Intestinal intussusception

Intestinal intussusception

    * Introduction
    * Causes and Risk Factors
    * Signs and symptoms
    * Diagnosis
    * Treatment
Intussusception is a bowel into the lumen of the intestine or telescopaj. The most common variety is encountered in infants. Can be ileoileala, ileocaecal, ileocolica, ileocecocolica or less colocolica.
Intestinal intussusception incidence is 5 cases per 1000 children, with a ratio boys: girls 3:2. The incidence is highest in children 9-24 months. He described an increased incidence depending on the season, with peaks in spring and summer and midwinter. They are associated with the occurrence of gastroenteritis and upper respiratory tract infections.
An infant of 4-7 months up to that time in good general condition shows sudden abdominal pain, paroxysms, accompanied by loud screams, which are cycled every minute for materials and gas transit stop, then few hours later shows a chair diarrhea with mucus and blood.
Evolution is fatal without treatment. Baloneaza abdomen, the temperature climbs to 40 degrees, overall loss of quality. Clinical examination highlight "Buda", cirnatul of invagination.
Under the effect of enema intussusception can be reduced. If you do not get this result or if it is only partial, surgical intervention was, the blind dezinvagineaza milked, not traction. If even this gesture fails or is Excision lesions are irreversible. Resection is burdened by a high mortality.
In adolescent or adult intussusception is rare and is usually secondary to tumors, diverticula, or appendicitis. In adult intussusception is more common ileocolica its ileoileala. In adult intussusception requiring surgical therapy. If they are large or if dezinvaginarea parietal lesions is impossible to use segmental resection followed by restoration of transit. Mortality rate is 1% of intestinal intussusception. Recurrence after nonoperative maneuvers and the surgical reduction is 5% and 4%-respectiv1.
Nonoperative reduction has negative results in these terms: Intussusception ileocolica installation of long duration of symptoms, rectal bleeding, failure of reduction by barium enema, age 2 years or less than 3 months. Intestinal perforation are factors that indicate age and long duration of symptoms less than 24 hours. The risk of postoperative adhesion formation with intestinal obstruction after manual reduction maneuver is 0% after the surgery is 5%.
Pathogenesis
Intussusception-boudin tumor is composed of a chance that invagineaza, intestine recipient and package-related segment, formed either by overthrowing receiver-bowel intussusception in rollover, fixed head intussusception, or bowel intussusception with invaginated-prolapse, intussusception mobile head.
A section of intussusception made boudin printrun longitudinal show him to be composed of three cylinders. Head end is formed bowel intussusception that invagineaza, parcel or ring of bowel intussusception being the receiver of making intussusception.
Once the bowel and mesentery is invagineaza loop that penetrates through the ring of intussusception between the internal and middle cylinder. As the intussusception progresses more and more bowel is trained so that at some point becomes agent intussusception ring strangulation. The first film are the veins and lymph. Venous and lymphatic stasis result, loop congestion, edema, mucus secretion, bleeding in the intestinal lumen. Explain the occurrence of mesenteric adenopathy lymphatic stasis in the right tumor intussusception.
Obliteration of arteries leading to tumor necrosis intussusception and intestinal lumen is blocked after 18-24 hours of onset evolution with occlusive. Intussusception as the tumor progresses along the frame colic, it trains more than mesentery, so that the remaining portion of the bowel shortens more and more free, which makes tumor intussusception be attracted to the midline, deep paravertebral, approaching the mesenteric insertion.
The reason nThis intussusception tumors progression in hemiabdomenul long sought to be extinguished, the spine, abdomen and not in the right flank in place of the usual colon. Intussusception mobile ring fixed head and usually cecocolice, having wide ring is long progression intussusception.
We can distinguish four types of anatomical intestinal intussusception.
Bowel intussusception with two variants: ECSC-colic intussusception most frequent. Currently she is called ileocaecal but ECSC-term colic is more logical, taking into account the subsequent events. Intussusception head consists of ileo-caecal valve and the neighboring portion of the check. He progresses by overthrowing the colon, intussusception phone ring. Sometimes this occurs with the onset of intussusception not ileo-caecal region but from the background check, out of a caecal boselura.
Colo-colic intussusception is rare, not interested in check, usually occurs in the transverse mobile.
Ileo-colic intussusception follows that the frequency of the ECSC-colic. Ileum is invagineaza in crossing the check valve becomes ring of Bauhinia intussusception. The ring remains fixed, the progression is being achieved by intussusception prolapsing ileum make a version with movable head.
ILEA-ileo intussusception in the small intestine begins and may progress passing through the valve into the colon of Bauhinia, realizing a 5-cylinder intussusception.
Intussusception of the appendix isolated or are exceptional in infants Meckel diverticulum.