Intussusception - symptoms and treatment
Treatment of intussusception involves disintussusception—the release of the strangulated intestine. According to Order of the Ministry of Health of the Russian Federation No. 203 “On approval of criteria for assessing the quality of medical care,” treatment of intussusception should be carried out no later than an hour after diagnosis.[7] The fact is that the pathological process in the wall of the strangulated intestine is very dangerous. Therefore, it is important to carry out disinvagination as early as possible and as quickly as possible.
There are two main principles for the treatment of intussusception: surgical (operative) and conservative.
In case of severe general condition of the child, it is necessary to carry out preoperative preparation:
- restore water and electrolyte balance;
- reduce hyperthermia;
- improve microcirculation;
- introduce antibacterial drugs as early as possible.
Conservative therapy
Treatment of intussusception for a long time was exclusively surgical, since the level of diagnosis was low. At the moment, in the absence of convincing data for peritonitis and necrosis of the strangulated intestine, conservative treatment is carried out using a special manipulation - air disinvagination.[8] This procedure is performed under general anesthesia and does not cause pain to the child. Its essence lies in inserting a special tube - a rectal probe with an air injection system connected to it and a pressure gauge (rectoscope with a Richardson balloon connected). Under a certain pressure, air is pumped into the intestines, and with the help of gas pressure, the invariant is straightened.
This method is considered the gold standard for conservative treatment of intussusception. Its effectiveness has been confirmed by many multicenter studies.[11][12][13][14][15]
There is also a method of hydrodisinvagination, based on the effect of hydrostatic pressure on the intussusception. It involves the use of an enema with the injection of a warm saline solution or a barium suspension under the control of an X-ray machine that conducts continuous filming.
It is worth noting that the method with a barium suspension, according to the authors, has one advantage: barium is a fairly dense and heavy substance, which can provide a better chance for conservative disinvagination. However, at present this suspension is not used, as it can lead to a serious complication: if a breakthrough of the intestinal wall occurs during disinvagination, the barium suspension will enter the abdominal cavity, from where it will be extremely difficult to remove it, which will give rise to the development of severe peritonitis.
Hydrodisvagination itself is indicated in the Federal Clinical Guidelines as an additional treatment method, but it is less preferred.[8]
Surgical treatment
Surgical treatment of intussusception is performed much less frequently. There are clearly defined indications for its implementation:
- the presence of peritonitis and a verified diagnosis of “Intussusception”;
- more than 24-48 hours from the onset of the disease;
- lack of effectiveness from three attempts at conservative disinvagination (pneumodesinvagination).
If the appropriate equipment is available and the surgeon is sufficiently qualified, intussusception is eliminated through laparoscopic access. If it is not possible to perform laparoscopic disinvagination, they resort to an open technique, which is inferior only in terms of postoperative rehabilitation.
The duration of rehabilitation is extremely individual and depends on many factors. It is generally accepted that after laparoscopic release of the strangulated intestine, rehabilitation is easier and faster due to reduced pain.
Grodno Regional Children's Clinical Hospital
Details Published March 24, 2015
Intussusception in children is a serious, acute condition that is the most common type of acquired intestinal obstruction. Intussusception is the most common pathology (70-80% of cases) among other types of intestinal obstruction in children, and most often (up to 80%) intussusception develops in a child aged 3-9 months, and boys most often suffer from it.
This condition ranks second after acute appendicitis from the group of acute surgical diseases of the abdomen at the age of 6 months to 2 years. The introduction of one section of the intestine into another occurs as a result of impaired intestinal motility. Impaired intestinal motility can be facilitated by the introduction of complementary foods containing vegetable or fruit ingredients: fiber from vegetables and fruits sharply increases intestinal motility, which leads to intussusception.
The main symptom of intussusception is a sharp, paroxysmal pain in the abdomen, due to which the child begins to cry despite feeling normally. Children are restless and tuck their legs to their stomach. Children often have no stool, and instead of it or with a small amount of feces, blood is released from the child's rectum.
