Identify signs of intussusception in children

This article is professionally consulted by Resident Doctor, Doctor Nguyen Hung Tien - Resident Doctor of Pediatrics - Neonatology - Department of Pediatrics - Neonatology - Vinmec Hai Phong International General Hospital.

Intussusception is a common surgical emergency in young children, due to a segment of intestine entering the lumen of the adjacent segment. Parents need to pay attention to the signs of intussusception in their child to get to the hospital in time. If you are admitted to the hospital early, the doctor will remove the baby's cage with air without surgery.

Intussusception is a common surgical emergency, when a segment of bowel turns and enters the lumen of the adjacent bowel, causing mechanical obstruction. The intussusception block prevents food and fluid from moving downwards, the intestinal wall presses against each other, causing edema, inflammation, and reduced blood supply to the intussusception. The result is intestinal infection, necrosis, and perforation.
The cause of intussusception in children is still unknown, but some experts believe that intussusception may be related to:
Bacteria or viruses that cause respiratory infections, gastrointestinal infections; Imbalance between the ileal size compared to the ileocecal valve; Mesenteric lymphadenitis ; After an episode of acute gastroenteritis; Physical injuries. Intussusception can occur at any age, but it is most common in children under 2 years of age (accounting for 80% of cases), in which it is most common in children aged 4-9 months and is rare in older children. The disease is mostly seen in healthy, chubby children, boys more than girls with a ratio of about 2:1.
Clinically, this condition is not the same in the two age groups, specifically:
Children < 24 months: Acute manifestations, rapid progression, severe prognosis hour by hour; Older children: The manifestation is less intense, the pain is dull, sometimes acute, but the course is not as rapid and severe as in the nursing baby. If the patient is brought to the hospital early, the doctor only needs to perform the air intubation procedure (success rate is more than 90% and recurrence after nonsurgical intubation is 8-12%). If the child arrives late or the air intubation fails, the doctor will choose the appropriate surgical method based on the situation (relapse rate is 0 - 3%). Children are at risk of dying after intubation surgery if they develop pneumonia and febrile convulsions, but the number of complications is now significantly reduced.

There are 4 functional symptoms when a child has intussusception that parents need to pay attention to:
2.1. Abdominal pain Abdominal pain is the earliest and most prominent symptom, appearing in 75% of children with intussusception. The characteristics of acute abdominal pain due to intussusception are as follows:
The child cries out intermittently, when the pain subsides, the crying will stop temporarily; Sudden, severe abdominal pain; Children hunched over, twisted, bent their knees toward their chest or kicked wildly; Having to wake up at night, forced to stop all activities during the day; Children who quit playing and breastfeeding; Each pain lasts 5 - 15 minutes, appears and disappears suddenly; Symptoms may repeat immediately, the interval between attacks becomes shorter and shorter; Children become weaker and weaker.

2.2. Vomiting 65% of cases of children with intussusception will vomit at the first pain. The patient initially vomits food, then vomits green or yellow fluid.
2.3. Bloody stools Bloody stools account for 95% of breastfed infants with intussusception. This sign may appear at the first pain if the intussusception is tight, difficult to remove, or appears late after 24 hours. Most of the time when patients defecate, they will find:
Fresh blood and mucus; Red or brown blood; Sometimes there is a few drops of fresh blood coming out of the anus or diaper rash. However, there are also cases where blood mucus can only be detected under the glove when the doctor examines the rectum.
2.4. Constipation or diarrhea This is a sign that easily leads to misdiagnosis because there are 3 cases as follows:
If the intussusception completely obstructs: The patient will have bowel obstruction - defecation (constipation); If the bowel is not completely blocked: The patient can still defecate normally; In addition, there are still some children who develop diarrhea after intussusception.

3.1. Physical symptoms When taking the child to the hospital, the doctor will conduct a clinical examination of the abdomen to diagnose the child with intussusception. Physical symptoms include:
85 - 95% of cases will be palpable transverse intussusception mass above the umbilicus, long, mobile, firm, smooth face and painful when pressed; The case that the intussusception is not palpable is because it is located deep below the right costal margin, the intussusception reaches the angle of the liver, or the bowel obstruction is late, causing the abdomen to distended; Right iliac fossa is empty Rectal examination reveals bloody mucus due to intestinal bleeding Sometimes the head of the intussusception is palpable on rectal examination if the intussusception is low. 3.2. Systemic symptoms The systemic symptoms of children with intussusception in the early stages are usually little changed, in the late stages, patients often:
Fatigue, weakness; Less activity; Dehydration and electrolytes Infection - intoxication High body temperature May appear fever Some children fall into a state of shock, showing lethargy, lethargy. After 48 hours, symptoms of mechanical intestinal obstruction may appear.

3.3. Subclinical Abdominal X-ray (Contraindications: Intestinal obstruction ≥ 48 hours late, peritonitis or intestinal perforation); General abdominal ultrasound: A reliable and accurate method to diagnose intussusception, the longitudinal section shows the sandwich-shaped cage, the cross-section shows the donut shape or the target; Color Doppler ultrasound: Used to predict and indicate surgery or intussusception, based on the flow of blood in the intussusception; Computed tomography: in cases where ultrasound cannot accurately examine the intussusception. 3.4. Definitive diagnosis In the case of a child who comes to the hospital early, the doctor can make a definitive diagnosis if the following signs of intussusception appear simultaneously:
Severe abdominal pain intermittently and palpable intussusception; Severe intermittent abdominal pain, with vomiting and blood on rectal examination; Severe intermittent abdominal pain, and specific radiographic (or ultrasound) findings. On the contrary, if it is late, the child with intussusception will be diagnosed when there are symptoms of intestinal obstruction or peritonitis, accompanied by anal mucus bleeding.

3.5. Differential diagnosis In addition to intussusception, there are some other conditions that often appear in children with similar symptoms, so it is important to note the differential diagnosis as follows:
Blood in the stool: dysentery syndrome, polyps colon - rectum and small intestine, hemorrhoids, rectal prolapse, hemorrhagic colitis - rectum, necrotizing enterocolitis; Vomiting: Inflammation of the brain, throat or bronchi; Palpable abdominal mass: Intestinal obstruction due to worms; due to food residue... Severe abdominal pain: Acute appendicitis, acute gastritis,... Intussusception after removal is still likely to recur right after a few hours or days. Therefore, parents need to detect symptoms early to bring their children back to the hospital in time. When a child shows signs of intussusception such as sudden abdominal pain, twisting, crying, vomiting food, etc., it is necessary to take him to the doctor immediately.
In addition, the child's body should be kept warm to limit respiratory infections in the cold season, eat hygienically to prevent mesenteric lymphadenitis leading to intussusception.

Pediatrics department at Vinmec International General Hospital is the address for receiving and examining diseases that infants and young children are susceptible to: viral fever, bacterial fever, otitis media, pneumonia in children, .... With modern equipment, sterile space, minimizing the impact as well as the risk of disease spread. Along with that is the dedication from the doctors with professional experience with pediatric patients, making the examination no longer a concern of the parents.