What happens to the gut
Most often, the final section of the small intestine is inserted into the large intestine, along with the mesentery and vessels. First, the outflow of venous blood is disrupted, the wall swells, mucus and blood are released into the lumen - hence the characteristic stool. Arterial blood flow then suffers, and a section of the intestine may become necrotic with the development of peritonitis. In young children, no obvious cause is usually found: it is assumed that the trigger is an increase in the lymphoid tissue of the intestine after a viral infection. In children over two years of age, a specific point is more often detected: a polyp, Meckel's diverticulum, or duplication of the intestine.
- One section of intestine slides into another
- The vessels of the mesentery are compressed
- Swelling of the wall and discharge of blood and mucus
- Without treatment - intestinal necrosis and peritonitis
- In children, the cause is often not obvious
How to recognize
The classic picture begins suddenly in a previously healthy child. The baby suddenly begins to scream, turns pale, pulls his legs towards his stomach, the attack lasts minutes, then the child calms down and looks exhausted. After 15–20 minutes everything repeats. Vomiting occurs, first with the food eaten, then with the greens. After a few hours, stool with blood and mucus, reminiscent of raspberry jelly, may appear - but you cannot wait for this sign, it does not happen to everyone and appears late. Between attacks, the abdomen is soft, sometimes a dense formation can be felt.
- Sudden bouts of screaming every 15–20 minutes
- Pulling the legs towards the stomach
- Paleness and sweating during an attack
- Lethargy and indifference between attacks
- Vomiting, later with greens
- Stool in the form of raspberry jelly is a late sign.
Why can't you wait?
Time is of the essence. In the first hours, it is almost always possible to straighten the intestine conservatively, without an incision, and the child is discharged after a day or two. After 12–24 hours, swelling increases, the likelihood of expansion decreases, and the risk of necrosis of a section of the intestine and the need to remove it increases. That is why, in case of repeated bouts of screaming with vomiting in a child under three years old, you need to call for help or take him to the hospital, without trying to give painkillers, give an enema or wait until the morning.
- The first hours - straightening without surgery
- Later, the risk of having part of the intestine removed increases
- Painkillers and antispasmodics should not be given
- Do not feed or drink until examined by a doctor
- Don't give an enema at home
- If you refuse to eat and feel lethargic, call 103
Diagnostics
The main method is ultrasound of the abdominal cavity: intussusception gives a characteristic picture in transverse and longitudinal sections, the method is fast and safe for the child. Plain radiography helps to see signs of intestinal obstruction and rule out perforation. The doctor examines the abdomen, assesses the child’s condition, the degree of dehydration, and prescribes a general blood test and biochemistry. In doubtful cases, a contrast study is used. The diagnosis is made quickly so that treatment can begin immediately.
- Ultrasound of the abdominal cavity is the main method
- Plain radiography of the abdominal cavity
- Examination by a pediatric surgeon
- Complete blood count and electrolytes
- Assessing the degree of dehydration
Treatment
In the absence of signs of peritonitis and perforation, the intussusception is straightened conservatively: air or liquid is injected into the colon under X-ray or ultrasound control, the pressure of which returns the retracted area to its place. The procedure is performed by a surgeon, the child is under observation. If straightening is unsuccessful or there are signs of intestinal necrosis, an operation is performed in which the area is straightened manually and the non-viable segment is removed. After successful treatment, the child remains under observation: in a small percentage of cases, intussusception recurs in the coming days.
- Controlled expansion by air or liquid
- Surgery in case of failure or peritonitis
- Removal of a non-viable section of intestine if necessary
- Replenishment of fluids through a vein
- Observation in the hospital after straightening
- Repeated episodes are possible, it is important to know the signs
