Intussusception is the invagination of an intestinal segment in an adjacent section. This leads to an obstruction of the bowel or intestinal hypoperfusion.
Intussusception occurs mostly between 6 months and 3 years; 65% of cases occur in the first year and 80 to 90% of cases before the age of two years. In this age group it is the most common cause of intestinal obstruction.
Intussusception is the invagination of an intestinal segment in an adjacent section. This leads to an obstruction of the bowel or intestinal hypoperfusion. Intussusception occurs mostly between 6 months and 3 years; 65% of cases occur in the first year and 80 to 90% of cases before the age of two years. In this age group it is the most common cause of intestinal obstruction. Most cases are idiopathic. However, there is a slight accumulation in male infants and seasonal fluctuations; the highest incidence coincides with the viral enteritis season. An older rotavirus vaccine was associated with a significant increase in the risk of intussusception taken in the US from trading. The newer vaccines, when administered at the recommended order, and the recommended time are not associated with a clinically significant higher risk. About 25% of children who have intussusception, usually very young and older children, a concrete indication triggers (eg. As a mass or other intestinal disorder) of the protuberance. Examples include polyps (colon and rectal polyps), lymphoma (lymphoma at a glance), Meckel’s diverticulum (Meckel’s diverticulum) and immunoglobulin-A-associated vasculitis (formerly Purpura Henoch-Schonlein genannt- immunoglobulin-A-associated vasculitis (IGAV) ) when purpura affects the intestinal wall. Also Cystic Fibrosis (Cystic fibrosis (CF)) is a risk factor. The invaginated intestinal sections move the intestinal lumen, ultimately reduce the intestinal blood flow to Invaginationssegment (intussusception), and cause ischemia, gangrene and perforation. Intussusception Symptoms The initial symptoms are the sudden onset of significant, colicky abdominal pain, which often occur with vomiting every 15-20 minutes. The child seems to be going well between attacks. Later, once the intestinal ischemia develops, the pain is permanent, the child becomes lethargic and may cause Mucosablutung Haemoccult-positive chair in digital rectal examination and sometimes spontaneous passage of gel-like chairs. However, the latter is a late onset of symptoms and doctors should not let happen that this symptom occurs when they suspect intussusception. Occasionally, a sausage-like abdominal tumor is palpable. The perforation is accompanied by signs of peritonitis, marked tenderness, guarding and board hard stomach. Pallor, tachycardia and cold sweats announce a state of shock. About 5 to 10% of children imagine without the colicky pain phase. Instead, they appear lethargic, as if they were stunned (atypical or apathetic presentation). In such cases, the diagnosis is often overlooked until the jelly-like chairs appear or an abdominal mass is palpable. Diagnostic sonography The suspicion of the diagnosis must be high, especially in children with atypical presentation, and diagnostic measures and intervention must be carried out quickly because the survival and the possibility of a non-surgical repositioning decrease with time significantly. Treatment depends on the clinical findings. Sick children with signs of peritonitis need hydration (dehydration in children: fluid replacement), broad-spectrum antibiotics (eg, ampicillin, gentamicin, clindamycin.), Nasogastric and surgical therapy. Clinically stable children need to confirm the diagnosis and treatment only imaging tests. Barium enema was once the preferred initial investigation because it is the classic “spiral spring” – reveals phenomena around the intussusception. In addition to the diagnostic function of the barium enema was also a treatment measure; the pressure of barium often reduced the turned-in sections. But barium can also be an unrecognized perforation enter the peritoneum and cause a pronounced peritonitis. Currently, ultrasound examination for diagnosis is preferred; it is easy to perform, relatively inexpensive and safe. Tips and risks, physicians should not wait for the jelly-like chairs until they suspect intussusception as they occur late. Surgery treatment air inlet when the inlet is unsuccessful or if the perforation is present is confirmed intussusception, one can use an air inlet to reduce invagination. This reduces the risk of perforation with all its consequences. The intussusception can be successfully minimized at 75-95% of children. If the air inlet is successful, the children will be observed overnight to exclude an occult perforation. If a repositioning is unsuccessful or if the bowel is perforated, immediate surgery is necessary. If the repositioning is achieved without surgery, the recurrence rate is 5-10%. Important points intussusception is the nesting of a segment of the intestine into another, usually in children <3 years. The children are usually with colicky abdominal pain and vomiting before, followed by the elimination jelly-like chairs. The diagnosis is made by ultrasound. The therapy is a repositioning by air inlet and sometimes surgery.