Intussusception is characterized by raspberry jelly-shaped stools—jelly-like mucus that is raspberry-colored due to the presence of blood in it. Against the background of abdominal pain, the child may experience vomiting that is not associated with food intake, sometimes repeated, indomitable, which indicates the serious condition of the child. Often the occurrence of intussusception is accompanied by a rise in temperature. Often intestinal intussusception is characterized by a wave-like course: the painful attack subsides as suddenly as it began, children become calm, play, and appetite appears. However, after some time, the above picture repeats itself. The paroxysmal nature of pain and its periodic occurrence are the most characteristic signs of intussusception. Without assistance, attacks of pain become more frequent, severe and prolonged, and periods of “quiet” with the absence of pain are shortened. As the disease progresses, the abdominal pain becomes constant, the child cries and screams almost without interruption, without calming down for a minute. If the above signs appear, parents should immediately call an ambulance and under no circumstances try to treat the child themselves, as this will only worsen his condition.
The choice of treatment method for intussusception is determined by the surgeon depending on the duration of the disease and the severity of its clinical signs. If the symptoms of intussusception appeared less than 6 hours ago and there are no signs of peritonitis, then the main diagnostic method, as well as the method of choice for treatment, will be conservative treatment - pneumoirrigoscopy. This is a low-traumatic, but at the same time quite simple and effective method under the control of x-rays. After the procedure, the child is given a liquid barium suspension to drink (a substance that enhances the contrast of the intestines on radiographs), and then a series of plain X-rays of the abdominal organs is taken at specific intervals, assessing the patency of the intestines. If a child is admitted to the hospital late, given the high probability of necrosis of the wall of the strangulated intestine, an operation is performed during which the intestine is straightened and the condition of its strangulated loop is assessed. If during the operation signs of necrosis of a section of the intestine are detected, it is removed.
What is the prognosis for intussusception? Provided timely diagnosis and early initiation of treatment, the prognosis is usually favorable. The main thing is to establish a diagnosis in time and begin treatment.
How to recognize intestinal obstruction
- Abdominal pain is the very first and characteristic sign; it can be sudden, cramping in nature, and, as a rule, its appearance does not depend on food intake. At first, attacks are repeated at certain intervals, which is associated with intestinal peristalsis, but then the pain becomes constant. When the intestine is strangulated or torsion, the pain becomes more intense during a wave of peristalsis. An alarming symptom is a decrease in pain; imaginary well-being indicates a cessation of peristalsis and the development of intestinal paralysis. The pain caused by obstruction due to paralysis is in most cases dull and bursting.
- Stool retention and failure to pass gas are a typical sign of low obstruction. But stool may appear in the first hours with mechanical compression, paresis or narrowing in the upper intestines, as well as with partial intestinal patency.
- Vomiting is a characteristic symptom, it can be repeated, not bringing relief, possibly with intestinal contents, increasing as intoxication increases.
- Bloating and asymmetry of the abdomen, peristalsis, which gradually subsides.
Almost always appear: weakness, lack of appetite, apathy, signs of intoxication. It is necessary to take into account that the manifestations of the disease may vary and depend on a number of factors, so the only correct decision is to seek medical help. If you have any questions, just call us and our specialists will tell you what to do.
Intestinal obstruction, what to do?
If intestinal obstruction is suspected, urgent hospitalization of the patient in the surgical department is necessary. Before the doctor arrives, it is strictly forbidden to take painkillers or laxatives, perform gastric lavage, etc.
Treatment tactics
At the first symptoms of the disease, the patient must be immediately hospitalized in a hospital. Before being examined by a surgeon, it is prohibited to take painkillers or any other medications, or to cleanse the stomach and intestines, so as not to blur the clinical picture and cause harm.
If intestinal obstruction is diagnosed in its initial stage, conservative treatment methods can be used:
- Emptying the stomach and intestines from food and feces using probing and siphon enema.
- Taking antispasmodics in the presence of spasms or drugs that stimulate peristalsis in case of intestinal paresis.
- Intravenous drip infusions of saline solutions to achieve water-electrolyte balance.
- Colonoscopy for diagnostic and therapeutic purposes.
If a conservative approach to treatment does not eliminate the disease, it is necessary to think about mechanical obstruction or the development of complications and resort to surgical intervention.
The following surgical treatment options are used:
- unraveling intestinal loops;
- cutting adhesions;
- hernia repair in the presence of a hernia;
- excision of a necrotic area of the intestine;
- the application of a colostomy to remove feces outside (in case of malignant neoplasms and the impossibility of anastomosis).
After the operation, drug correction is carried out, which, as a rule, includes antibiotic therapy, detoxification measures, restoration of peristalsis, etc. The main goal of treatment is to save the patient’s life and prevent possible complications that may develop if the disease is not diagnosed and treated in a timely manner. The most life-threatening consequences are pain shock, sepsis and peritonitis.
