Symptoms of intussusception
Characteristic for an intussusception is the phase-like course of the symptoms. At the beginning, the child often has sudden cramp-like abdominal pain, cries and appears sickly. This is usually followed by a period without symptoms, which is typically interrupted by the child’s sudden shrill screaming in connection with the pulling up of the legs or the assumption of a squatting position.
There may be gushing vomiting with sweating, the child becomes increasingly lethargic and in the worst case may faint. These symptoms indicate an intestinal obstruction (ileus) and the child must be taken to hospital immediately. Due to the characteristic symptoms, the suspicion of intussusception is quickly raised.
After admission to hospital, this suspicion must be substantiated and other diseases, such as appendicitis or constipation, must be ruled out. During the physical examination, a cylindrical elevation is palpable, often in the area of the right lower abdomen. In 10-20% of the cases blood is found on the glove after the rectal examination with the finger.
In the ultrasound image, a double ring structure (cockade, shooting target phenomenon) can be seen, which corresponds to the cross-sectional image of the two intestinal tubes lying one inside the other. Thus the diagnosis of intussusception is already clear. In case of doubt, an X-ray of the abdomen (abdominal overview) with contrast enema can be taken.
This has the advantage that in addition to the clear image diagnosis, therapy can be started immediately. In order to reverse the intestinal invagination, one tries to unfold the intestine again with the help of the intestine (devagination). To do this, the air or liquid is introduced into the colon through an intestinal tube and the inverted part of the intestine (invaginate) is pushed back into its original position by the pressure coming towards it.
An ultrasound or x-ray image is taken to check this. This therapy is most promising within the first 14 hours, which is why it is important to bring the child to the hospital quickly.If this method does not work, the only remaining option is surgery (laparotomy). In this case, the abdomen is opened and the intestinal parts are manually repositioned.
If the intestine is already too badly damaged due to the reduced blood flow caused by the intussusception, the affected section must be removed (resection). Because of the danger of a renewed intussusception, the child must remain in the hospital for at least 24 hours for observation, after a surgical treatment correspondingly longer.
- Air (pneumatic disinvagination)
- Saline solution (NaCl solution) or
- Water-soluble contrast medium (hydrostatic reduction)
An intussusception usually proceeds without problems with rapid treatment and the child is well again after a short time.
The decisive factor for the outcome of an intussusception is the length of time during which the affected bowel segment cannot be supplied with sufficient blood. The longer this time is, the higher the risk that the organ part will perish and a life-threatening situation for the child will arise. It is therefore important to recognize an intussusception quickly and to treat it quickly.
