Pediatric surgery. Acute intussusception clinic (most important)

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Pediatric surgery. Acute intussusception clinic (most important)

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46. Clinic of acute intestinal intussusception

Clinical picture of acute intussusception depends on the level of introduction of the intestine, the age of the child and the time elapsed since the onset of the disease.

Clinical picture of cecocolic and ileocolic intussusception. The disease begins acutely, in the midst of complete health. Suddenly the child begins to become extremely worried, scream, and convulsively kick his legs. The face becomes pale, sometimes covered in cold sweat. The attack of pain is usually short-lived (3-7 minutes), accompanied by vomiting and stops as suddenly as it began. The child immediately calms down, his behavior becomes normal; sucks the mother's breast and is interested in toys. After a few minutes (5-10, sometimes 15-20), the attack of pain repeats with the same intensity. Again, the child begins to kick his legs, scream, become extremely anxious, and rush about in bed or in the arms of his parents. Vomiting repeats. The occurrence of pain depends on pinching and tension of the mesentery, a sharp spasm of the intestine in the area of intussusception. Periodic increased peristalsis, followed by a weakening of intestinal motor function (response to sudden painful stimulation), explains the cramping nature of the pain. Their intensity depends on the compression force of the intussusceptum cylinders on the embedded mesentery and the degree of its tension.

As edema and circulatory disorders increase, pain sensations decrease due to the onset of neurological changes and limitation of invaginate advancement in the aboral direction.

Palpation of the abdomen is painless, the tension of the muscles of the anterior abdominal wall is not determined. One of the earliest and most persistent symptoms of intussusception is the presence of a tumor-like formation in the abdominal cavity, which is palpable along the colon.

Clinical picture of small bowel intussusception has some features depending on the severity of neurotrophic disorders in the intestine. The first signs of incipient implantation in infants will be intense restlessness and, as a rule, a high-pitched, loud cry. Older children complain of sharp pains. The child's face turns pale, vomiting appears, usually multiple. The duration of anxiety and cry is different (10-20 minutes). Then the patient calms down somewhat, but the typical "light" period does not occur, the child does not take the nipple, refuses the mother's breast, older children note the subsidence, but not the disappearance of pain.

Clinical picture of colonic intussusception. The penetration of the large intestine into the small intestine is manifested by less pronounced clinical signs than with other types of intussusception.

In an infant, the disease begins with a mild short-term anxiety. The general condition remains unchanged, pain attacks are relatively rare, there may be a single vomiting.

When examining a patient, it is always possible to feel the invaginate, which is localized in the left upper quadrant of the abdomen or the left iliac region. Finger examination through the rectum often allows you to determine the head of the intussusceptum.

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

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