As the name suggests, intussusception or intestinal obstruction in young children is a very acute disease of the intestines in infancy, which can result in a life-threatening intestinal obstruction. Suspected intussusception is usually a medical emergency situation.
What is invagination?
An intussusception is initially manifested by strong, colicky stomach cramps, which usually occur suddenly. Affected children are in severe pain and express this by crying, screaming and the typical relieving posture with drawn-up legs. See wholevehicles for What are the Meanings of BTD.
The doctor understands an invagination as the invagination of parts of the intestine into other sections of the intestine. As a result of this invagination, the intestinal wall is no longer supplied with sufficient blood, the vessels in the intestinal wall are pinched off and parts of the intestine can die off. There may be an intestinal obstruction.
Intussusception can occur in all areas of the intestine, the occlusion is usually found at the transition from the small to the large intestine. Babies and small children up to the age of two are mostly affected. If intussusception occurs in older children or adults, the causes are different than in smaller children.
Causes
The causes of an invagination have not been fully clarified to this day. Doctors suspect intestinal motor disorders (peristalsis). In younger patients, doctors have noticed that peristalsis is too violent and uncontrolled. In older children or adults, a tumour, inflammation or bleeding usually triggers disturbances in peristalsis and thus intussusception.
Mechanical stimuli in the intestine can also be considered as a cause. These include, for example, worms, hardened remains of faeces, gallstones, tumors or swallowed foreign bodies.
Invaginations and entanglements, such as volvulus (intestinal entanglement), intestinal polyps or diverticula in the intestine (diverticulosis) are also known to be causes.
Finally, invagination can also occur as a result of complications after surgery or abdominal wall hernias.
Symptoms, Ailments & Signs
An intussusception is initially manifested by strong, colicky stomach cramps, which usually occur suddenly. Affected children are in severe pain and express this by crying, screaming and the typical relieving posture with drawn-up legs. Usually there are also gastrointestinal problems, such as vomiting and nausea.
First the contents of the stomach 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 a panic attack can occur. The pain attacks occur in labor-like phases that vary greatly in intensity.
The symptoms can subside completely, only to reappear after a few minutes or hours. In severe cases, shock can occur. The bowel movement is normal at the beginning and takes on a jelly-like consistency over time. The stool is often bloody or slimy and can smell bad.
If there is an intestinal obstruction, this can be recognized by a bloated abdomen. Fever symptoms also set in relatively quickly. Then there is a high temperature, chills and a strong feeling of illness. Due to the severity of the symptoms, an ambulance must be called immediately if an intussusception occurs.
Diagnosis & History
At the beginning of the diagnosis there is of course the questioning of the patient or the parents (since the patients are usually very young). An important indication for the diagnosis is the course of the abdominal pain. Quite typical are very painful and pain-free phases. During palpation, the doctor can feel roller-like hardening in the lower abdomen. The doctor can also often feel the invaginated piece of intestine. The typical pain and the tactile findings confirm the finding of an intussusception. The suspicion is checked with an ultrasound examination.
In the phases characterized by pain, it is typical that the pain occurs very severely and suddenly. The children often writhe under the colic and first vomit up stomach contents, later also bile and then often also stool, since the intestinal contents can no longer take the normal path due to the invagination.
The children have pale skin and are anxious. Because of the severe pain, the little patient may also show signs of shock.
The intestinal loops are overinflated, the abdomen is distended, there are initially increased intestinal noises, but later these are absent. If the bowel is invaginated for a long time, raspberry jelly-like mucus comes out of the anus. Infants exhibit high-pitched cries and conspicuously draw their legs up. They usually cannot be calmed down and are pale greyish. The chance that an intussusception will resolve itself is there, but it is very small.
Complications
An intestinal obstruction in small children can be life-threatening and must therefore always be examined and treated by a doctor. In the worst case, without treatment, the patient dies. Those affected primarily suffer from very severe abdominal pain. These usually occur very suddenly and are extremely strong.
Sweating and vomiting also occur. Those affected appear very pale and exhausted. Striking and unusual noises also occur in the intestines. Unusual mucus, which differs from feces, can also continue to extrude from the anus. The everyday life of those affected is significantly restricted by the intestinal obstruction in small children. The severe pain can also lead to shock.
Treatment must be carried out immediately by a doctor. There are usually no complications and the symptoms can be resolved relatively quickly and effectively. Surgery may only be necessary in severe cases, in which part of the intestine is removed. However, the life expectancy of the patient is not reduced if the treatment is successful.
When should you go to the doctor?
