Intussusception is a medical condition in which a portion of the intestine folds into the adjacent section. This usually involves the small intestine and less colon. Symptoms include abdominal pain that can come and go, vomiting, flatulence, and bloody stools. Often causes intestinal obstruction. Other complications may include peritonitis or bowel perforation.
Causes in children are usually unknown while in adults the main point often exists. Risk factors in children include certain infections, diseases such as cystic fibrosis, and intestinal polyps. Risk factors in adults include endometriosis, bowel adhesion, and intestinal tumors. Diagnosis is often supported by medical imaging. In children, ultrasound is preferred while in adults a CT scan is preferred.
Intussusception is an emergency that requires prompt treatment. Treatment in children is usually by enemas with surgery used if this does not work. Dexamethasone may lower the risk of other episodes. In adults, partial removal of the intestine is needed more often. Intussusception occurs more often in children than adults. In children, men are more affected than women. The usual age is six to eighteen months.
Video Intussusception (medical disorder)
Signs and symptoms
Early symptoms may include periodic abdominal pain, nausea, vomiting (sometimes green from the bile), pulling the legs into the chest area, and moderate to severe abdominal cramp pain. Pain is intermittent - not because the intussusception temporarily disappears, but because the intranuscenter intestinal segment transiently stops contraction. Subsequent signs include rectal bleeding, often with "red currant jelly" (stools mixed with blood and mucus), and lethargy. Physical examination can reveal a mass of "sausage-shaped", felt when touching the stomach. Children, or those who can not communicate symptoms verbally, may cry, pull their knees to their chest, or have dyspnea (difficult or painful breathing) with pain paroxysms.
Fever is not a symptom of intussusception. However, intussusception may cause intestinal loops to be necrotic, secondary to ischemia due to compression of the arterial blood supply. This causes perforation and sepsis, which causes fever.
In rare cases, intussusception may be a complication of Henoch-SchÃÆ'¶nlein purpura (HSP), immune-mediated vasculitis disease in children. Such patients who develop intussusception often present with severe abdominal pain in addition to classic signs and HSP symptoms.
Maps Intussusception (medical disorder)
Cause
The cause of intussusception is not clear or understood. Approximately 90% of cases of intussusception in children arise from unknown causes. They can include infection, anatomical factors, and changes in motility.
- Meckel's Diverticulum
- Polyp
- Duplication
- Attachment
- Peyer hyperplasia patch
- Idiopathic
Previous versions of rotavirus vaccines that are no longer used are associated with intussusception, but current versions are not clearly connected. Due to potential risks, they are not recommended in infants who have undergone intussusception.
Pathophysiology
In the most common type of intussusception, the ileum enters the cecum. However, other types occur, such as when part of the ileum or jejunum experiences prolapse into itself. Almost all intussusception occurs with an intussusceptum located proximal to the intussuscipiens. This is because the intestinal peristaltic action pulls the proximal segment into the distal segment. However, there are some rare reports about the exact opposite.
The part that degenerates to another is called intussusceptum , and the receiving part is called intussuscipiens .
An anatomical point (ie, a piece of intestinal tissue protruding into the intestinal lumen) is present in about 10% of the intussusception.
The trapped part of the intestine may have an interrupted blood supply, which causes ischemia (lack of oxygen in the tissues). The mucosa (the lining of the intestine) is very sensitive to ischemia, and responds by peeling to the intestine. This creates a classically described "red colored jewel" bench, which is a mixture of eliminated mucosa, blood, and mucus. One study reported that in fact, only a small percentage of children with intussusception had stools that could be described as "red jelly currants," and therefore intussusception should be considered in the differential diagnosis of children who pass any kind of . bloody stools.
Diagnosis
Intussusception is often suspected based on history and physical examination, including Dance sign observations. Anal rectal examination is helpful in children, because the intussuseptum can be felt by the fingers. The exact diagnosis often requires confirmation with a diagnostic imaging modality. Ultrasound is the imaging modality of choice for the diagnosis and exclusion of intussusception, due to its high accuracy and lack of radiation. The appearance of a target mark (also called a "donut mark" on sonography, usually about 3 cm in diameter, confirms the diagnosis.Figure seen on transverse sonography or computed tomography is a donut form, made by hyperechoic core nucleus of the intestine and mesentery surrounded by edemaous hypoechoic gut In imaging longitudinal, intususepsi resembling a sandwich.
X-ray abdomen may be indicated to check for intestinal obstruction or free intraperitoneal gas. Recent findings indicate that bowel perforation has occurred. Some institutions use air enema for diagnosis, because the same procedure can be used for treatment.
Classification
- Ileoileal - 4%
- Ileokolic (or ileocecal) - 77%
- Ileo-ileo-colic - 12%
- Colocolic - 2%
- Many - 1%
- Retrograde - 0.2%
- More - 2,8%
In children, the incussus is at the ileocecal junction and accounts for 90 percent of all cases.
Differential diagnosis
Intussusception has two main differential diagnoses: acute gastroenteritis and rectal prolapse. Abdominal pain, vomiting, and impurities with mucus and blood are present in acute gastroenteritis, but diarrhea is a major symptom. Rectal prolapse can be distinguished by projecting the perceived mucosa in continuity with the perianal skin, whereas the intussusception of the finger can pass indefinitely into the depth of the sulcus.
Treatment
This condition is usually not immediately life-threatening. Intussusception may be treated with barium or water-contrast contrast enema or air contrast enema, both of which confirm the diagnosis of intussusception, and in many cases manage to reduce it. The success rate is over 80%. However, about 5-10% of this occurs within 24 hours.
Cases where it can not be reduced by a damaged enema or gut require surgical reduction. In surgical reduction, the surgeon opens the abdomen and manually squeezes (not pulls) the telescoped part. If the surgeon does not manage to overcome it, or the bowel is damaged, they will resect the affected part. More often, intussusception may be reduced by laparoscopy, pulling the segment of the intestine apart with pliers.
Prognosis
Intussusception can become a medical emergency if it is not handled early, because it eventually leads to death if not reduced. In developing countries where medical hospitals are not easily accessible, especially when other problems complicate intussusception, death becomes almost inevitable. When intussusception or other severe medical problems are suspected, the person should be immediately taken to the hospital.
The intussusception prospect is excellent when treated rapidly, but when untreated it can cause death within two to five days. This requires rapid treatment, as the longer the segment of the intestine will prolapse the longer the flow without blood flow, and less effective non-surgical reduction. Prolonged intussusception also increases the likelihood of intestinal ischemia and necrosis, requiring surgical resection.
Epidemiology
This condition is diagnosed most often in infancy and early childhood. It attacks around 2,000 babies (one in every 1,900) in the United States in the first year of life. The incidence began to increase by about one to five months of life, peaking at the age of four to nine months, and then gradually decreasing by about 18 months.
Intussusception occurs more frequently in boys than girls, with a ratio of about 3: 1.
In adults, the intussusception is the cause of about 1% of intestinal obstruction and is often associated with neoplasm, malignancy or otherwise.
References
Further reading
- Intussuception: A guide to diagnosis and intervention in children
Source of the article : Wikipedia
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