Intussusception can be defined as a proximal segment of intestine telescoping into the more distal intestinal segment. It is an important cause of rectal bleeding and intestinal obstructions in infants and children. It is the most common cause of intestinal obstruction in babies between the ages of 3 and 24 months.
In most cases, 80-90% ileo-ileal intussusception,
15% ileoileal intussusception,
Rarely, cocolic intussusception occurs. It can be seen in double or triple forms such as jejunojejunal or ileo-colic.
Colocholic intussusception may develop secondary to parasitic diseases. Idiopathic intussusception is classically seen between the ages of 5-10 months. Half of all intussusception occurs by the age of 1, 63-95%. 10% of cases are seen in children younger than 2 years of age, and 10-25% of cases occur between the ages of 2 and 5. The incidence of intussusception, which is seen all over the world, varies between regions.
Although it is not certain, the frequency of intussusception is seen on average between 1-4 in 1000 live births.
We all witness that intussusception cases occur one after another in some seasons from time to time. we are becoming. It is especially common in spring and summer, when gastroenteritis is more common, and in winter, when upper respiratory tract infections are more common.
What are the causes?
Classical intussusception. There is no obvious etiological factor, and this is called idiopathic intussusception. The etiology of this type of intussusception includes Peyer's plate hypertrophy following food changes, mesenteric lymphadenopathy occurring during upper respiratory tract infections due to Adenoviruses, and gastro enteritis due to rotavirus infection. It is suggested that some structural features play a role in the emergence of idiopathic intussusception. In many young babies, the more mobile descending colon paves the way for intussusception. In the early ages, Peyer's patches were more prominent in the terminal ileum, which causes intussusception.
Intussusception is more common in infants due to the obvious diameter difference between the ileum and the colon.
Since the ileocecal valve extends into the cecum, this It also paves the way for intussusception under one year of age. The pathologies that cause intussusception only cover 3%, this rate is 57% in children over the age of 5 and 75-90% in adults.
These reasons are;
Meckel's diverticulum is the most common cause, making up half of it.
Peutz-Jeghers syndrome makes up almost the other half.
What happens after intussusception?
In the invaginated bowel segment, firstly the lymphatic circulation is disrupted, then the venous circulation is disrupted, gradually increasing edema and mucosal bleeding also disrupt the arterial circulation.
What are the symptoms?
Vomiting and weakness in the early period.
There are attacks of pain that occur at intervals of 20 minutes and are severe enough to draw the legs to the abdomen.
There is abdominal tenderness, the lower left abdomen is usually empty.
Diagnosis
Abdominal USG is an indispensable imaging method in the diagnosis of intussusception. Ultrasonographically, it is expressed as target sign, false kidney, ox eye. It is 98.5% sensitive and 100% specific.
Treatment
Two different methods are followed.
Non-surgical method
By using fluid and air, intussusception can be corrected 75-95% without surgery.
Surgical method
In children with intussusception, the case takes 48 hours. Children with a history of bloody poop and poor general condition should be taken into surgery immediately and reduced manually without delay.
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