Invagination, or intestinal obstruction in young children, is, as the name suggests, a very acute condition of the intestine in young children that can result in life-threatening intestinal obstruction. Suspected intussusception is usually an emergency medical situation.
What is intussusception?
An intussusception is defined by doctors as an invagination of parts of the intestine into other parts of the intestine. This invagination means that the intestinal wall no longer receives an adequate supply of blood, the vessels in the intestinal wall are pinched off, and parts of the intestine may die. An intestinal obstruction may result. Intussusception can occur in any part of the intestine, but most often the obstruction is found at the transition from small to large intestine. It usually affects infants and young children up to the age of two. If intussusception occurs in older children or adults, the causes are different than in younger children.
Causes
The causes of intussusception are not fully understood to date. Doctors suspect disorders of intestinal motor function (peristalsis). In younger patients, doctors could find that peristalsis is too violent and uncontrolled. In older children or even adults, a tumor, inflammation or bleeding usually triggers disturbances in peristalsis and thus intussusception. Furthermore, mechanical stimuli in the intestine can be considered as a cause. These include, for example, worms, hardened fecal residues, gallstones, tumors or swallowed foreign bodies. In addition, invaginations and tangles, such as volvulus (intestinal tangles), intestinal polyps or diverticula in the intestine (diverticulosis) are also known as causes. Last, intussusception can also occur as a result of complications after surgery or hernias of the abdominal wall.
Symptoms, complaints, and signs
Invagination is first manifested by severe, colicky stomach cramps that usually occur suddenly. Affected children are in severe pain and express this by crying, screaming and the typical protective posture with legs drawn up. In most cases, gastrointestinal complaints are also present, such as vomiting and nausea. First the stomach contents and later bile are vomited. The skin is pale and covered with cold sweat. Affected children are also nervous and anxious, and in severe cases may have a panic attack. The pain attacks occur in contraction-like phases that vary greatly in intensity. Thus, the discomfort may subside completely, only to recur a few minutes or hours later. In severe cases, shock may occur. The stools are normal at first, and take on a jelly-like consistency as they progress. The stool is often bloody or mucous and may have an unpleasant odor. If intestinal obstruction occurs, this can be recognized by a distended abdomen. Fever symptoms also develop relatively quickly. Then there is an elevated temperature, chills and a violent feeling of illness. Because of the severity of the symptoms, an emergency physician must be called immediately if intussusception occurs.
Diagnosis and course
At the beginning of the diagnosis is, of course, the questioning of the patient or the parents (since the patients are usually still very young). An important clue for the diagnosis is the course of the abdominal pain. Very painful and painless phases are quite typical. During palpation, the physician can feel a cylindrical hardening in the lower abdomen. The doctor can also often feel the invaginated piece of intestine. The typical pain and palpation findings corroborate the finding of intussusception. The suspicion is verified with an ultrasound examination. In the phases characterized by pain, it is typical that the pain is very severe and sudden. The children often double over under the colic and vomit first stomach contents, later bile and then often stool, because the intestinal contents can no longer take the normal route due to the invagination. The children show a pale skin coloration and are anxious. Because of the severe pain, the young patient may also show signs of shock. The intestinal loops are overinflated, the abdomen is distended, there is initially increased bowel sounds, later these are absent. With prolonged intussusception, raspberry jelly-like mucus exudes from the anus. Infants show shrill crying and conspicuously tighten their legs. They usually cannot be calmed and are pale grayish.There is a chance that an intussusception will resolve on its own, but it is very small.
Complications
Intestinal obstruction in young children can be life-threatening and therefore must always be examined and treated by a physician. In the worst case, this will result in the death of the patient without treatment. Those affected suffer first and foremost from very severe abdominal pain. These usually occur very suddenly and are extremely severe. Furthermore, there are outbreaks of sweating and vomiting. The affected persons appear very pale and depressed. There are also noticeable and unusual noises in the intestines. Furthermore, an unusual mucus, which differs from feces, may be discharged from the anus. The daily life of the affected person is significantly limited by the intestinal obstruction in infants. Furthermore, the severe pain can also lead to a state of shock. Treatment must be provided immediately by a physician. In most cases there are no complications and the symptoms can be resolved relatively quickly and well. Only in severe cases, surgery may be required to remove a portion of the intestine. However, the patient’s life expectancy is not limited if treatment is successful.
When should you go to the doctor?
