How is small bowel intussusception performed?

This article is professionally consulted by resident Doctor Le Thanh Tuan - Department of General Surgery - Vinmec Nha Trang International Hospital. The doctor has extensive experience in examination, treatment and surgery of abdominal diseases.

Intussusception is a common cause of intestinal obstruction in children between 3 months and 6 months. Intussusception in children greatly affects the metabolism and growth of children.

Children with intussusception often show some of the following symptoms:
Abdominal pain: Children with severe abdominal pain, manifested by sudden, intense crying, hunched over, twisted, the pain could stop the child. play, quit breastfeeding. Vomiting food in the early stage, in the late stage, the child may vomit green or yellow fluid. Blood in the stool: The child's stool may be red or brown with blood, may appear soon after the pain or appear late after 24 hours. Occurs in 95% of nursing infants. Bloody defecation along with vomiting and drainage of fluid into the intestinal lumen are important factors contributing to hypovolemia.

Currently, the most reliable method to diagnose intussusception is ultrasound. After the child is identified with intussusception, depending on the condition, the doctor will prescribe some of the following methods of intussusception:
2.1 Intubation by intubation Nowadays, intubation by intubation in treatment Intussusception is commonly used instead of the previous Baryt intubation method. This method is usually indicated for children with a confirmed diagnosis of intussusception, under 2 years of age and must be detected early 72 hours. The child has no signs of intestinal perforation.

The child's position is lying on his back with his head tilted to one side, legs extended. The catheter is placed in the anus by the nurse and the catheter is connected to a defibrillator with a pressure control valve. The doctor inserts air into the colon through a catheter. The radiologist will take pictures when seeing the image of the intussusception, the doctor continues to pump air into the colon, the intussusception gradually moves until the gas suddenly rushes into the small intestine, when the intussusception is removed. The radiologist takes a second film after the cage block is removed. At this time, the nurse will remove the catheter from the machine to let the air in the intestines escape almost completely and then remove the catheter from the anus. After successful intussusception, the child usually has no pain, sleeps peacefully, bloody diarrhea may still be present but will gradually decrease, the stool turns yellow. The stool may be loose because when removing the intussusception, more water is absorbed into the intestinal lumen. Depending on the child's condition, the doctor will prescribe intravenous fluids to relieve anesthesia (if there is a pre-anesthesia injection), water and electrolyte replacement. Children need to be monitored for recovery for about 12-24 hours and then discharged from the hospital. The advantage of the air intubation method is that the process is quite fast and effective after about 5-10 minutes. But in some cases, the child arrives late, has a lot of bloody diarrhea, the tight intussusception may not be removed immediately, the doctor will prescribe fluid and electrolyte replacement, antibiotic injection and removal of the cage after about 1 hour. .

2.2 Removing the cage with water The solution used includes water, Ringer's solution or physiological saline. The drain solution is warmed to body temperature, then injected rectally through a Foley tube (no. 10 - 18F) under 100 mmHg pressure. Follow up the results of intubation by ultrasound, if there is no image of the intussusception, and water and air bubbles from the cecum overflow to the terminal ileum, the intubation has been successful. The success rate of water intussusception is about 50-89%. When applying this method, pediatric patients do not have to use X-rays.

Depending on the condition, the intussusception after removal can still return as soon as a few hours or many days later. Therefore, parents need to carefully monitor, do not let the child dance too much after removing the cage, give the child a little food, take medicine according to the doctor's prescription. When detecting signs of recurrent intussusception: Sudden abdominal pain, twisting, crying, vomiting food ... need to take the child to the hospital immediately. In the case of children with recurrent intussusception, the child will be ordered to have tests to check for physical causes: Polyps, ileal tumors, colon. If there is a physical cause, the child will be surgically treated to treat the cause. Parents should note to keep the child's body warm, limit respiratory infections in winter and spring, and eat hygienically to avoid mesenteric lymphadenitis leading to intussusception.