In intussusception, a section of the intestine telescopes into another section of the intestine along its longitudinal axis. This can lead to intestinal obstruction (ileus) due to disturbances in the blood supply to the intestinal wall. The intussuscepted part of the intestine is called an intussusception. Invagination usually occurs in the direction of food transport, i.e. the intestine invaginates in the direction of its normal undulating transport movements.

Dienvagination mainly affects infants and small children up to the age of two. Boys are affected three times more frequently than girls. The cause is usually a disruption of normal bowel movements, typically following a gastrointestinal infection, for example. If intussusception occurs after the age of two, another cause can often be found. In this case, intestinal movement is obstructed by a lymph node, a Meckel's diverticulum, an intestinal polyp or an intestinal duplication.

The forms of intussusception are named according to the sections of bowel involved:

• Invagination: small intestine invaginates into small intestine
• Invagination: small intestine invaginates into the large intestine(most common form in children, over 80 %)
• Invagination: large intestine invaginates into the large intestine (rare)

The clinical symptoms of affected children can occur when they are completely healthy. However, the signs of a gastrointestinal infection (diarrhea and vomiting, possibly fever) are often present beforehand. In addition, sudden onset of cramp-like abdominal pain, vomiting and conspicuous pallor occur. Sometimes the child is completely symptom-free for a few minutes at a time. In infants, the severe abdominal pain is manifested by shrill crying and tightening of the legs. Later, bloody, slimy deposits may appear in the stool ("like raspberry jelly"). Sometimes a cylindrical induration can be felt in the area of the right-sided abdomen.

The diagnosis is confirmed by ultrasound. Treatment initially consists of an attempt at therapy using a sonography-guided enema. In this enema, body-warm liquid is introduced through an intestinal tube inserted via the anus. If successful, the protrusion of the intestine can then be visualized using ultrasound. If the reduction is unsuccessful, surgery must be performed immediately afterwards, as there is a risk of the intestine rupturing due to the intestinal obstruction (ileus) and the increasing damage to the intestinal wall.

After referral by your pediatrician, your child will be observed by the experienced team of our outpatient clinic or the pediatric surgery ward (pediatric nurses and physicians) and the diagnosis will be confirmed by ultrasound examination, which shows the telescopically inverted intestine. The lack of food intake and possible vomiting can lead to pronounced imbalances in blood salts (electrolytes) and a lack of fluids (dehydration). Your child's blood will therefore be drawn and, if necessary, balanced by infusing fluids.

Once the diagnosis has been confirmed, a treatment trial will be carried out using an ultrasound-guided enema. Under anesthesia, body-warm liquid is introduced via an intestinal tube inserted through the anus. If successful, the protrusion of the intestine can then be visualized using ultrasound. If the reduction is unsuccessful, surgery must be performed immediately afterwards, as there is a risk of the intestine rupturing due to the intestinal obstruction (ileus) and the increasing damage to the intestinal wall.

 

 

If the enema fails to reposition the bowel, especially if the symptoms started a long time ago or if it is suspected that parts of the bowel have already died, your child will need surgery. This is to prevent further damage to the trapped (invaginated) bowel. In some cases, a minimally invasive technique (laparoscopy) can be used. In this procedure, only a small incision is made at the navel and two further incisions (3 mm) are made on the right and left of the abdominal wall. These incisions can then be used to free (de-vaginate) the intestine, which is tucked in on itself, with the appropriate surgical instruments and optimal visibility. However, it is often necessary to operate via an abdominal incision (open surgery). In rare cases, if parts of the bowel are dead, they must be removed.

We use absorbable suture material for the skin suture, so sutures are not usually necessary. If the wounds are OK, further wound checks can be carried out by your pediatrician. Routine re-presentation to us is not planned. However, if you still have questions about the operation itself, you can arrange an outpatient appointment at any time.