Intussusception

Intussusception

overview

Intussusception

Intussusception

Intussusception is a rare, serious condition in which part of the intestine slips into an adjacent part.

Intussusception (in-tuh-suh-SEP-shun) is a serious condition in which part of the intestine slips into an adjacent part of the intestine. This telescopic action often blocks the passage of food or liquid. Intussusception also cuts off the blood supply to the affected portion of the intestine. This can lead to a tear in the intestine (perforation), infection, and death of intestinal tissue.

Intussusception is the most common cause of intestinal obstruction in children under 3 years of age. The cause of most cases of intussusception in children is unknown. Although intussusception in adults is rare, most cases of intussusception in adults are the result of an underlying medical condition, such as: B. a tumor.

In children, the intestines can usually be brought back into position with a small procedure. In adults, surgery is often required to correct the problem.

Symptoms

Children

The first sign of intussusception in an otherwise healthy infant may be sudden, loud crying caused by abdominal pain. Infants with stomach pain may pull their knees to their chest when crying.

The pain of intussusception comes and goes, usually every 15 to 20 minutes at first. These painful episodes last longer and become more frequent over time.

Other common signs and symptoms of intussusception include:

• Mit Blut und Schleim vermischter Stuhl – wegen seines Aussehens manchmal als Johannisbeergelee-Stuhl bezeichnet
• Erbrechen
• Ein Knoten im Bauch
• Schwäche oder Mangel an Energie
• Durchfall

Not everyone has all the symptoms. Some infants have no obvious pain, and some children do not lose blood or have a lump in their abdomen. Some older children have pain but no other symptoms.

Adult

Because intussusception is rare in adults and the symptoms of the condition often overlap with symptoms of other conditions, it is more difficult to identify. The most common symptom is abdominal pain that comes and goes. Nausea and vomiting may also occur. People sometimes experience symptoms for weeks before seeking medical attention.

When to go to the doctor?

An intussusception requires emergency medical care. If you or your child develops any of the signs or symptoms listed above, seek medical attention immediately.

For infants, remember that signs of abdominal pain may include recurrent attacks of pulling knees to chest and crying.

Causes

Your intestines are shaped like a long tube. Intussusception is when a part of your intestine—usually the small intestine—slides into an adjacent part. This is sometimes called telescoping because it is similar to how a collapsible telescope is pushed together.

In some cases in adults, telescoping is caused by an abnormal growth in the intestine, such as: B. a polyp or a tumor (so-called lead point). The normal wave-like contractions of the intestine grab this guide point and pull it and the intestinal lining in front of it into the intestine. In most cases, however, no cause for intussusception can be identified.

Children

In the vast majority of cases of intussusception in children, the cause is unknown. Because intussusception seems to be more common in the fall and winter, and many children with the problem also have flu-like symptoms, some suspect that a virus may play a role in the condition. Sometimes a lead point can be identified as the cause of the condition - most commonly the lead point is a pouch in the lining of the small intestine (Meckel's diverticulum).

Adult

In adults, intussusception is usually the result of a medical condition or procedure, including:

• Ein Polyp oder Tumor
• Narbenartiges Gewebe im Darm (Verwachsungen)
• Operationen zur Gewichtsreduktion (Magenbypass) oder andere Operationen am Darmtrakt
• Entzündungen aufgrund von Krankheiten wie Morbus Crohn

Risk factors

Risk factors for intussusception include:

• Das Alter. Kinder – insbesondere Kleinkinder – entwickeln viel häufiger eine Invagination als Erwachsene. Es ist die häufigste Ursache für Darmverschluss bei Kindern im Alter zwischen 6 Monaten und 3 Jahren.
• Sex. Die Invagination betrifft häufiger Jungen.
• Abnorme Darmbildung bei der Geburt. Darmfehlrotation ist ein Zustand, bei dem sich der Darm nicht richtig entwickelt oder dreht und das Risiko einer Invagination erhöht.
• Gewisse Bedingungen. Einige Erkrankungen – wie Mukoviszidose, Purpura Schönlein-Henoch (auch bekannt als IgA-Vaskulitis), Morbus Crohn und Zöliakie – können das Risiko einer Invagination erhöhen.

Complications

Intussusception can interrupt the blood supply to the affected section of the intestine. If left untreated, blood deficiency leads to the death of intestinal wall tissue. Tissue death can lead to a tear (perforation) in the intestinal wall, which can cause infection of the lining of the abdominal cavity (peritonitis).

Peritonitis is a life-threatening condition that requires immediate medical attention. Signs and symptoms of peritonitis include:

• Bauchschmerzen
• Abdominale Schwellung
• Fieber
• Erbrechen

Peritonitis can cause your child to go into shock. Signs and symptoms of shock include:

• Kühle, klamme Haut, die blass oder grau sein kann
• Ein schwacher und schneller Puls
• Abnormale Atmung, die entweder langsam und flach oder sehr schnell sein kann
• Angst oder Aufregung
• Tiefe Lustlosigkeit

A child who is in shock may be conscious or unconscious. If you suspect your child is in shock, seek emergency medical attention immediately.

Sources:

1. Feldman M. et al., Hrsg. Darmverschluss. In: Gastrointestinale und Lebererkrankungen von Sleisenger und Fordtran: Pathophysiologie, Diagnose, Management. 11. Aufl. Elsevier; 2021. https://www.clinicalkey.com. Abgerufen am 7. Dezember 2020.
2. Goldman L. et al., Hrsg. Entzündliche und anatomische Erkrankungen des Darms, des Bauchfells, des Mesenteriums und des Omentums. In: Goldman-Cecil Medicine. 26. Aufl. Elsevier; 2020. https://www.clinicalkey.com. Abgerufen am 4. Dezember 2020.
3. Invagination. Nationales Institut für Diabetes und Verdauungs- und Nierenerkrankungen. https://www.niddk.nih.gov/health-information/digestive-diseases/anatomic-problems-lower-gi-tract/intussusception. Abgerufen am 7. Dezember 2020.
4. Invagination. Merck Manual Professional-Version. https://www.merckmanuals.com/professional/pediatrics/gastrointestinal-disorders-in-neonates-and-infants/intussusception. Abgerufen am 7. Dezember 2020.
5. Invagination. Fragen Sie MayoExpert. Mayo-Klinik; 2019.
6. Schock. Amerikanisches College für Notärzte. https://www.emergencyphysicians.org/article/know-when-to-go/shock. Abgerufen am 8. Dezember 2020.
7. Bennett JE, et al. Peritonitis und intraperitoneale Abszesse. In: Prinzipien und Praxis von Infektionskrankheiten von Mandell, Douglas und Bennett. 9. Aufl. Elsevier; 2020. https://www.clinicalkey.com. Abgerufen am 8. Dezember 2020.
8. Kliegman RM, et al. Ileus, Adhäsionen, Invagination und Closed-Loop-Obstruktionen. In: Nelson Lehrbuch der Kinderheilkunde. 21. Aufl. Elsevier; 2020. https://www.clinicalkey.com. Abgerufen am 10. Dezember 2020.
9. Picco MF (Gutachten). Mayo-Klinik. 13. Dezember 2020.