What Is an Intussusception?

Intussusception refers to the intussusception of a segment of the intestinal canal that leads to the passage of intestinal contents. Intussusception accounts for 15% to 20% of intestinal obstruction. There are two types of primary and secondary. Primary intussusception occurs mostly in infants and young children, and secondary intussusception is more common in adults. Most intussusceptions are caused by the proximal intestine to the distal intestine. Reverse intussusception is rare, less than 10% of the total cases.

Basic Information

English name

intussusception

Visiting department

Surgery, pediatrics

Multiple groups

Infants, especially children under 2

Common locations

belly

Common causes

Mostly due to disturbances in the normal rhythm of bowel movements

Common symptoms

Abdominal pain, vomiting, blood in the stool, abdominal mass, etc.

Contagious

no

Clinical manifestations of intussusception

1. Frequently occurring in infants and young children, especially children under 2 years of age.

2. Typical performance

Abdominal pain, vomiting, blood in the stool, and abdominal mass.

3. Adult intussusception

Clinical manifestations are not as typical of young children, often manifested as chronic recurrent episodes, and less bloody stools. Intussusception in adults is often associated with organic diseases (especially intestinal polyps and tumors).

Intussusception classification

1. It can be divided into two types, primary and secondary. Primary intussusception occurs in the intestinal tube without pathological changes, and it mostly occurs in children. Intestinal peristalsis is active in children. At the age when supplementary food is added, intussusception can occur due to intestinal peristaltic disorders. Children's upper respiratory tract or gastrointestinal infections often swell with mesenteric lymph nodes, which may also affect the normal peristalsis of the intestine and cause intussusception. Intussusception in adults mostly occurs in the intestinal canal with lesions, such as benign or malignant tumors, polyps, tuberculosis, adhesions, and Merkel diverticulum, which can affect the normal peristalsis of the intestine and become an inducing factor of intussusception. Intestinal ascariasis and spastic intestinal obstruction are also sometimes factors. Adenovirus infection is related to the pathogenesis. At the time of infection, the distal ileum is significantly enlarged and swollen as the starting point of nesting. A few children's intussusception have obvious mechanical factors, such as Merkel's diverticulum, polyps, tumors, intestinal wall hematoma (such as allergic purpura), etc., as the inducement of intussusception.

2. Intussusception can occur in any part of the gastrointestinal tract. According to the intussusception part, it can be divided into jejunum, jejunum, jejunum, ileum, ileum, ileum, ileum, cecum, ileum, colon, and colon (in rare cases, sigmoid colon). Introduced into the rectum) and so on, of which the ileum and cecal, that is, the ileocele type are the most common; the small intestine and the small intestine, ie the small intestine type, are rare; the colonic or colon type is rare. The upper end of the jejunum is retrogradely inserted into the stomach, which is more rare. After the sheathed intestinal segment enters the sheath, its apex can continue to advance along the intestine, the mesentery is also drawn in, and the mesenteric blood vessels are compressed, resulting in local circulation disorders. Intestinal edema gradually occurs, the intestinal cavity is blocked, and the sheathed intestinal segment is twisted. Narrow and necrotic, the sheath is dilated to show ischemic necrosis, and even perforation leads to peritonitis.

Intussusception

X-ray examination of air or barium enema shows that air or barium is blocked at the nest, and the barium blocking agent is "cup-shaped" or even "spring" -shaped.

Differential diagnosis of intussusception

Acute hemorrhagic enteritis

The acute onset of acute hemorrhagic enteritis begins with abdominal pain, mostly around the umbilicus or throughout the abdomen, and is paroxysmal colic or persistent pain with paroxysmal exacerbations. There are often chills and fever. Mostly accompanied by diarrhea, 80% of patients have bloody stools, bloody or jam-like, and sometimes purple-black bloody stools. 60% of patients have nausea and vomiting. About 1/4 of the patients are more severe and may be accompanied by toxic shock. Physical examination has varying degrees of abdominal distension, abdominal muscle tension and tenderness, and bowel sounds generally weaken. Sometimes with a tender mass. X-ray abdomen radiography showed that the small intestine was dilated, inflated, and fluid was flat. Widening of the intestinal space showed fluid in the abdominal cavity.

2. Chronic abdominal pain caused by other reasons

Intussusception in adults is often manifested by chronic recurrent episodes, with less bloody stools. Most were incomplete intestinal obstruction, with mild symptoms and manifested as paroxysmal abdominal pain. It should be distinguished from chronic abdominal pain caused by other reasons, such as chronic appendicitis.

Intussusception

1. Pediatric intussusception is mostly primary, which can be reduced by air or barium enema. But those with suspected intestinal necrosis are contraindicated.

2. Enema can not be reset or suspected of having intestinal necrosis, or feasible surgical treatment for secondary intussusception. The specific surgical method should be decided based on the investigation. Patients without intestinal necrosis should undergo surgical reduction; in case of difficulty, the outer sheath neck is cut to restore it, and then the intestinal wall is repaired; those who have been necrotic or have other organic diseases can be treated with enterectomy and anastomy.

Intussusception prevention

1. Diarrhea, especially autumn diarrhea, should be avoided. Parents should be highly vigilant against the disease.

2. Usually pay attention to scientific feeding, do not be too hungry and full, change food at will, add supplementary food step by step, do not be rushed.

3. Pay attention to climate change, add or remove clothes at any time, and avoid various adverse factors that may easily induce bowel movement disorders.

4. If a healthy infant suddenly has unexplained paroxysmal crying, pale expression, cold sweats, vomiting, bloody stools, and depression, he should think about the possibility of intussusception.

5. The main symptoms are abdominal pain, vomiting and jam-like bloody stools.