Intussusception

　　1. Anatomical factors of ileocecal junction: The ileocecal junction is highly mobile in infancy, with an overly thick ileocecal valve, relatively longer mesentery, and a neonatal ileocecal diameter ratio of 1:1.43, which increases to 1:2.5 in adults, indicating different developmental speeds of the ileocecal region. Ninety percent of infants have a lip-like convex ileocecal valve that extends more than 1cm into the cecum. Added to this is the rich lymphoid tissue in the area, which is prone to congestion, edema, and hypertrophy after inflammation or food stimulation. The intestinal peristalsis is likely to push the ileocecal valve forward, pulling the intestinal tube and forming an intussusception.

　　2. Dietary changes: From 4 to 10 months of age, it is the period of adding complementary foods and increasing milk intake, which is also the peak period for the occurrence of intussusception. Since the infant's intestine cannot immediately adapt to the stimulation of the changed food, it leads to intestinal dysfunction and causes intussusception.

　　3. Viral infection: A series of research reports indicate that acute intussusception is related to intestinal adenovirus and rotavirus infection.

　　4. Intestinal spasm and autonomic nerve dysfunction: Due to various stimuli such as food, inflammation, diarrhea, bacterial toxins, etc., the intestine produces spasms, causing the rhythmic disorder of intestinal peristalsis or retrograde peristalsis, leading to intussusception. Some people also propose that due to the delayed development of sympathetic nerves in infants, the activity of the autonomic nervous system is disordered, causing intussusception.

　　5. Genetic factors: Clinically, some patients with intussusception have a family history of disease.

　　Air enema treatment for intussusception can cause complications such as intestinal perforation, delayed intestinal necrosis, and cortical blindness. The following is a simple introduction to the complications of air enema reduction for intussusception:

　　Intestinal perforation

　　The following are the characteristics of complications such as intestinal perforation that may occur during air enema reduction: (1) Perforation may occur within the first 48 hours of the course, (2) the site of perforation can occur in the hepatic flexure of the colon or the middle of the transverse colon. The intussuscepted part and the top mainly develop hemorrhagic intestinal necrosis, while the sheath part mainly has ischemic necrosis. The appearance of the bowel is spotted necrosis, and the grayish-white ischemic necrotic area makes the bowel wall thin. This perforation is not caused by high enema pressure, but rather when the intussuscepted part retreats to the necrotic area of the bowel, air escapes from the necrotic area. (3) Due to the long course of the disease, the bowel wall edema thickens, making the intussusception tighter, and the high reduction pressure is a cause of perforation. (4) Some children have been confirmed to have bilobed intussusception with a relatively small age, and air enema is difficult to be successful.

　　Delayed intestinal necrosis and perforation

　　Some patients undergo routine upright abdominal radiography after reduction of intussusception, and there is no free gas under the diaphragm. Charcoal powder has been excreted orally, and the next day there is still abdominal distension with low fever. Ultrasound examination did not find intussusception shadows, and 2 days later there were abdominal tenderness and signs of peritoneal irritation. Abdominal X-ray film showed free gas under the diaphragm, and laparotomy confirmed that some patients had multiple serosal tears in the hepatic flexure and transverse colon. Some patients have purple dot-like perforations in the凹陷 part of the ileum at the end of the reduced intussuscepted bowel, and it is considered that it is mostly due to delayed ischemic necrosis caused by mesenteric artery embolism of the intussuscepted bowel.

　　Cortical blindness

　　Some patients with intussusception may develop perforation followed by respiratory distress and generalized pallor of the skin, cyanosis, and a history of transient convulsions. Although it is rare for air enema to correct intussusception and perforation resulting in blindness, it should not be ignored. Its characteristics are: it is difficult to find during emergency treatment and surgery for perforation, and it is usually found 3-4 days after surgery that the child does not respond to breastfeeding, cannot see toys, and then loses light sensation. Fundus examination shows pallor of both optic discs, followed by atrophy. This leads to cortical blindness. The cause may be acute hypoxia of brain tissue leading to brain edema and fat embolism.

　　Sudden abdominal pain accompanied by abdominal distension and vomiting, the child becomes restless and cries, pale, and sweating.

　　Blood in stool, mostly jam-like blood in stool, and the anal finger is stained with blood.

　　The abdomen can be palpated for sausagelike masses, slightly movable and painful. The cecocolic mass is located in the upper right quadrant of the umbilicus, while there is a sense of emptiness in the lower right abdomen.

　　Part of the adult patients with chronic recurrent intussusception often have polyps, tumors, and other lesions, presenting incomplete obstruction with mild symptoms and rare blood in stool.

