Subscribe
intussusception
Pediatric intussusception should see which department?
Intussusception often occurs in infants and young children, so the main symptoms are vomiting, bloody stools, and abdominal pain. Therefore, the initial consultation is usually in pediatric emergency. When intussusception is suspected as a cause of acute abdomen, the doctor will conduct intestinal tube and abdominal ultrasound examinations. If the ultrasound confirms intussusception, a transfer to pediatric surgery or emergency surgery may be considered for appropriate surgical treatment. Thus, the initial choice for consultation is usually pediatrics, but after a diagnosis is confirmed, treatment should be transferred to pediatric surgery.
Can intussusception in children cause fever?
In the early stages of intussusception, the child generally remains in good condition, with normal body temperature and no symptoms of systemic poisoning. As the disease progresses and worsens, complications such as intestinal necrosis or peritonitis may develop, leading to deterioration of the overall condition. At this point, severe dehydration, high fever, lethargy, coma, and shock, among other symptoms of poisoning, can occur. Therefore, fever can indeed appear in the later stages of intussusception.
Causes of intussusception in children
The etiology of intussusception is divided into primary and secondary types, with 95% being primary, which is common in infants and young children. In infants, the mesentery of the ileocecal region is not yet fully fixed and has a larger degree of mobility, which is a structural factor conducive to the occurrence of intussusception. Secondary cases account for about 5%, often secondary to Meckel's diverticulum, intestinal polyps, intestinal tumors, intestinal duplications, and abdominal purpura causing swelling and thickening of the intestinal wall, which can lead to intussusception. Certain factors may cause a change in the rhythmic movement of the intestines leading to disorder, thereby inducing intussusception, such as changes in diet, viral infections, and diarrhea.
Symptoms of intussusception in infants
The clinical manifestations of intussusception mainly include abdominal pain, vomiting, bloody stools, and an abdominal mass. The abdominal pain is often spasmodic and regular, manifesting as sudden severe colicky pain. The child appears to be crying and restless, with knees drawn up to the abdomen, pale complexion, and the pain lasts for several minutes or longer but lessens after; it recurs every ten to twenty minutes, accompanied by intestinal movements. Vomiting is an early clinical symptom, initially consisting of milk curds or food residue, and later may include bile and fecal-like liquid. Bloody stool is an important symptom, appearing within the first few hours; initially, the stools can be normal, with about 85% of cases excreting jam-like mucoid bloody stools within six to twelve hours of onset. The abdominal mass is often located in the upper right abdomen below the costal margin, where a slight, tender mass can be palpated.
How many days will pneumatic reduction for intussusception take to recover?
The indications of successful reduction of intussusception by air enema treatment are as follows: First, after the removal of the tube, a large amount of foul-smelling mucousy bloody stool and yellow feces are expelled. Second, the patient quickly falls asleep, no longer cries, and ceases to vomit. Third, the abdomen is soft and flat, with no palpable mass as before. Fourth, after the enema reduction, 0.5-1 grams of activated charcoal is administered orally; if charcoal residue is expelled within six to eight hours, it indicates a successful reduction. However, even after successful reduction, it is necessary to remain under observation in the hospital for two to three days to monitor for any recurrence of the intussusception.
Causes of intussusception in children
The causes of intussusception are divided into primary and secondary types, with 95% being primary, commonly seen in infants and young children. In infants, the mesentery of the ileocecal area is not yet fully fixed and has greater mobility, which is a structural factor prone to intussusception. Secondary cases account for 5%, where intussusception occurs. Some intestines show clear organic changes, such as Meckel's diverticulum, intestinal polyps, intestinal tumors, intestinal duplication anomalies, abdominal purpura, and thickening of the intestinal wall, which can cause intussusception of the intestines. Certain triggers, including dietary changes, viral infections, and diarrhea, can induce intussusception.
Intestinal intussusception described by ultrasound.
The appearance of intussusception under ultrasound shows concentric or target ring-shaped mass images on a transverse section scan, and a sleeve sign on a longitudinal section scan. For an ultrasound-guided hydrostatic reduction, a balloon is inserted through the anus and inflated, connecting a T-tube to a Foley catheter with a side tube connected to a sphygmomanometer to monitor water pressure. Isotonic saline at a temperature of thirty to forty degrees is injected, and the target ring-shaped mass image can be seen retracting to the ileocecal region. The disappearance of the concentric circles or sleeve sign under ultrasound indicates the completion of this therapeutic diagnosis.
How to treat intussusception in infants
The treatment of intussusception mainly includes non-surgical and surgical methods. The non-surgical method involves enema treatment. Within 48 hours of the onset of intussusception, if the overall condition is good, there is no abdominal distension, no apparent dehydration, and no electrolyte disorders, ultrasound-guided hydrostatic enema, air enema, or barium enema can be performed. If the intussusception lasts more than 48 to 72 hours, or if the duration is shorter but the condition is severe, with intestinal necrosis or perforation, surgical treatment is required.
Does intussusception require a CT scan?
Intussusception is commonly diagnosed through routine abdominal ultrasound examinations, which have a positive rate of over 90%. In the ultrasound, the transverse section of the intussusception can show concentric circles or target ring-shaped mass images, and the longitudinal section may reveal the sleeve sign. Additionally, a barium enema can be employed, along with X-ray imaging. Under X-ray, the lead point of intussusception appears as a mass shadow, and air enema reduction treatment can be performed concurrently. Generally, CT is not used as a routine diagnostic tool.
Is intussusception in children serious?
Intussusception is a life-threatening emergency, and its reduction is an urgent treatment measure that should be performed immediately once diagnosed. In the early stages, the child generally appears healthy, with normal body temperature and no obvious symptoms of poisoning. However, as the condition progresses and the duration of the intussusception increases, it can lead to intestinal necrosis or peritonitis, causing a deterioration in the overall condition. Commonly, severe dehydration, high fever, coma, shock, and other serious symptoms of poisoning may occur.