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Intussusception

An intussusception is a situation in which a part of the intestine has prolapsed into another section of intestine, similar to the way in which the parts of a collapsible telescope slide into one another. This causes the bowel walls to press on one another, blocking the bowel This causes obstruction and cuts off the blood supply to the intestine. The child strains and cries loudly, and characteristically wants to lie very still during the attack of pain. Intussusception is known to occur with greater frequency in children who have undergone recent abdominal surgery, either intraperitoneal or retroperitoneal operations. This, in turn, leads to swelling, inflammation, and decreased blood flow to the intestines involved. The tissues around the bowel (called the mesentery) contain the blood vessels that support the bowel and these get trapped and strangulated. After surgery, intravenous feeding and fluids are continued until normal bowel movements resume.

Intussusception causes the compression of blood vessels in the involved intestine which reduces the supply of blood to the affected intestine. The most frequent type of intussusception is one in which the ileum enters the cecum , however other types are known to occur, such as when a part of the ileum or jejunum prolapses into itself. The first sign of intussusception is usually sudden, loud, and pained crying caused by abdominal pain If your child gets a tummy ache, that doesn't mean she has an intussusception. The reason for this is that peristaltic action of the intestine "pulls" the proximal segment into the distal segment.

Causes of Intussusception

Here are the list of the possible sauses of Intussusception:

  • Benign or malignant tumors of the mesentery or of the intestine, including lymphoma, polyps, and hamartomas associated with Peutz-Jeghers syndrome
  • Submucosal hematomas, which can occur in patients with HSP and coagulation dyscrasias
  • The pressure created by the two walls of the intestine pressing together causes irritation, swelling, and decreased blood flow.
  • The first sign of intussusception is usually sudden, loud, and pained crying caused by abdominal pain .
  • Intussusception is most common around the age that infants are being introduced to solid foods.

Symptoms of Intussusception

Some sign and symptoms related to Intussusception :

  • passing stools (or poop) mixed with blood and mucus, known as currant jelly stool (60% percent of infants with an intussusception will pass currant jelly stool)
  • lethargy (i.e., drowziness or sluggishness)
  • As a child's condition worsens, vomiting decreases. Green fluid in vomit is a sign that the intestine is blocked.
  • Frequent chest and sinus infections with recurring pneumonia or bronchitis.
  • Abdominal pain alternating with some pain-free periods
  • Protrusion of part of the rectum through the anus (rectal prolapse). This is often caused by stools that are difficult to pass or by frequent coughing.
  • Shock ( pale color, lethargy , sweating)
  • As the condition progresses, the infant becomes weak and then shocky with pale color, lethargy, and sweating.

Tratmeant of Intussusception

  • Therapeutic enema is of no value in patients with small bowel–to–small bowel intussusception, which usually occurs in older patients who have other associated diseases (eg, HSP, hemophilia, Peutz-Jeghers syndrome, malignancies).
  • If manual reduction is not possible or perforation is present, perform a segmental resection with an end-to-end anastomosis. A diligent search for any lead points is warranted, especially if the patient is older than 2-3 years.
  • In some cases, the bowel obstruction can be treated with a barium enema performed by a skilled radiologist.
  • In a surgical reduction, the abdomen is opened and the part that has telescoped in is pulled out manually by the surgeon or if the surgeon is unable to successfully reduce it or the bowel is damaged, the affected section will be resected.
  • Usually the bowel tissue can be saved, but if not, any dead tissue will be removed.

 


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