As invagination or intussusception of the bowel which is made in the longitudinal axis of indentation is an intestinal section referred to another. Disturbances in the blood supply to the intestinal wall as a result of blood congestion and edema lead to the development of the symptoms of an intestinal obstruction , which is an acute, life-threatening clinical picture.
The invaginated part of the intestine is called the invaginate (or intussusceptum ). The intestinal invagination mostly runs in the aboral direction in the invaginans (or intussuscipiens ), so the intestine invades in the direction of its peristalsis waves . Oral intussusception is relatively rare (retrograde intussusception), which is mainly described as a complication after gastric resection .
Depending on the intestinal sections involved, a distinction is made between several forms of intussusception:
- ileo-ileal intussusception: the small intestine invades into the small intestine
- ileo- (coeco-) colical intussusception: the small intestine and, if applicable, the appendix invade the colon (this is the most common form in childhood with over 80%)
- Colical intussusception: Colon invagination
- ileo-ileo-colicale intussusception: the small intestine invades the colon several times.
Intussusception in children
Infants and toddlers (ratio boys: girls 3: 1) up to the age of two are mainly affected by the disease; The cause here is usually a (temporary) disturbance of the intestinal motor function . The invaginated appendix is the second most common cause of the acute abdomen in infancy and early childhood.
An accumulation is observed in autumn and winter.
The vaccination with rotavirus vaccine , which has been recommended by STIKO since 2013 , leads, according to current knowledge, to a slightly increased rate of intussusception (1–2 additional intussusception per 100,000 vaccinated children). The incidence regardless of vaccination is given as around 62 / 100,000 in children under 12 months of age.
In children, the disease is idiopathic in over 90% ; a tangible cause cannot be found. In 2–8% there is a - mostly anatomical - change.
In children, symptoms appear from perfect health. Sudden cramp-like abdominal pain, vomiting and noticeable paleness, possibly with symptom-free intervals. High-pitched screaming and pulling of the legs are typical in babies. As a later symptom, stool with bloody, slimy deposits ("currant jelly") can appear. A cylindrical hardening can be palpable.
The disorder can be determined quite reliably with an ultrasound examination , since the turned-in parts of the intestine form an onion skin-like structure (target phenomenon). Before the introduction of the ultrasound examination, an enema with X-ray contrast agent under fluoroscopy was made to confirm the diagnosis and simultaneous therapy. Computed tomography can also help diagnose adults .
The form of therapy is selected depending on the period of time in which the intussusception exists and the accompanying circumstances. If the symptoms started a long time ago and there is a suspicion of a submerged piece of intestine, if the patient has symptoms of shock, if the intussusception is purely in the small intestine area, or if a process (e.g. polyp) in the intestine is suspected that causes the Maintains intussusception, surgery is performed immediately. Otherwise - if the department has the necessary experience - an attempt at therapy using a sonography-guided enema is first carried out. During this enema, fluid at body temperature (possibly with contrast agent) is introduced through an intestinal tube inserted rectally . If the ultrasound is successful, the bulging of the bowel is visible. Air or contrast medium insufflation under fluoroscopic control has now been given up in most clinics because of the associated radiation exposure. If the reduction is unsuccessful, an operation must be performed immediately afterwards, otherwise there is a risk of death due to the increasing damage to the intestinal wall.
Intussusception in adults
Small and large intestine vagination in adulthood is a rare diagnosis. In a large German surgical clinic there were only 7 cases in two years.
In contrast to children, a morphological cause can be found in more than 90% of adults ; as a rule it is a structural lesion ( Meckel's diverticulum , polyp , intestinal duplication ). Often a tumor is the cause, in 66% with intussusception of the large intestine and in 30% when the small intestine is affected.
In adults, the symptoms often develop slowly and the symptoms of a partial or complete intestinal obstruction develop .
The standard diagnostic method is computed tomography of the abdomen and sonography . It is not uncommon for the diagnosis to be made when the abdominal cavity is surgically opened (a so-called laparatomy trial ).
Adults usually need an operation.
- Volvulus - bowel entanglement, bowel twist
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