" - this is the most common and most dangerous disease of the abdomen in infants. It leads to squeezing veins, swelling and intestinal obstruction. Most cases of the development of intussusception are characteristic of the area where the small intestine passes into the colon.
If the disease is left to chance, the condition will worsen and pose a threat to the life of the child. Timely diagnosis and treatment almost always help to correct the situation.
Types of disease
Intestinal intestines are of the following types:
- Primary - the causes of its occurrence have not yet been clarified.
- Secondary - develops as a result of various intestinal diseases.
Depending on where the disease develops, there are:
- small bowel intussusception;
- large intestine;
- mixed type (thin-colonic and gastrointestinal).
In invagination, both two sections of the intestine, and more, can take part.
In the course of the disease, an acute, recurrent and chronic form is distinguished. In this case, the acute form occurs most often, but its consequence is necrosis of the intestinal loop.
Causes
To explain why one segment of the intestine is introduced into another, many doctors find it difficult. In the scientific literature, all causes of intestinal invagination are divided into two groups: nutritional and mechanical. As a rule, for children under 3 years of age, the causes of the disease associated with food intake are characteristic, and in children a little older, with mechanical factors.
Reasons related to nutrition, or nutritional factors:
- Incorrect introduction of complementary foods.
- Failure to comply with the child’s diet (feeding by hours, alternating too long intervals between feedings).
- Too thick food.
- Coarse fiber food.
- Hasty eating.
- Swallowing food in large, uncooked chunks.
Mechanical factors include:
- Intestinal polyps.
- Cystic formations.
- The atypical location of the pancreas.
- Intestinal tumors.
Increase the risk of developing pathology:
- Intestinal allergy.
- Surgical intervention.
- Viral intestinal infections.
- Male.
- Genetic predisposition.
Often, intestinal invagination develops as a complication of the following diseases:
- Bacterial and viral lesions of the intestine.
- Colitis, gastritis, enteritis.
- Tuberculosis of the intestines or peritoneum.
- Pathology in the form of prolapse of the small intestine.
How does the disease develop?
Whatever the causes of the disease, it is directly provoked by a violation of intestinal peristaltic activity. Peristalsis manifests itself randomly, one section of the intestine, as it were, “runs into” the neighboring one and penetrates into it.
The invaded area does not return to its original position due to squeezing the intestinal wall, as a result of which it changes, that is, tissue edema that occurs due to stagnation of lymph, arterial and venous blood. This swelling does not allow the segment to straighten out.
Due to the fact that the arteries are pinched, blood begins to circulate worse, tissues do not receive oxygen, and they starve. This, in turn, leads to necrosis of the intestinal wall. Gastrointestinal bleeding of varying degrees of intensity may develop.
If medical care is not provided, then intestinal perforation is possible at the site of necrosis, which will lead to peritonitis, which, in turn, may result in the death of the patient.
Symptoms
Symptoms of intestinal invagination in children are very similar to signs of gastric invagination. The following symptoms are usually observed:
- In children, sudden intermittent cramps begin. The pain progresses, the baby screams inconsolably and bends the legs to the tummy. Attacks occur at intervals of 20-25 minutes, but over time they become more frequent and more serious.
- Vomiting may occur, in which bile impurities appear over time, and it becomes yellow or green.
- Between pain attacks, the child can behave normally, which is why the initial symptoms can be confused with gastroenteritis.
Common signs of the disease are:
- Stool with mucus and blood (this is a sign of the onset of tissue death), feces resemble jelly from currants.
- The child always wants to go to the toilet, but can not.
- A lump is felt in the stomach.
- The pressure drops sharply.
- Tachycardia appears.
- Lethargy, drowsiness.
- Constant obsessive thirst.
- Diarrhea.
- Fever, fever.
But not all symptoms are so obvious and can be observed in a child, some babies do not have obvious pain, others do not vomit, and others do not have an admixture of blood in the feces. Older children often have pain, but there are no other symptoms.
A few hours after the first painful cramps, the child shows signs of dehydration: sunken eyes, dry mouth, sticky sweat on the forehead, prolonged lack of urination.
Intestinal or intestinal invagination is a dangerous condition that requires qualified medical attention. The sooner it is diagnosed, the better.
Symptoms of intestinal invagination in adults are as follows:
- Abdominal pain.
- Single or multiple vomiting.
- Spotting in feces.
- Dizziness, weakness.