If the child suffers from digestive problems, a doctor is needed. If severe abdominal pain or cramps in the upper body suddenly occur, medical examinations should be initiated. In case of vomiting, sweating and a pale appearance, a doctor’s visit is advisable. If the limbs are cold and pale and there is a cold sweat, the child has a medical condition that needs treatment. If unusual bowel sounds occur, constipation, a drop in performance or apathy of the child occurs, a doctor should be consulted. In the case of severe tiredness, refusal to eat, mucus secretion and feeling unwell, medical examinations are necessary to determine the cause.
If there is a fever, inner restlessness, sleep disorders, a feeling of illness and increased irritability, a doctor’s visit is required. Since intussusception can lead to a life-threatening condition, it is advisable to consult a doctor at the first symptoms. If the symptoms persist for several days, the state of health deteriorates immensely. In most cases, the existing symptoms spread within a few hours. Treatment must be given as soon as possible, as organ failure and death can occur without medical intervention. If the child loses consciousness, an emergency doctor must be contacted so that the child can be treated in intensive care.
Treatment & Therapy
If the invagination is still in the early stages, the doctor can first try to loosen the intestinal obstruction manually with a special massage. An enema can also help at this early stage. With the pressure of the enema liquid, the doctor tries to push the bowel back into the correct position. The enema is performed under ultrasound control so that the doctor can immediately check whether the intestine is free again.
If the doctor cannot solve the invagination with an external massage or an enema, an operation is necessary. Otherwise, the piece of intestine with poor or no blood supply dies off. The patient is in a life-threatening situation because bacteria can now get through the perforated intestine into the abdomen and cause peritonitis. This can lead to a life-threatening circulatory system and shock situation.
An operation is also necessary in any case if the invagination is very high in the intestine, i.e. in the small intestine area. The aim is to preserve the intestine completely. This can usually be done without any complications. In the case of very advanced intestinal invaginations, however, it can also happen that the doctor has to remove part of the intestine during the operation.
Outlook & Forecast
An invagination can have very different prognosis. This depends on the duration of the intestinal blockage, any damage to the tissue, the extent of any swelling and any damage caused by the treatment. In principle, however, the prognosis is good if the intestinal obstruction in small children is treated quickly.
If treated, however, there is a very high risk of intussusception recurring in around 5 to 15 percent of affected infants. Nevertheless, it should be mentioned that a quickly treated intestinal obstruction usually has no consequences. In very rare cases, however, conservative treatment can lead to intestinal perforation, which worsens the prognosis.
This is different with a persistent, untreated intestinal obstruction in small children. Intestinal tissue can die here or inflammation and further colic can occur. Again, the prognosis depends on the speed of treatment. If intestinal tissue has already died, an operation must be carried out, otherwise peritonitis will occur. In the worst case, this can lead to sepsis.
Basically, an intussusception can be life-threatening. Depending on the person and the damage, this becomes acute after hours or days. That is why it is so important to have an intestinal obstruction treated as quickly as possible so that the prognosis remains the best possible.
Prevention
An invagination should always be treated by a doctor as soon as possible, as earlier therapy greatly improves the chances of recovery. Early medical intervention also greatly reduces the risk of peritonitis. As a preventive measure, children should continue to be physically active, do sports and eat a high-fiber diet. In addition, attention should be paid to worms in the stool of children.
Aftercare
In most cases, the person affected with an intussusception has very few or even no special follow-up measures available. The disease must be recognized by a doctor at a very early stage, so that further deterioration of the symptoms can be prevented. Self-healing cannot occur in this case, and in the worst case the intussusception can lead to the death of the child.
Parents should take their child to see a doctor as soon as the first signs and symptoms of the disease appear. The treatment itself usually takes the form of a massage or an operation. The person concerned should definitely rest after such an operation and protect his body. Here, exertion or stressful activities should be avoided in order not to unnecessarily burden the body.
Regular checks and examinations by a doctor are often necessary even after a successful procedure in order to detect further inflammation or damage to the intestines at an early stage. The further course of invagination depends very much on the severity of the disease and also on the time of diagnosis, so that a general prediction cannot usually be made.
You can do that yourself
An invagination is a medical emergency for which there are no acute self-help options. In this case, however, parents can ensure that the child is adequately hydrated, for example by giving them tea or water. Otherwise there is a risk of dehydration. Painkillers should only be administered in consultation with a doctor. However, these measures in no way replace medical treatment. They only have a supportive and complementary effect.
The everyday life of the affected small children is significantly restricted by the pain during intussusception. If the illness lasts longer or occurs repeatedly, the affected child can also experience psychological problems, feelings of shame, anxiety, depressive moods and eating disorders. In such cases, parents should try to calm the child and take away any fears.
In the case of serious psychological problems, psychotherapeutic support should also be considered. Since intussusception can also lead to repeated relapses, it is also important to monitor the child’s condition after an illness and to prevent a new illness through nutrition and exercise.
