Recognizing signs of intussusception in children
Intussusception is a common surgical emergency in young children, due to a segment of the intestine entering the lumen of the adjacent segment. Parents need to pay attention to the signs of intussusception in their child to get to the hospital in time. If you are admitted to the hospital early, the doctor will remove the baby’s cage with air without surgery.
1. What is intussusception?
Intussusception is a common surgical abdominal emergency when a segment of the intestine turns and enters the lumen of the adjacent bowel, causing mechanical intestinal obstruction. The intussusception block prevents food and fluid from moving downward, and the intestinal wall presses against each other, causing edema, inflammation, and reduced blood supply to the intussusception. As a result, the intestines become infected, necrotic, and perforated.
The cause of intussusception in children is unknown, but some experts believe that intussusception may be related to:
- Bacteria or viruses that cause respiratory infections, gastrointestinal infections;
- The imbalance between the ileal size compared to the ileocecal valve;
- Mesenteric lymphadenitis;
- After an episode of acute gastroenteritis;
- Physical injuries.
Intussusception can occur at any age, but it is most common in children under 2 years of age (accounting for 80% of cases), most of which are children from 4 to 9 months old, and rarely in older children. The disease is mostly seen in healthy, chubby children, boys more than girls with a ratio of about 2:1.
Clinically, this condition develops differently in the two age groups, specifically:
- Children < 24 months: Acute manifestations, rapid progression, severe prognosis hour by hour;
- Older children: The manifestations are less aggressive, the pain is dull, sometimes acute, but the course is not as rapid and severe as in the nursing infant.
If the patient is brought to the hospital early, the doctor only needs to perform the procedure of air intubation (success rate is more than 90% and recurrence after nonsurgical intubation is 8-12%). If the child is late or fails to remove the air cage, the doctor will choose the appropriate surgical method based on the situation (relapse rate is 0 – 3%). Children are at risk of dying after intubation if they develop pneumonia and febrile convulsions, but the number of complications has now decreased significantly.
2. Signs of intussusception in children
2.1. Abdominal pain
Abdominal pain is the earliest and most prominent symptom, present in 75% of children with intussusception. The characteristics of acute abdominal pain due to intussusception are as follows:
- Children cry out in bursts, when the pain subsides, they will stop crying temporarily;
- Sudden, severe abdominal pain;
- Children hunched over, twisted, bent their knees toward their chest, or kicked wildly;
- Having to wake up at night, forced to stop all activities during the day;
- Children quit playing, quit breastfeeding;
- Each pain lasts 5 – 15 minutes, appears and disappears suddenly;
- Symptoms may repeat immediately, and the interval between attacks becomes shorter and shorter;
- Children become weaker and weaker.
- Children cry
- Child has abdominal pain
2.2. Vomit
65% of children with intussusception will vomit at the first pain. The patient initially vomits food, then vomits green or yellow fluid.
2.3. Bloody mucus in the stool
Blood in the stool accounts for 95% of cases of intussusception while nursing. This sign may appear at the first pain if the intussusception is tight, difficult to remove, or appears late after 24 hours. Most of the time when patients defecate, they will find:
- Fresh blood and mucus;
- Red or brown blood;
- Sometimes there is a few drops of fresh blood coming out of the anus or the diaper.
However, there are also cases where blood mucus can only be detected under gloves when the doctor examines the rectum.
2.4. Constipation or diarrhea
This is a sign that easily leads to misdiagnosis because there are 3 cases as follows:
- If the intussusception causes complete obstruction: The patient will have a bowel obstruction – constipation (constipation);
- If the bowel is not completely blocked: The patient can still defecate normally;
- In addition, there are still some children who develop diarrhea after intussusception.
- Constipation in babies
- Constipation may occur when intussusception occurs
3. Diagnosis
3.1. Physical symptoms
When taking the child to the hospital, the doctor will conduct a clinical examination of the abdomen to diagnose the child with intussusception. Physical symptoms include:
- 85 – 95% of cases will be palpable horizontal mass above the umbilicus, long, mobile, firm, smooth surface, and painful when pressed;
- The case of no palpable intussusception is due to deep-lying below the right costal margin, intussusception to the angle of the liver, or late bowel obstruction causing abdominal distension;
- The pothole must be empty
- Rectal examination showed bloody mucus under the gloves due to intestinal bleeding
- The tip of the intussusception is sometimes palpable on rectal examination if the intussusception is low.
3.2. Systemic symptoms
The systemic manifestations of children with intussusception in the early stage are often less changed, in the late stage, patients often:
- Tired, weak;
- Less activity;
- Loss of water and electrolytes
- Infection – poisoning
- High body temperature
- Fever may occur
- Some children fall into a state of shock, lethargy, and lethargy.
- After 48 hours, symptoms of mechanical intestinal obstruction may appear.
3.3. Subclinical
- Abdominal X-ray (Contraindications: Late-onset bowel obstruction ≥ 48 hours, peritonitis or intestinal perforation);
- General abdominal ultrasound: A reliable and accurate method to diagnose intussusception, the longitudinal section shows the sandwich-shaped cage, the cross-section shows the donut shape or the target;
- Color Doppler ultrasound: Used to predict and indicate surgery or intussusception, based on the blood flow in the intussusception;
- Computed tomography: in cases where ultrasound cannot accurately examine the intussusception.
3.4. Implementing the quadrants
In case the child comes to the hospital early, the doctor can confirm the diagnosis if the following signs of intussusception appear simultaneously:
- Intermittent severe abdominal pain and palpable intussusception;
- Severe intermittent abdominal pain, with vomiting and blood on rectal examination;
- Severe intermittent abdominal pain, and specific radiographic (or ultrasound) findings.
On the contrary, if it is late, children with intussusception will be diagnosed when there are symptoms of intestinal obstruction or peritonitis, accompanied by anal mucus bleeding.
3.5. Differential diagnosis
In addition to intussusception, other conditions often appear in children with similar symptoms, so the differential diagnosis should be noted as follows:
- Blood in the stool: dysentery syndrome, polyps of the colon-rectum and small intestine, hemorrhoids, rectal prolapse, hemorrhagic colitis – rectal inflammation, necrotizing enterocolitis;
- Vomiting: Inflammation of the meninges, pharynx, or bronchi;
- Palpable abdominal mass: Intestinal obstruction due to worms; food residue…
- Severe abdominal pain: Acute appendicitis, acute gastritis,…
Intussusception after removal is still likely to recur within hours or days. Therefore, parents need to detect early symptoms to bring their children back to the hospital in time. When a child shows signs of intussusception such as sudden abdominal pain, twisting, crying, vomiting food, etc., it is necessary to take him to the doctor immediately.
In addition, it is recommended to keep the child’s body warm to limit respiratory infections in the cold season, and to eat hygienically to prevent mesenteric lymphadenitis leading to intussusception.
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