　　Once a child is diagnosed with intussusception, he or she should immediately be prohibited from eating and drinking, complete all necessary examinations, quickly establish a venous access to replenish fluids, correct the disorder of water, electrolyte, and acid-base balance, and actively cooperate with the doctor's treatment. Specific preventive measures are as follows:

　　Psychological care

　　Since children cannot express their emotions, family members may have varying degrees of anxiety. Therefore, psychological care should be integrated throughout the entire diagnosis and treatment process. Doctors and nurses should provide warm services, actively explain the condition and related knowledge to parents, and perform nursing operations stably, accurately, gently, and quickly, in an orderly manner, so that family members can relieve their concerns and trust medical staff, thereby cooperating with treatment.

　　Observation of the condition

　　Observe carefully the child's vital signs and vomiting, stool, and other conditions, such as whether there is distension in the abdomen, muscle tension, and sausagelike masses, the nature and smell of vomit, etc. After surgery, provide the child with low-flow continuous oxygen therapy, turn the head to one side, and promptly clear the oral and airway secretions to keep the airway open, and if necessary, suction. After regaining consciousness, passive turning and semi-recumbent position should be given to facilitate breathing. Follow the doctor's instructions to provide nutritional support therapy and observe urine output to adjust the speed and amount of fluid replacement. Keep the gastric tube patent, and the doctor should explain the importance of the gastric tube to the parents to prevent it from being pulled out spontaneously. Only after the intestinal peristalsis recovers and the child has anal exhaust and defecation can the gastric tube be removed. During the decompression period, the nurse should flush the gastric tube with normal saline once per shift to prevent the obstruction of the gastric tube by gastric contents and accurately record the color, nature, and quantity of the gastric juice. If there are any abnormalities, notify the doctor immediately for treatment. At the same time, keep the oral cavity, skin, perineum, and wound clean. Replace the dressing in time when it is contaminated. When red fluid is found to seep out from the abdomen and the wound, notify the doctor immediately for treatment.

　　Health education

　　In order to reduce the recurrence rate of pediatric intussusception, doctors must teach parents how to care for the child's life after discharge. Breastfeeding should be encouraged as much as possible for infants and young children. Parents should be guided to add complementary foods correctly, pay attention to dietary hygiene, avoid the stimulation of various foods to the intestines, and avoid diarrhea and剧烈 exercise after meals to enhance the child's resistance and prevent colds. When the child has abdominal distension and diarrhea, it is necessary to stop adding complementary foods. When vomiting occurs, the child's head should be turned to one side to prevent the aspiration of vomit into the respiratory tract, which may cause asphyxia or aspiration pneumonia. If clinical symptoms of intussusception occur, it is necessary to seek medical attention promptly.

　　When the child shows paroxysmal crying and restlessness, vomiting, jam-like blood stools, and palpation of a sausagelike mass in the abdomen, the diagnosis can be confirmed. However, in clinical practice, about 10% to 15% of cases lack typical symptoms of acute intussusception when they come to the hospital for treatment, or only have 1 to 2 of the symptoms. At this time, the abdomen should be carefully examined for palpable masses, a空虚 feeling in the lower right abdomen, and anal examination to observe the gloves for jam-like mucus stools, in order to further confirm the diagnosis. If necessary, auxiliary examinations such as abdominal ultrasound can be performed to assist in diagnosis.

　　1. Air enema Before air enema, a comprehensive anteroposterior and lateral abdominal radiographic examination should be performed, observing the inflation and distribution of gas in the intestine. After injection, a dense soft tissue mass in the shape of a semicircle can be seen at the top of the intussusception, protruding into the colon, with a clear cup-shaped shadow formed at the front end of the gas, and sometimes part of the gas enters the sheath to form different degrees of clamping shadows. At the same time as the diagnosis is clear, pressure can also be applied for reduction treatment.

　　2. Abdominal ultrasound is the preferred examination method, which can assist in clinical diagnosis by showing characteristic imaging of intussusception. On the cross-section of intussusception, it appears as a 'concentric circle' or 'target ring' sign, and on the longitudinal section, it presents as a 'sleeve' sign.

