[Editor’s article/Lin Yiping, pictures/provided by Baby and Mother Magazine]
One minute the baby is restless and crying, and the next minute he is playing normally? Be careful, if your baby is having a tantrum or acting coquettishly, he may be in pain and cannot tell! It may be “intussusception”, an abdominal emergency that requires immediate treatment in pediatrics, with initial abdominal pain!
A 1-year-old baby boy suddenly became restless before going to bed. The child could not fall asleep or be comforted, so the anxious mother brought the baby boy to the emergency room for help. The child did not have a fever, nor did he have any respiratory or gastrointestinal symptoms. His mental state was also very good during the consultation, but he did cry intermittently. After detailed questioning by the pediatric emergency physician and physical examination, it was discovered that both the baby boy and his brother had a history of adenovirus infection in the past week.
In order to rule out the possibility of an abdominal emergency, the careful doctor immediately performed an abdominal ultrasound. Sure enough, the ultrasound image showed an intestinal entrapment in the child’s right upper quadrant, and he was accurately diagnosed as “intussusception”, a common abdominal emergency in infants and young children. Then, under the arrangement of the doctor, the baby boy underwent air-guided intussusception reduction a few hours later. The process went smoothly and the reduction was successful. Not only did the symptoms resolve smoothly, but the possibility of subsequent intestinal perforation and peritonitis was also avoided.
Intussusception is common in children under 2 years old and is an abdominal emergency that requires immediate treatment in pediatrics
Zhang Yurui, the attending pediatrician at the Zhongxiao Campus of Taipei City United Hospital, said that from the above cases, it can be seen that it is a very typical process of intussusception in infants and young children.
What is intussusception? It refers to two similar sections of small intestine or large intestine in the body. Due to reasons such as lymph node enlargement, tumor, Meckel’s diverticulum (distal ileum diverticulum) or large intestinal polyps, the two sections of intestine are unable to move normally when they are put together, and thus Cause intermittent abdominal pain in patients. The most common location is at the proximal end of the ileocecal valve. In the vernacular, it means “the small intestine slips into the large intestine.”
The incidence rate of boys to girls is about 3:1. It usually occurs between 6 months and 3 years old, and 80% occurs within 2 years old. It most commonly occurs in babies aged 5 to 9 months, but it also occurs in older children and teenagers. It can still happen.
When the intestines are trapped for too long and are not treated immediately, the intestines may rupture and lead to peritonitis. Therefore, “intussusception” is an abdominal emergency that requires immediate treatment in pediatrics.
Causes of intussusception
75% of cases of “intussusception” are primary, and about 5% of cases are caused by anatomical abnormalities, such as tumors, Menkel diverticula, or colorectal polyps.
30% of patients may have had previous viral infection of the upper respiratory tract, otitis media, or intestinal tract. The viral infection is related to lymph node hyperplasia in the intestinal wall. Among them, cases of respiratory adenovirus (type C) are most commonly reported.
Therefore, if children older than 2 years old develop intussusception, structural abnormalities should be considered. If children older than 5 years old have intussusception, lymphoma is a common factor.
One second I’m holding my belly and crying, and the next second I’m playing normally? Beware of the onset of “intussusception”!
Clinically, intussusception usually presents with intermittent severe abdominal pain, accompanied by vomiting, restlessness, straining to bend the legs, and loud crying. Sometimes vomiting and bloody stools may also occur. After the labor pain, the patient will appear tired and pale, and the stool may appear to be mucus-like mucus similar to strawberry jam (current jelly stool). Sometimes, a sausage-shaped lump can be felt in the abdomen. However, when the patient presents with abdominal stiffness, bloating, fever, etc., the intestinal tract may have necrosis and strangulation.
It is worth noting that the initial manifestation of abdominal pain in intussusception is very “dramatic”. One minute the infant may be restless and crying, and the next minute he or she will be playing normally. In addition, children under two years old cannot express themselves clearly. Because of their own discomfort, the patients are often mistaken by their parents for throwing tantrums or acting coquettishly when intussusception occurs.
Dr. Zhang Yurui also reminds parents that for children who have already suffered from gastroenteritis, it will be particularly difficult to diagnose intussusception, because acute gastroenteritis can also cause intermittent abdominal pain or vomiting. When acute gastroenteritis cannot be distinguished from intussusception, further imaging examinations are necessary, and ultrasound is the preferred method for detecting intussusception. If you see “concentric circles” or “doughnuts” in the ultrasound, it means that the intestinal layers in the intestines have become encased and the mucosa has overlapped.
Prioritize non-surgical treatment for intussusception reduction
How to deal with intussusception after diagnosis? Under normal circumstances, priority is given to “non-surgical” intussusception reduction: under the guidance of ultrasound or X-ray, try to inject air, barium or saline from the patient’s anus, and use the pressure created by the instilled object to seal the intussusception. The intestines are stretched to achieve the goal of intussusception reduction, and the success rate is about 80-95%. However, please note that although “non-surgical” intussusception reduction is convenient and generally safe, about 10% of intussusception patients will still experience recurrence, and most recurrences occur within 72 hours after reduction.
If intussusception recurs repeatedly, it is suspected that the patient has an abnormality in the intestinal structure (such as tumors, Menkel diverticula, or colorectal polyps). At this time, further examinations and even “surgery” should be considered to reduce the intussusception. In addition, if intussusception is diagnosed too late and the patient has developed suspected intestinal necrosis or perforation, peritonitis and other complications, “surgery” is also directly considered.
＊For the complete article content, please refer to:[Baby and Mother]December 2023 issue.
＊More real-time parenting information:【Baby and Mother】Official website
2023-12-25 07:27:02
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