Invagination, also known incorrectly as “intestinal knotting”, means the intertwining of the intestines. In fact, in everyday life, the intestines go in and out of each other. If the entering bowel cannot come back, then signs of intussusception occur. It is most commonly seen in infancy (6 months-1 years). It is more common in seasonal changes such as spring and autumn. Intussusception in children of this age occurs when the last part of the small intestine (ileum) enters the first part of the large intestine (cecum) (ileo-cecal intussusception). Increased bowel movements for reasons such as diarrhea may cause intussusception. This is the reason why it is seen more frequently in rotavirus outbreaks. The last part of the small intestine is rich in lymph tissue.
In general systemic infections such as upper respiratory tract infection, the lymph tissue found here also swells. This thickened tissue prevents the bowel, which has become intertwined for any reason, from coming back. If there is a polyp in the intestine, it can also cause intussusception. In children over the age of two, intestinal lymphoma (lymph cancer) is one of the causes of intussusception. Invagination first begins with vomiting. Vomiting, which initially contains what the child ate, turns yellow-green after a while. This is a sign of intestinal obstruction. The blockage causes the intestines to swell backwards.
This is seen as distention in the abdomen. As time passes, the edema that occurs in the inner wall of the intertwined intestine causes bleeding from there. This is why blood comes from the anus during intussusception. This condition, defined as bleeding in the form of “strawberry jelly”, is the most typical finding of intussusception. Patients with invagination are hospitalized, vascular access is established, and antibiotic treatment is started with serum therapy. As a result, the main treatment of the disease is interventional methods and surgery under emergency conditions.
Treatment Options:
Reduction with Hydrostatic-Serum (Isotonic): Barium or isotonic fluid (saline) with ultrasonography is injected into the intestines through the anus at a maximum of 1.5 meters above 150 mm/Hg pressure. It is a method of opening the nested intestines by giving them. It should not be applied to delayed and poor patients. It can be repeated up to two or three times. The success rate is between 50-90%. If there is no opening, open surgical technique should be used. The probability of recurrence after reduction of the disease is 2-20%, and recurrences mostly occur in the first 72 hours.
Pneumatic (with air) reduction: It is the process of opening the nested intestines by giving the air to the intestines through the anus. It should not exceed 80 mm/Hg in infants and 110-120 mm/Hg in older children. The chance of success is 75-90%. The probability of recurrence after reduction of the disease is 2-20%, and recurrences mostly occur in the first 72 hours.
Surgical Treatment:
Lapasroscopic Reduction: It is the process of opening the intestines with the help of laparoscopy. If the conditions are suitable, the postoperative period is more comfortable than open surgery and the cosmetic results are better.
Open Surgery: It should be preferred when the above treatment options fail or patients are not suitable for these options. In open surgery, if the intestinal circulation is not impaired and there is no congenital anomaly that will cause invagination, manually opening the intestines (manual reduction) is sufficient. If the process is prolonged and intestinal circulation is impaired, part of the intestines can be removed during the surgery (segmental resection) or the end of the intestine can be mouthed to the abdominal wall (making a stoma).
