intussusception
Introduction
Introduction Intussusception refers to the insertion of a segment of the intestine into the lumen of the intestine and causes the contents of the intestine to pass through the barrier. Often the nesting accounts for 15% to 20% of intestinal obstruction. There are two types of primary and secondary. Primary intussusception occurs mostly in infants and young children, and secondary intussusception is more common in adults. The vast majority of intussusception is the insertion of the proximal intestine into the distal intestine. The reverse intussusception is rare, less than 10% of the total number of cases.
Cause
Cause
1. Dietary changes: 4 to 10 months after birth, it is the period of adding complementary food and increasing milk volume, and it is also the peak period of intussusception. Because the baby's intestines can not immediately adapt to the stimulation of the altered food, leading to intestinal dysfunction, causing intussusception.
2. Anatomical factors of ileocecal: In babies, the ileocecal part is large, the ileocecal valve is hypertrophic, the small mesentery is relatively long, the neonatal ileum cecum diameter ratio is 1:1.43, and the adult is 1:2.5, suggesting the ileum The rate of development of the cecum is different. 90% of the ileum of the baby protrudes into the cecum with a lip-like shape, which is more than 1cm long. In addition, the lymphatic tissue in this area is rich, and it is easy to cause congestion, edema and hypertrophy after being stimulated by inflammation or food. The intestinal peristalsis tends to move the ileocecal valve forward. And pull the intestine to form a nest.
3. Viral infection: A series of studies reported that acute intussusception is associated with adenovirus and rotavirus infection in the intestine.
4. Intestinal fistula and autonomic dysfunction: Due to various foods, inflammation, diarrhea, bacterial toxins, etc., it stimulates the intestinal tract to produce sputum, which causes the intestinal peristaltic function to be disordered or reversed to cause intussusception. It has also been suggested that due to sympathetic developmental delay in infants and young children, the autonomic nervous system is dysfunctional and causes intussusception.
5. Genetic factors: Clinically, some patients with intussusception have a family history.
Examine
an examination
X-ray examination of the air or barium enema showed that the air or tincture was blocked at the nesting, and the barrier agent was "cup-shaped" or even "spring"-like.
Diagnosis
Differential diagnosis
Pediatric intussusception should be differentiated from many other gastrointestinal diseases.
(1) Bacterial dysentery
Also more common in infants and young children, acute onset, paroxysmal abdominal pain, bloody stools, etc., may be confused with intussusception. However, the number of bowel movements is high, and it contains a lot of mucus and pus and blood. It is heavy and heavy, and there is fever in the early stage. The abdominal pain is not as strong and regular as the intussusception, and the abdomen can not touch the mass. Fecal examination showed a large number of pus cells, and the growth of dysentery bacilli was cultured. There is often no difficulty in identification, but it is worth noting that on the basis of bacterial dysentery, intussusception can also occur due to intestinal peristalsis disorder.
(two) acute necrotic enteritis
It can be expressed as abdominal pain, vomiting and bloody stools, but the disease has a history of diarrhea. It can be manifested as bloating, high fever and frequent vomiting in the early stage. The stool is frequent, and it is washed with water. It has a large amount of odor and has a worsening general condition. Fast, often showing severe dehydration, skin patterns and other shock symptoms.
(3) Aphid intestinal obstruction
More common in older children, may have paroxysmal abdominal pain, vomiting, in the abdomen can touch the mites group, quite like a sausage-like mass, but its surface is often strip-like, generally no bloody stool. The onset is not as fast as the intussusception, and there are many cases of mites or improper deworming.
(four) allergic purpura
More common in older children, most have a fresh hemorrhagic rash, accompanied by joint pain, sometimes accompanied by hematuria. Bloody stools are mostly dark red, and the abdomen cannot touch the mass. These symptoms help to identify with the intussusception. Sometimes the disease can be complicated with intussusception, which should be noticed. X-ray examination should be performed if necessary.
