Intestinal knotting in infants and children is a rare health problem that causes severe abdominal pain. This condition, which is called in different ways such as intussusception, volvulus and intestinal obstruction, can bring serious complications as it prevents the progress of nutrients in the digestive system. The bending of the small or large intestine around itself, around each other or around the surrounding tissues holding the intestines, is the cause of most of these blockages. In intestinal obstruction, which may require surgery in some cases, prompt treatment is very important in order to prevent complications. For this reason, babies and children who show symptoms such as sudden onset abdominal pain and nausea should be taken to health institutions and examined.
What is Intestinal Knotting? It is a health problem also known as intestinal obstruction. This disease, which is more common especially in infants under the age of 1, occurs when a part of the intestine is compressed by entering another part, and as a result, a blockage develops in the region. While it is very rare in newborns and in the first four months of life, infants between 6-12 months constitute approximately 70% of cases of intestinal knots. However, the disease can also occur in adults. Tissue adhesions, especially in those who have undergone intra-abdominal surgery, may predispose to intestinal knotting. Under normal conditions, the intestines pass through each other continuously and come back out. If, for any reason, the intestine cannot come back from where it passed, knotting occurs and the nutrients in the digestive process begin to fail to pass. With prompt diagnosis and treatment, intestinal knotting in infants is usually successfully treated and intestinal health is not adversely affected. In case of delay in diagnosis and treatment, tissue death may occur in the intestinal tissues in the part where the obstruction is located, and the possibility of permanent damage to the intestine may come to the fore. What are the Symptoms of Intestinal Knot in Children?
Since it is a disease that can be seen in infancy, parents of babies who have abdominal pain problems are often asked questions such as how to understand intestinal knotting in babies and what are the symptoms of intestinal obstruction in babies. Among the symptoms of intestinal knotting in infants are the following:
- Loss of appetite
- Abdominal pains (colic-style pain) that comes in the form of intermittent cramps and causes the movement of pulling the feet to the abdomen in infants
- Constipation
- Vomiting
- Abdominal distention
- Decreased bowel movements
- Gas pain and difficulty passing gas
- Blood from the rectum (in the form of strawberry jelly)
What Causes Intestinal Knot in Babies?
Intestinal knotting is observed in infancy and most frequently between 6-10 months. Intestinal obstruction in infants of this month usually occurs when the last part of the small intestine is compressed into the first part of the large intestine. Diarrhea, due to increased bowel movements, is a risk factor for intestinal knotting. The small intestine, the last part of which is rich in lymph tissues, swells and thickens due to any infectious disease in infancy. This can lead to intestinal knotting by preventing the intestines from coming back from the area they pass through. In addition to these, chronic inflammatory diseases such as polyps in the intestine, cancers originating from the intestine, hernias, adhesions after surgery, diverticulitis and Crohn's disease can also cause intestinal knotting in infants.
How is the Treatment of Intestinal Knots in Children? With the help of an abdominal ultrasonography, it can be determined whether there is a blockage in the intestine or not. Treatment and follow-up procedures in intestinal intussusception are carried out by pediatric surgery units. Babies diagnosed with intestinal obstruction are hospitalized and usually started on antibiotic therapy. Necessary blood tests are performed while intravenous antibiotic treatment continues. Depending on the condition of the obstruction, the appropriate one among the surgical or non-surgical treatment options is preferred. Sigmoidoscopy, which is one of the non-surgical treatment options, is a treatment application that can be tried if the obstruction is in the sigmoid colon, which is the last part of the large intestine. For this procedure, a flexible tube (sigmoidoscope) is inserted from the rectum into the large intestine. Some air is pumped through the tube to open the colon.
The mentioned operation is usually sufficient to open the blockage. However, since there is a high probability of re-bending at the same point, surgery may be recommended by the physician. Another similar procedure is a colonoscopy. In this process, it can be tried to open the blockages in the beginning of the colon. Non-surgical reduction applications have some advantages such as not requiring anesthesia and risk of intra-abdominal adhesions. However, in most cases, surgery is needed as a full recovery cannot be achieved after the procedure. Non-surgical methods, known as air-contrast and liquid-contrast reduction, are highly likely to relapse, and most relapses occur within the first three days. The treatment plan that will follow the non-surgical treatments will be determined by looking at the health status of the patient and the severity of the obstruction. Surgery is planned for patients who cannot be treated with these procedures or who have recurrences. Intestinal Occlusion Surgery in Children
In case of intestinal knotting, the treatment goal is to remove the obstruction as soon as possible and restore the intestinal functions to a healthy state. is to ensure that it continues. For this reason, intestinal obstructions that cannot be treated with non-surgical applications such as air reduction should be treated by planning a surgical operation. In case of delayed diagnosis and treatment and advanced intestinal knotting, treatment should be performed with direct surgical intervention without trying other methods. Intestinal obstruction surgery in infants can be performed with open surgery or closed (laparoscopic) surgery methods. Which method will be preferred depends on the condition of the patient, the degree of obstruction and the complications that develop. In the operation, the problematic part of the intestine where the obstruction develops is removed and the two healthy ends of the intestine are brought together. The operation is performed under general anesthesia, accompanied by a pediatric anesthesiologist. In the closed operation, it is sufficient to make 0.5-1 cm incisions from several different regions of the abdomen and from a region close to the navel. The operation is performed with the help of special laparoscopy sticks inserted through other incisions, while the inside of the abdomen is viewed by placing a camera near the navel. In the open operation, a single and slightly larger incision is made and the operation is performed with traditional methods. In both operations, necessary interventions are made to eliminate intestinal intussusception. In cases of obstruction that cannot be resolved in a different way, the relevant part of the intestine is removed. Then the incisions are sutured and the operation is terminated. Although it varies according to the method of the surgery, patients who are kept under control in the hospital for one or a few days are discharged if deemed appropriate by the physician. apply to the health institution and have the necessary examinations and tests done. You can prevent the development of permanent health problems in your child by providing early diagnosis and treatment of intestinal knots.
What should we pay attention to after treatment?
It has been observed that 10% of patients have recurrence in the first 24 hours after treatment. watch should be followed closely.
He started feeding with your doctor's recommendation After the operation, a 3-week diet (away from fast food, chocolate, acidic drinks) with food groups that will not be heavy and foreign to the intestines (fiber foods, red meat and fish, whole grain foods, green leafy vegetables, red fruits) and foods that will strengthen immunity and vitamin groups should be supported. Care should be taken to ensure that the child does not have constipation or diarrhea. You can prevent the development of permanent health problems in your child by providing early diagnosis and treatment of intestinal knots.
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