Understanding Intestinal Invagination in Children
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ScribdTranslationsUnderstanding Intestinal Invagination in Children
Translated by
ScribdTranslationsIntestinal Invagination
Intestinal intussusception is the most common cause of intestinal obstruction in the
infants and young children.
It is an acquired invagination of the proximal portion of the intestine into the distal portion.
of the intestine.
Pathophysiology
The proximal portion is introduced into the distal portion by the activity
peristaltic.
Venous obstruction and edema of the intestinal wall occur.
as the mesentery of the proximal intestine is pulled towards the
distal portion.
If the invagination is not reduced: Ischemia and necrosis will be provoked.
the intestinal wall.
The natural evolution of an intestinal invagination towards ischemia and necrosis
intestinal.
Primary Intestinal Invagination
Primary Intestinal Invagination: These are the majority of cases.
especially nursing.
They do not have a guide point.
What is the cause? Hypertrophy of the Peyer's patches within the
intestinal wall, that is to say, hypertrophy of lymphatic tissue.
Hypertrophy of lymphatic tissue due to an upper respiratory tract infection
gastroenteritis.
The adenoviruses under 2 years old are also considered rotaviruses.
Initially, the vaccine against rotavirus was associated with an increase in intussusception.
Secondary Intestinal Invagination
The one that has an identifiable injury that serves as a guide point.
Guide point that draws the proximal portion of the intestine towards the distal portion.
The incidence of the guide point varies between 1.5% and 12%.
The presence of the guiding point increases in proportion to age.
The most common guiding point is a Meckel's diverticulum.
Followed by polyps and duplications.
Malignant causes (Uncommon) are lymphomas and tumors
of the small intestine.
Diseases related to conditions such as purpura, cystic fibrosis, celiac disease and
colitis due to Clostridium.
Incidence
Primary intestinal invagination can occur at any age.
Population: Most are healthy and well-nourished children, 2/3 are boys.
The highest incidence occurs in infants from 4 to 9 months.
- Es poco frecuentedebajo de los 3 meses y por encima de los 3 años.
Clinical Presentation
The classic presentation consists of a triad: Infant or Small Child with pain
intermittent abdominal - colic + 'currant jelly' stools and mass
palpable.
Sudden abdominal pain can become rigid.
The crisis usually stops as quickly as it started.
Amid the crises, the child may seem comfortable, but over time it
becomes lethargic.
Stools of 'Grosella Gelatin': Stained with blood due to ischemia.
It is a late sign.
It is a mistake to expect that type of feces, leukocytosis, and electrolyte abnormalities.
Physical Examination
Vital signs are usually normal at the beginning of the
intestinal invagination.
The crises (Pain episodes) usually occur every 15 - 30 minutes.
Dough: In the form of sausage or curve.
Sign of the dance: Right Lower Abdominal Quadrant flat or empty because of the mass
adopts a cephalic position.
If intestinal ischemia occurs, the patient will be dehydrated, febrile, tachycardic and
hypotensive
It is a serious sign the prolapse of the invaginated intestine through the anus.
What is the greatest danger? Confusing it with a rectal prolapse and
try to reduce it.
An exploration with a tongue depressor through the anus next to the mass:
If more than 1 - 2 cm can be inserted into the anus, invagination should be considere
Intestinal.
Abdominal X-ray
Simple X-rays have limited value for the
Better to use for stratifying risk.
Indicative radiographic anomalies:
Abdominal mass.
Anomalous distribution of gases and feces.
Dispersion of gases and hydroaeric levels.
Ultrasound
Ultrasound has been adopted as a low-cost tool,
no radiation and ability to identify the guide points.
The characteristic finding is a target or doughnut lesion: It is the
intestinal wall and mesenteric fat in the invagination.
The sign of the pseudo-kidney through the edematous walls of the intestine
inside the invagination.
CT and MRI
Neither the CT nor the MRI are used to evaluate a patient with intussusception.
They can confirm the diagnosis or the pathological causes.
In the CT scan, it appears as a sign on a target or donut.
Medical Treatment
In case of suspected intestinal invagination, it will be useful:
Nasogastric tube to decompress the stomach.
Intestinal rest: IV fluid administration.
Obtain a complete blood count and serum electrolytes.
Antibiotics? Not usually necessary.
An air or contrast enema is first line if there are no contraindications for it.
medical reduction
The contraindications are intestinal perforation (Pneumoperitoneum), peritonitis
persistent hypotension.
Medical reduction can be hydrostatic or pneumatic.
Hydrostatic reduction with bariobajo under radioscopic guidance, nowadays
with isotonic contrast.
A successful reduction of 85% is observed.
Advantages of pneumatic reduction? Faster, less
ionization, safer.
The possible complication is a tension pneumoperitoneum.
In the case of a tense pneumoperitoneum, intervention is performed and it
decompress with needle, later go to surgery.
After an unsuccessful reduction, a second attempt is made with laparoscopy.
Premedication with Midazolam increases successful reduction.
Abdominal pain after reduction: Sign of ischemic bowel or intussusception
Recurrent! Repeat the ultrasound!
Surgical Treatment
Surgery will be needed in the case of unsuccessful or incomplete medical reduction due to:
Signs of Peritonitis, Presence of guide point or Pneumoperitoneum on the X-ray.
The preoperative preparation includes: Broad-spectrum antibiotics, IV fluids,
urinary catheter and nasogastric tube for gastric decompression.
Laparoscopic Approach
Laparoscopic approach has become the surgery
election initial.
Advantages: Improvement of postoperative pain, shorter time
for feeding and hospitalization duration.
-30% Conversion rate to open approach.
Contraindications of Laparoscopy: Instability
hemodynamics, peritonitis, pneumoperitoneum sign, and intestinal distension.
Risk factors for becoming open approach are invagination beyond the
ascending colon and known pathological guide points.
The appendectomy will be performed if it is the guiding point.
Open Approach
The most common thing is that the cecum and terminal ileum are
affected.
The ischemic intestine can be heated with compresses.
with saline solution and reevaluate.
An accidental appendectomy is usually performed because the
the location of the scar is similar to that of an appendectomy
open.
Recurrent Intestinal Invagination
Recurrent intestinal invagination associated with medical intervention in 10% of the
cases.
- 1/3 se producen dentro de las 24 horas.
Most within 6 months following the initial episode.
They will consult first because the parents will recognize signs and symptoms.
The medical approach as initial treatment in most patients.
What is the great fear of recurrence? A hidden malignant neoplasm.
Postoperative Intestinal Invagination
It is an uncommon entity: 3% - 10% of cases of post intestinal obstruction
operations.
It occurs more frequently in the first 10 days after the intervention.
Most postoperative invaginations are ileal and respond to reduction.
surgical without resection.