Intestinal invagination is a type of intestinal obstruction in a separate nosoform, the cause of which is the introduction of one part of the intestine into the lumen of another [3] .
Intestinal invagination | |
---|---|
ICD-10 | K 38.8 , K 56.1 |
ICD-10-KM | |
ICD-9 | 543.9 , 560.0 |
ICD-9-KM | |
OMIM | 147710 |
DiseasesDB | 6913 |
MedlinePlus | 000958 |
eMedicine | emerg / 385 |
Mesh | and |
This variant of intestinal obstruction occurs predominantly in infants (85–90%), especially often from 4 to 9 months. In children older than 1 year, intussusception is rarely observed and in most cases is associated with organic nature ( ileal diverticulum , hyperplasia of lymphoid tissue, polyp , malignant neoplasm , etc.) [4] .
Content
Causes and development mechanism
Invagination is referred to as a mixed form of intestinal obstruction, which combines both obstructive and strangulated factors. Initially, intestinal blockage occurs from the inside ( obturation ), and only then, as a rule, after 6-12 hours, can a malnutrition be caused due to compression of the mesentery ( strangulation ). Invagination develops due to impaired intestinal motility , and impaired motility, in turn, may be caused by the age characteristics of the connective tissue in infants ( ileocecal valve insufficiency , high colon mobility, etc.) or the presence of an organic obstacle in the intestinal wall, tumors (often a polyp on the leg), a foreign body. At the same time, the contracted section of the intestine together with its mesentery along the longitudinal axis is pulled into the distal section of the intestine with a normal lumen. It forms the inner cylinder of the invaginate. Edema develops here, circulatory disorders and necrosis gradually occur [5] .
Such diseases and pathological conditions as intestinal allergy, cystic fibrosis, various nervous and humoral regulation disorders, enteroptosis, peritoneal and intestinal tuberculosis, viral intestinal infections, complications after surgical interventions on the organs of the gastrointestinal tract [6] increase the risk of intussusception.
When invagination distinguish the outer tube (vagina) and internal (invaginate). The initial section of the invasive colon is called the invaginate head.
Changes in diet , introduction of complementary foods , etc. may also lead to uncoordinated contraction of muscle layers. [4]
Preferred localization
Depending on the location, there are types of intestinal invagination:
- small bowel
- fine colic
- small-celiac disease (ileocecal)
- colonic
- thin-thick and small
Invagination in the area of the ileocecal angle (more than 95%) is most often observed.
Clinical picture
Invagination is more common in infants (between 4 and 10 months of age) who are well-fed. The disease begins suddenly. The child becomes restless, cries, writhes, presses legs. The attack ends as suddenly as it begins. The child calms down, even plays, but after a while the attacks of pain recur. Attacks of pain correspond to the waves of intestinal peristalsis , which move the invaginated part of the intestine forward. Attacks of pain occur in 90% of cases. Soon after the first bouts of pain, one or two vomiting occurs, which also occurs periodically. At the onset of the disease, vomiting is reflex in nature, and then the lumen of the invaginated intestine becomes obstructed. Body temperature, as a rule, remains normal. Initially, a child has a normal stool 1-2 times, but later, after 6-10 hours, blood in the stools appears impurities and they acquire the characteristic “raspberry jelly” appearance. Later, the excretion of feces and gases stops. As a result of compression of the invaded section of the intestine and the corresponding area of the mesentery , pronounced circulatory disorders occur in them. Inflammation leads to the adhesion of the cylinders, which prevents the expansion of invagination. With careful palpation in the intervals between attacks, the abdomen is soft, not swollen. During an attack, the child reflexively strains the abdominal muscles and the abdomen cannot be carefully examined. It is often possible to palpate the invaginated section of the intestine, the tumor-like formation of a soft-elastic consistency, of the sausage shape, painful on palpation. The tumor changes its shape and location depending on the timing of the disease and intestinal motility. The literature describes cases when invaginate, after passing through the colon, falls out of the anus , and it is taken for the rectum that fell out. The severity of the condition of a child with invagination of the intestine can be judged by the pronounced symptoms of intoxication . In cases of late diagnosis, the clinic of peritonitis develops, the abdomen becomes swollen, tense, sharply painful during palpation in all departments. Examination of the child ends research through the rectum. In some cases, bimanually, it is possible to feel the tumor . After removing the finger from the anus, mucus is secreted from the blood, without any admixture of feces .
Treatment
Depending on the cause of the invagination (which, as a rule, varies significantly for different age groups), its treatment may be conservative or operative. In infants, invagination in most cases is resolved by conservative measures. At present, a conservative method of treatment of intestinal invagination is being used - forcing air into the large intestine through the gas outlet by means of a gauge pear. This method is effective for thin-colonic invaginations on up to 18 hours. Small-intestinal invagination, as a rule, cannot be straightened in this way. The inclusion of laparoscopy in the complex of therapeutic and diagnostic measures for intestinal invagination can significantly increase the percentage of patients cured conservatively. The purpose of laparoscopy is visual control over the expansion of invaginate and the assessment of intestinal activity . The indications for this method are:
- ineffectiveness of conservative treatment in the early stages of the disease
- attempt to conservative expansion of invaginate with late admission (excluding complicated forms of the disease)
- clarification of the causes of invagination in children older than 1 year
Surgical treatment consists of laparotomy and manual disinvagination, which is performed not by extruding the implanted intestine, but by the method of careful “extrusion” of the invaginate captured by the whole hand or two fingers.
If disinvagination was not possible or necrosis of the intestinal section is detected, resection is performed within healthy tissues with anastomosis overlapping [4] .
Invagination of the intestines in animals
Different types of animals are affected by this disease. Mostly it occurs in ruminants and carnivores. Distinguish descending (implantation of the forward intestinal loop into the posterior) and ascending. Intestinal segments of various lengths are inserted with a hanging mesentery. In case of anterior invagination, complete obstruction can lead to death for 2–3 days. Invagination of the ileum in the blind in a horse lasts from two or more weeks. Partial obstruction with posterior invagination is delayed for a month or more. Necrosis of the invaginated area, its release and spontaneous healing of the animal is rarely observed. Forecast cautious [7] .
Sources of information
- ↑ Disease Ontology release 2019-05-13 - 2019-05-13 - 2019.
- ↑ Monarch Disease Ontology release 2018-06-29sonu - 2018-06-29 - 2018.
- ↑ Archived copy (inaccessible link) . The date of circulation is February 4, 2007. Archived on September 27, 2007. The article "Invagination of the intestines" in the Minor Medical Encyclopedia.
- ↑ 1 2 3 Isakov Yu. F. Surgical diseases in children. - M.: "Medicine" .- 1998. — P.192-197.
- ↑ Archived copy (inaccessible link) . The appeal date is February 4, 2007. Archived July 6, 2007. The article "Intestinal Obstruction" in the Minor Medical Encyclopedia.
- ↑ Intestinal intussusception in children: causes, symptoms, treatment, consequences (rus.) , OkayDoc (August 12, 2017). The appeal date is August 17, 2017.
- ↑ V.S.Ershov et al. Parasitology and Invasive Diseases of Farm Animals. - M. , 1959. - 492 p.