Pediatric surgery. Acute intussusception (most important)

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Pediatric surgery. Acute intussusception (most important)

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45. Acute intestinal intussusception

The introduction of a certain section of the intestine into the lumen below (or above) the located area is called intussusception. At the same time, at the injection site, the intestine has three cylinders: an external one and two internal ones - intussusception. The apex of the intussusception is usually called the head, which corresponds to the transition of the inner cylinder to the middle one. The increase in the length of the invaginated part of the intestine occurs only due to the screwing in of the outer cylinder; the “head” of the intussusception remains unchanged. The advancement of the intussusception is accompanied by “tightening” and pinching of the mesentery of the implanted part of the intestine between the internal and middle cylinders (the serous membrane facing each other). In rare cases, “double” intussusceptions are observed, in which the intussusceptum complex is introduced into the lower part of the intestine, forming 5 cylinders.

The direct cause of intussusception in children of the first year of life is considered to be a change in the dietary regimen characteristic of this age period. Various intestinal diseases (dyspepsia, colitis) are of some importance. In children older than 1 year, mechanical causes of intussusception are relatively common.

Intussusception can occur at any level of the intestinal tract. Isolated introduction of the large intestine into the large intestine and small intestine into the small intestine is relatively rare, mainly in children over the age of 1 year. Most often, the introduction occurs in the region of the ileocecal angle, which is associated with the anatomical features of this section of the intestine in infancy: greater mobility of the caecum and ileum, the frequent presence of a common mesentery, underdevelopment of the valvular apparatus of the Bauhinian valve, a discrepancy between the diameter of the ileum and its ampulla.

Not only the clinical picture, therapeutic measures, but to a certain extent the prognosis of the disease depend on the localization of the primary introduction (the level of formation of the vaginate head) and the nature of further progress. The most acceptable for practical purposes can be considered the classification of X. I. Feldman's intussusceptions:

1) small intestine intussusception (3,5%) - the introduction of the small intestine into the large intestine;

2) ileocolic invagination (41%) - the introduction of the ileum into the ileum and then into the colon through the Bauginian damper. With further advancement of the intussusceptum, the blind and further located sections of the colon are involved;

3) blind colonic invagination (52,7%) - the head of the invaginate is the bottom of the caecum. The appendix and the terminal ileum are passively retracted between the cylinders of the intussusceptum;

4) colonic invagination (2,8%) - the introduction of the colon into the colon;

5) rare forms of intussusception (isolated invasion of the appendix, retrograde intussusception, multiple).

Authors: Drozdov A.A., Drozdova M.V.

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