Intestines invagination

Description:

Intestines invagination — the type of impassability of intestines allocated in a separate nozoforma which reason implementation of one part of intestines in a gleam another is.  This option of intestinal impassability occurs preferential at children of chest age (85-90%), is especially frequent during the period from 4 to 9 months. At children 1 years are more senior invagination is observed seldom and is in most cases connected with the organic nature (a diverticulum of an ileal gut, a hyperplasia of an adenoid tissue, a polyp, a malignant new growth, etc.)

Depending on localization distinguish types of intestinal invagination:

  1. thinly - enteric
  2. thinly - colic
  3. thinly - cecal (ileocecal)
  4. thickly - colic
  5. thinly - it is thick - cecal

Invagination in the field of an ileocecal corner (more than 95%) is most often observed.

Intestines Invagination symptoms:

Invagination meets more often at babies (between 4 and 10 m month of life) who are well-fed. The disease begins suddenly. The child becomes uneasy, cries, writhes, draws in legs. The attack comes to an end also unexpectedly, as well as begins. The child calms down, even plays, but after a while attacks of pains repeat again. Attacks of pains correspond to waves of an intestinal vermicular movement which advance the invaginated part of a gut. Attacks of pains meet in 90% of cases. Soon after the first attacks of pain there is one - or double vomiting which also arises periodically. At the beginning of a disease vomiting has reflex character, and then obturation of a gleam of the invaginated gut becomes the reason. Body temperature as a rule remains normal. In the beginning the child has a normal chair 1-2 times, but later, through 6-10ch in excrements impurity of blood appear and they take a characteristic form of "crimson jelly". Late allocation of excrements and gases stops. Owing to a prelum of the implemented site of a gut and the site of a mesentery corresponding to it in them there come the expressed circulatory disturbances. The inflammatory phenomena lead to adhesion of cylinders that interferes with an invagination raspravleniye. At an attentive palpation in intervals between attacks, the stomach soft, is not blown up. During an attack the child reflex strains belly muscles and a stomach it is impossible to inspect carefully. Often it is possible to propalpirovat the invaginated site of a gut, tumorous formation of a soft and elastic consistence, kolbasovidny form, painful at a palpation. The tumor changes the form and localization depending on terms of a disease and mobility of intestines. In literature cases when having passed an intussusceptum on a large intestine are described, drops out of a back prkhod, and take it for the dropped-out rectum. About weight of a condition of the child with invagination of intestines it is possible to judge by the expressed intoxication phenomena. In cases of late diagnosis the clinic of peritonitis develops, the stomach becomes blown up, intense, sharply painful at a palpation in all departments. Survey of the child is finished with a research through a rectum. At the same time in some cases it is bimanualno possible to feel a tumor. After extraction of a finger from an anus slime with blood, without impurity of fecal masses is emitted.

Intestines Invagination reasons:

Invagination is carried to the mixed form of intestinal impassability in which both obturatsionny, and strangulyatsionny factors are combined. Initially there is an obstruction of intestines (obturation) from within, and only then, as a rule, in 6 — 12 hours, disturbance of food because of a prelum of a mesentery (strangulation) can join. Invagination develops owing to disturbance of a vermicular movement of intestines, and disturbance of a vermicular movement, in turn, can be caused by age features of connecting fabric in babies (insufficiency of the ileocecal valve, high mobility of a large intestine, etc.) or existence in a wall of a gut of an organic obstacle in the form of inflammatory process, a tumor (is more often than a pediculated polype), a foreign body. At the same time the reduced site of a gut together with the mesentery on a longitudinal axis drags on in distal department of a gut with a normal gleam. It creates the internal cylinder of an intussusceptum. Here develops swelled, gradually there come disturbance of blood circulation and a necrosis. At invagination distinguish an outside tube (vagina) and internal (intussusceptum). The initial department of the implemented gut carries the name of a head of an intussusceptum. Can lead to in-coordinate reduction of muscular layers also changes of a diet, introduction of a feeding up, etc.

Treatment of Invagination of intestines:

Depending on the invagination reason (which, as a rule, significantly differs for different age groups) its treatment can be conservative or operational. At children of chest age invagination is in most cases allowed by means of conservative actions. At present the conservative method of treatment of intestinal invagination - forcing of air in a large intestine via the gas outlet by means of a manometrical pear is applied. This method is effective at thinly - colic invaginations on terms till 18 o'clock. Thinly - enteric invagination usually in such a way does not manage to be straightened. Inclusion of a laparoscopy in a complex of medical and diagnostic actions at intestinal invagination can significantly increase percent of the patients cured conservatively. The laparoscopy purpose - direct vision behind a raspravleniye of an intussusceptum and assessment of life activity of intestines. Indications to this method are:

  1. inefficiency of conservative treatment at early terms of a disease
  2. attempt of a conservative raspravleniye of an intussusceptum at late receipt (excepting the complicated disease forms)
  3. clarification of the reasons of invagination at children is more senior than 1 year

Operational treatment consists in a laparotomy and manual disinvagination which is made not a pulling of the implemented gut, but by method of careful "expression" of the intussusceptum taken by all hand or two fingers. If it was not succeeded to carry out disinvagination or the necrosis of the site of a gut is found, make a resection within healthy fabrics with imposing of an anastomosis.