Pediatric surgery. Diagnosis of acute intussusception (most important)

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Pediatric surgery. Diagnosis of acute intussusception (most important)

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47. Diagnosis of acute intestinal intussusception

Non-contrast survey radiography of the abdominal cavity does not provide significant assistance in establishing the diagnosis of intussusception and reveals only some indirect signs of obstruction (absence of gas in the large intestine, a homogeneous shadow due to intussusceptum, several loops of the small intestine swollen with gas with the presence of single horizontal levels of fluid). More valuable data for the diagnosis of intussusception is provided by a contrast study of the colon with the introduction of air. The indication for this research method is the doubt in the diagnosis or the need to clarify the type of invagination, but only in cases where the use of a conservative method of treatment is acceptable.

Differential diagnosis. Differential diagnosis must be made with diseases accompanied by attacks of abdominal pain, vomiting, bloody discharge from the rectum, and the presence of a tumor-like formation in the abdominal cavity.

In infants, intussusception is most often mistaken for dysentery. For dysentery, such an acute onset of the disease that occurs in the midst of complete health is uncharacteristic and is accompanied by severe bouts of abdominal pain, followed by "light" intervals, which is typical for intussusception.

Abdominal syndrome in Henoch-Schonlein disease often has manifestations similar to intussusception: sudden attacks of abdominal pain, vomiting, and bloody stools. The abdominal syndrome of Shenlein-Genoch disease is characterized by inconstancy and instability of symptoms, while with intussusception they persist and grow. A clinical feature of uncomplicated forms of abdominal purpura can be considered a discrepancy between the severity of the general condition of the patient and local signs of the disease.

In older children, intussusception often has to be differentiated from acute appendicitis. Symptoms of intussusception in older children are usually less pronounced than in typical cases in infants, however, consistent clinical examination reveals characteristic signs of the introduction of the intestines. In contrast to appendicitis with intussusception, abdominal pain is cramp-like in nature with "light" intervals. Signs of intestinal obstruction (stool retention, gases) are also not characteristic of appendicitis. With intussusception, the abdomen is always soft, while tension in the abdominal wall is the most constant symptom of acute appendicitis.

The most difficult differential diagnosis of intussusception with peptic ulcer of Meckel's diverticulum or intestinal hemangioma. In these diseases, intestinal bleeding is the first and main symptom. Unlike intussusception, bleeding is not preceded by pain attacks, the child remains calm. Older children do not complain about pain. Bleeding is usually so significant that symptoms of acute anemia soon come to light.

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

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