- Abdominal distention due to increased gas formation (while gas exhaust is difficult or impossible).
- Bleeding.
The acute form of the disease usually occurs when the colon enters the small intestine. In this case, complete intestinal obstruction occurs. The chronic form is characteristic of colonic invagination.
Complications
The most common complications of the disease are:
- Intestinal obstruction.
- Perforation of the intestinal wall.
- Peritonitis.
- Intestinal bleeding.
- Internal adhesions and hernias.
- Necrosis of the intestinal tract.
Diagnostics
Symptoms of some diseases are very similar, therefore, to confirm the diagnosis, it is necessary to carry out instrumental, physical and laboratory research.
Physical is an examination, palpation, tapping and listening to the abdomen with a phonendoscope.
Instrumental methods for the diagnosis of intestinal invagination:
- Ultrasound examination (ultrasound) - the area where the tissue was densified is determined.
- Computed tomography - reveals the causes of the development of invaginate.
Laboratory methods:
- General blood analysis.
- Coprogram (study of feces).
The doctor will certainly ask about the state of health, pay special attention to the stomach, which will be sensitive and swollen. He needs to know about allergies and drugs that the child takes on an ongoing basis.
If the doctor suspects intussusception, he sends the child to the emergency department to the pediatric surgeon. You can confirm the diagnosis of "intestinal invagination" by ultrasound.
If the child looks very sick, weak, and the doctor suggests damage to the intestine, then he immediately sends him to the operating room.
Bowel intussusception treatment
All patients with intussusception are hospitalized in the surgical department.
Young children under 3 years of age are treated with a conservative method, but this method is possible if no more than 10 hours have passed from the onset of the disease and there are no complications.
Conservative treatment consists in introducing air into the intestines using a Richardson balloon. The air is pumped until the invaginate has recovered. After the child put a gas tube in order to remove this air from the intestines. The effectiveness of the method is 60% of all cases.
In other cases (both in children and adults), surgery is performed to treat intussusception. During it, a thorough audit of the intestine is carried out to exclude additional pathologies. In the absence of necrosis, one segment is carefully removed from another. If there is a change in the tissue of the intestinal wall, then a segment is removed, capturing healthy areas. During surgery, the appendix is also removed, even if it is healthy.
After surgery to invaginate the intestine, conservative treatment is performed. The next 2-3 weeks from the moment of surgery, you must be careful to notice possible complications in time:
- Diarrhea.
- Nausea.
- Temperature rise.
- Crying, anxiety, insomnia, irritability, apathy, lethargy.
- Vomiting
After the operation, you need to take care of the suture: maintain hygiene, check for wound infection: tissue swelling, temperature increase in this area, tissue redness, pain in this area.
Prevention
For the prevention of disease in children, it is important:
- correctly and according to the schedule to introduce complementary foods (that is, not earlier than 6 months);
- introduce new dishes very carefully and gradually;
- gradually increase the volume of dishes;
- in the first year of life, it is recommended to give food in the form of mashed potatoes;
- if the child has acute intestinal infections, it is necessary to consult a doctor and begin to treat them;
- timely treat the child from worms;
- Examine the baby (regularly) for adhesions or neoplasms in the intestine.
In adults, preventive measures are:
- Compliance with diet.
- Exception from the diet of rough food.
- Chewing thoroughly.
- Periodic examination of the digestive system.
Forecast
With timely treatment, the prognosis is favorable. Most babies recover within 24 hours.
But in some cases relapses are possible. Their frequency is less than 10%. Most relapses occur within 72 hours, but there have been reported cases of recurrence after a few years. Relapses, as a rule, are accompanied by the appearance of the same signs as with the primary nature of the disease.
Also, the prognosis is ambiguous in the event of complications, and with every hour the risk to the life of a small patient increases.
Recommendations to parents
All diseases are much easier to prevent than to treat later. Parents are advised to:
- Always seek help from a specialist as soon as possible after the onset of the first symptoms.
- Do not give your child any medicine.
- Do not force the baby to eat by force.
Instead of a conclusion
With early diagnosis, adequate timely treatment, the mortality rate in children with intestinal invagination is less than 1%. But if this condition is not treated, the baby's death may occur in 2-5 days.
This is a dangerous disease, on the successful treatment of which the health and full life of a small person depends. Children who have the damaged part removed may have digestive problems all their lives. But in most cases, timely treatment and surgery takes place without consequences for the child.