If the child suffers from abnormalities in digestion, a doctor is needed. If severe abdominal pain or cramps in the upper body suddenly occur, medical examinations should be initiated. If vomiting, sweating, and a pale appearance occur, a doctor’s visit is advised. If the limbs are cold as well as pale and cold sweat is coming out, the child is suffering from an illness that needs to be treated. If unusual bowel sounds occur, there is constipation, a drop in performance or the child is listless, a doctor should be consulted. In case of severe fatigue, refusal to eat, secretion of mucus and malaise, medical examinations are necessary to determine the cause. If fever, inner restlessness, sleep disturbances, a feeling of illness and increased irritability occur, a visit to the doctor is necessary. Since intussusception can lead to a life-threatening condition, consultation with a physician is advisable at the first symptoms. If the symptoms persist for several days, the health condition deteriorates immensely. In most cases, the existing symptoms spread within a few hours. Treatment must be given as soon as possible, because without medical intervention, organ failure can result in death. In the event of loss of consciousness, an emergency physician must be contacted so that the child can receive intensive medical treatment.
Treatment and therapy
If the intussusception is still in its early stages, the physician may first manually attempt to relieve the intestinal obstruction with a special massage. A bowel enema may also help at this early stage. With the pressure of the enema fluid, the doctor tries to push the intestine back into the correct position. The enema is performed under ultrasound guidance so that the doctor can check right away whether the intestine has become pervious again. If the doctor cannot solve the intussusception by external massage or an enema, surgical intervention is necessary. Otherwise, the intestine, which is poorly perfused or not perfused at all, will die. The patient is then in a life-threatening situation, as bacteria can now also enter the abdominal cavity through the perforated intestine and cause peritonitis. This can lead to a life-threatening circulatory and shock situation. In any case, surgery is also necessary if the intussusception is located very high in the intestine, i.e. in the small intestine area. The goal is to preserve the intestine completely. This usually succeeds without complications. However, in the case of very advanced intestinal invaginations, the doctor may also have to remove part of the intestine during the operation.
Outlook and prognosis
An intussusception can have a very different prognosis. This depends on the duration of the bowel obstruction, any damage to the tissues, the extent of any swelling, and possible damage from treatment. In general, however, the prognosis is good if intestinal obstruction is treated promptly in young children. If treated, however, there is a very high risk of recurrence of intussusception in approximately 5 to 15 percent of affected infants.Nevertheless, it should be mentioned that a rapidly treated intestinal obstruction usually remains without consequences. However, conservative treatment can lead to intestinal perforation in very rare cases, which worsens the prognosis. This is different in the case of persistent, untreated intestinal obstruction in young children. Here, intestinal tissue may die or inflammation and further colic may occur. Again, the prognosis depends on the speed of treatment. If intestinal tissue has already died, surgery must be performed, otherwise peritonitis will occur. This can become sepsis in the worst case. As a general rule, intussusception can be life-threatening. It becomes acute – depending on the person and the damage – after hours or days. This is why it is so important to have an intestinal obstruction treated as soon as possible, so that the prognosis remains the best possible.
Prevention
An intussusception should always be treated by a doctor as soon as possible, as earlier therapy greatly improves the chances of recovery. The risk of peritonitis is also greatly reduced by early medical intervention. As a preventive measure, children should continue to get plenty of exercise, play sports and eat a diet rich in fiber. In addition, attention should be paid to worms in the stool in children.
Follow-up
In most cases, very few or even no special measures of aftercare are available to the person affected by intussusception. In this case, the disease must be detected by a physician at a very early stage, so that a further worsening of the symptoms can be prevented. Self-healing cannot occur, and in the worst case, intussusception can lead to the death of the child. Parents should therefore consult a doctor with the child at the first signs and symptoms of the disease. The treatment itself is usually done by massage or surgical intervention. In any case, the affected person should rest and take care of his or her body after such an operation. In this case, the patient should refrain from exertion or stressful activities in order not to put unnecessary strain on the body. Even after a successful operation, regular checks and examinations by a doctor are necessary in order to detect further inflammation or damage to the intestine at an early stage. The further course of intussusception depends very much on the severity of the disease and also on the time of diagnosis, so that a general prediction can usually not be made.
What you can do yourself
An intussusception is a medical emergency for which there are no acute self-help options. However, in this case, parents can ensure adequate hydration, for example, by giving tea or water. Otherwise, there is a risk of dehydration. Painkillers should only be administered in consultation with a doctor. However, these measures are in no way a substitute for medical treatment. They only have a supporting and supplementary effect. The everyday life of affected infants is significantly restricted by the pain during intussusception. If the condition persists for a long time or occurs repeatedly, the affected child may also experience psychological discomfort, feelings of shame, anxiety, depressive moods and eating disorders. In such cases, parents should try to calm the child and alleviate fears. In case of severe psychological discomfort, psychotherapeutic support should also be considered. In addition, since recurrences of intussusception may also occur, it is important to pay special attention to the child’s condition after an illness and to prevent a new illness by diet and exercise.