　　Dietary taboos for patients with intussusception

　　1. Real symptoms

　　Type of real heat pressing downward

　　Commonly caused by wind with heat, clinically presenting with symptoms such as hematochezia, perianal swelling and pain, and erythema of the anal skin. While using traditional Chinese medicine to disperse wind and clear heat, diet can be supplemented with: (1) Patrinia scabiosa 60g, pig large intestine 250g, cooked into soup for consumption to clear heat and detoxify, alleviate pain and drain pus, relieve fatigue and pain, and is good for internal pain. (2) Fresh mung beans 50g, washed and soaked in a thermos as tea to cool the body, detoxify, relieve summer heat, and quench thirst, used for symptoms such as summer heat and thirst or boils and abscesses.

　　Type of downward invasion of damp-heat

　　Due to external invasion of dampness-heat or internal injury from diet, damp-heat accumulates, pressing down on the anal canal. Clinically, there may be hematochezia, or purulent stools, swelling and pain,坠胀, prolapse of internal hemorrhoids, leakage of pus and water, etc. While using traditional Chinese medicine to clear heat and drain dampness, diet can be supplemented with: (1) Coix seed 50g, lotus seed 50g, pig small intestine 250g, cooked into soup for consumption to promote diuresis and drain dampness, invigorate the spleen and relieve stiffness, clear heat and drain pus. (2) Rehmannia glutinosa 30g, Rhizoma Smilacis glabrae 30g, lean meat 250g, cooked into soup for consumption. (3) Water spinach can be eaten either dried or fresh after boiling. (4) Dandelion 30g, pig large intestine 250g, cooked into soup for consumption.

　　Type of heat and dryness in the colon

　　Due to dietary accumulation and retention, dampness transforms into heat, heat accumulates in the Yangming meridian, and constraints on the Taiyin meridian lead to abnormal升降of the spleen and stomach, with the qi of the fu not descending and fluid deficiency. Hematochezia and constipation are commonly seen. Traditional Chinese medicine is proposed to increase fluid, moisten and unblock the fu, with diet supplemented by: (1) Angelica sinensis 20g, Rehmannia glutinosa 30g, lean pork 250g, simmered for consumption. (2) Adzuki beans 30g, silver ear 20g, black glutinous rice 200g, cooked into porridge for drinking.

　　Second, Deficiency Syndrome

　　Deficiency of Qi and Blood

　　For those with chronic illness, weak physique, or elderly with depleted body, a series of symptoms of blood deficiency and deficiency can often be seen, such as: unceasing hematochezia, diarrhea, mucoid stools, constipation, sagging, prolapse of hemorrhoids, etc. Traditional Chinese medicine is prescribed to tonify Qi and nourish blood, and diet is matched: (1) American ginseng 20g, pig small intestine 250g, boil and take the soup to tonify Qi and nourish Yin, clear fire and generate fluid. (2) Astragalus 30g, Codonopsis 30g, lean pork 200g, stew and take. If Qi deficiency is severe, increase the amount of raw Astragalus; if blood deficiency is severe, add tonifying and blood-nourishing ingredients such as red dates.

　　The Western medical treatment methods for intussusception are as follows:

　　Non-surgical Treatment

　　In the early stage, air (or oxygen, barium) enema reposition can be used, with an efficacy of over 90%. This method is convenient to operate, simple to implement, does not require special equipment, and can be performed under X-ray. For critically ill children with intussusception, continuous inflation can be used to avoid the repeated retreatment of the intussusception head during intermittent inflation; intermittent multiple enemas can be used; this can make the intestinal wall tense and loose, intermittently reduce intraperitoneal pressure and reduce the intussusception resistance, so that the blood stasis in the sheath intestinal tract can quickly return to the intussusception head, reduce edema, and thus be conducive to the repositioning of intussusception. The therapeutic effect of intussusception diagnosis and treatment instruments is also good, and its main advantages are: simple equipment, simple operation method; low medical costs; avoids the contamination of the abdominal cavity by barium during barium repositioning when intestinal perforation occurs; avoids the trauma caused by routine laparotomy and the complications such as intestinal adhesion brought by surgery; at the same time, it has high diagnostic and therapeutic value. In addition, measures such as fractional pressure air enema combined with massage therapy, underwater hydrostatic enema repositioning therapy for children with acute intussusception, and barium enema repositioning for infants and young children with intussusception can also be adopted.

　　Surgical Treatment

　　If the Cope method is used, the incision can be made as a right midabdominal rectus sheath longitudinal incision, exposing the invaginated intestinal segment, and then gently squeezing the top of the invaginated part towards the proximal side with fingers until the invaginated intestinal segment is fully复位. If it is difficult to compress and reset, a small finger can be inserted between the outer sheath and the invaginated intestinal segment, gently separating the adhesions to facilitate repositioning. In addition, laparoscopic and appendiceal enteroclysis also have good therapeutic effects.