How to treat intussusception in children?

Written by Hu Qi Feng
Pediatrics
Updated on September 03, 2024
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Intussusception is a life-threatening emergency that requires urgent reduction once diagnosed. Reduction methods include non-surgical and surgical therapies. Within forty-eight hours of intussusception, if the overall condition is good, there is no abdominal distension, and no significant dehydration or electrolyte imbalance, reduction can be attempted under ultrasound guidance using hydrostatic enema, air enema, or barium enema. If the intussusception has lasted beyond forty-eight to seventy-two hours, or if there is severe abdominal distention, intestinal necrosis, or perforation, surgical treatment is necessary.

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Written by Hu Qi Feng
Pediatrics
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Is infant intussusception dangerous?

Intussusception is a life-threatening emergency, and its reduction is an urgent treatment measure that should be performed immediately once confirmed. It is a common acute abdomen disease in infants and young children. Initially, the general condition may be good, but as the disease progresses, the condition worsens, leading to systemic deterioration, complications such as intestinal necrosis or peritonitis, and severe symptoms of poisoning such as severe dehydration, high fever, lethargy, coma, and shock.

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Caused by infantile intussusception

Intussusception is divided into primary and secondary types, with 95% being primary cases, most commonly seen in infants and young children. This is due to the fact that the mesentery of the ileocecal part in infants and young children is not yet fully fixed and has a greater degree of mobility, which are structural factors that facilitate the occurrence of intussusception. The remaining 5% are secondary cases generally occurring in older children, where the affected intestines often have a clear organic cause, such as a Meckel's diverticulum turning into the ileal lumen, serving as the starting point for intussusception. Other causes like intestinal polyps, tumors, duplications, or abdominal purpura can cause the intestinal wall to swell and thicken, which can also trigger intussusception.

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Is intussusception in children serious?

Intussusception is a life-threatening emergency, and its reduction is an urgent medical treatment that must be performed immediately once diagnosed. Generally, in the early stages of intussusception, the general condition is still good, with normal body temperature and no symptoms of systemic toxicity. As time progresses, the condition worsens, and there may be necrosis of the intestines or peritonitis, with overall health deteriorating. Common severe symptoms include dehydration, high fever, lethargy, coma, and shock from toxicity.

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Infant intussusception symptoms

Intussusception clinically presents with abdominal pain, which occurs in fits and starts and has a regular pattern. This manifests as sudden spasmodic colic; the child cries and is restless, drawing the knees up to the belly and turning pale. The pain lasts for several minutes or longer, then eases off, allowing the child to fall asleep quietly. These episodes recur every 10 to 20 minutes as intestinal movements provoke further attacks. Vomiting occurs, initially consisting of curdled milk or food residues and later containing bile-stained, feculent fluid. Moreover, blood in stools is an important symptom. Symptomatically, stools may appear normal for a few hours, but within six to twelve hours, 85% of affected children might pass jelly-like mucus blood stools. A palpable lump can be detected in the upper right abdomen, indicative of the point of intussusception. As for general symptoms, the child may appear well early on, but as the condition worsens, intestinal necrosis or peritonitis may occur, leading to severe dehydration, high fever, lethargy, coma, shock, and other signs of systemic toxicity.

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Infant Intussusception Symptoms and Treatment

Clinical manifestations of intussusception include: firstly, abdominal pain, which is paroxysmal, regular, and characterized by sudden episodes of colicky pain. The child may cry, appear restless, draw knees to the abdomen, have a pale face, and experience pain that lasts for several minutes or longer. The pain subsides, and the child may fall asleep quietly, but the pain typically recurs at intervals of ten to twenty minutes. Secondly, vomiting is an early symptom, initially reflexive and containing curds and food residue, later possibly including bile. Thirdly, bloody stools are an important symptom, with about 85% of cases passing jelly-like mucoid bloody stools within six to twelve hours after onset. Fourthly, an abdominal mass is often located in the upper right abdomen below the costal margin, where a slightly prominent intussusception mass can be felt. In terms of systemic symptoms, the general condition is good in the early stages, with no symptoms of systemic poisoning. As the disease progresses, the condition worsens, and complications such as intestinal necrosis or peritonitis may develop, leading to deterioration of systemic symptoms and possibly resulting in dehydration, high fever, coma, shock, and other toxic symptoms. Treatment methods include both surgical and non-surgical treatments.