- The essence of the pathology of
- Why does it occur in infants?
- Pathological conditions contributing to a child's turnaround
- Symptoms of swelling of the intestines in children
- Dangerous complications
- Features of nutrition
- Why do relapses occur?
- What should I do when my baby is growing?
- Video on topic
Inversion of the intestines in children is a rare pathology that causes intestinal obstruction. The child does not have chronic diseases characteristic of an adult organism. Therefore, the causes of the disease differ from an adult person, especially - an advanced age. Disease in infants proceeds extremely The essence of the pathology
The essence of the pathology of
In cases of inversion, intestinal loops are twisted around their axis or mesenteric. Transportation of food is disrupted even if the bow of the intestinal loop is deviated by the baby 90 degrees from its normal direction. A larger angle causes compression of arterial vessels and nervous branches passing between the leaves of the mesentery. Vapor may be observed in several areas or in one place.
As a result, the intestinal tract ceases to be fed, the wall is necrotic. After necrosis, the permeability of the vessels increases, the effusion into the abdominal cavity begins. The wall of the gut ruptures, the contents exit into the abdominal cavity. This means that develops peritonitis. A deadly danger is created for the baby. The only way to save a child is an urgent operation.
Why does it occur in infants?
The most common cause of gut flukes as seen by pediatric surgeons is congenital malformations. They are more concerned with the small intestine. Identified in a newborn or at the age of up to a year.
With an abnormal intrauterine fetal formation, anatomical abnormalities are possible: the
- is an excessively long mesentery( the most common cause of small bowel swelling);
- disruption in the size of the initial and terminal areas of the intestine;
- internal hernia;
- formation of a cyst or tumor on a mesentery;
- functional deficiency of the sphincter system and valves of the gastrointestinal tract;
- connection of the intestinal loops with a common mesentery.
The development of anomalies is associated:
- with a complicated pregnancy;
- forced treatment of the future mother antibacterial drugs;
- hereditary disorders.
In infants, the first signs of obstruction can begin with the introduction of complementary feeding or a sharp transition to the artificial feeding of
It is important that the undeveloped digestive system is not ready to receive a new food substance. There comes a reaction in the form of impaired peristalsis: instead of alternating contractions of circular and longitudinal fibers, pronounced spasms, a backward wave, form. By turning the wrist constipation in infants, stasis stool.
Pathological conditions that contribute to a child's spine
At the age of up to 6 years, the frequent cause is the formation of a glistular coil in the intestine until complete obstruction. Among other reasons, it can be noted:
- dehydration of the body with a lack of drinking, in the heat, in cases of severe intoxication;
- belly trauma;
- functional or pathological spasm and intestinal paresis;
- adhesive process after a surgery or untreated enterocolitis;
- compression of the intestinal loops by tumor formation, cyst;
- Hirschsprung's disease - a rare congenital disease, is determined by the absence of nerve endings in the wall of the large intestine, in these areas the peristalsis is impossible, constipations are formed;but the overlying intestine is actively contracting, and this creates conditions for the turn of the sigmoid colon in newborns;
- megacolon - an anomaly of an innate character, is expressed in a significant increase in the large intestine and underdevelopment of the system of nerve endings, manifested with persistent constipation from the first month of life.
Symptoms of gut flusation in children
Clinically, the turn is manifested by mechanical obstruction at the point of torsion. An initial symptomatology can be noticed by attentive parents. Pain syndrome occurs suddenly, the child screams. Older children describe the cramping character of pain. Perhaps the development of pain shock.
Repeated excruciating vomiting with an unpleasant odor. With intestinal obstruction first eaten food, then bowel movements. Vomiting does not bring relief, it is more pronounced when the small intestine turns. A rare gag reflex indicates a lesion in the large intestine.
Asymmetric bloating due to over-inflating of the adductor gut and dilution of the outflowing department, tension of the muscles of the abdominal wall. In the initial period, the stool was removed, followed by a complete stool and gas retention. When setting the enema, if the turn is in the small intestine, the feces come from the lower parts, blood may be included.
Infringement of the umbilical hernia creates conditions for torsion of the intestine
Increases temperature to high digits with a spasmodic decline. Babies often hiccup for three days, even after surgery. In a newborn baby with a twist, attention is drawn to the cyanotic nasolabial triangle, the desire to draw knees to the trunk. In subacute, seizures are accompanied by interruptions and improvement of the condition. At the height of the disease the baby becomes weak, sluggish, restless. These are signs of an increase in intoxication.
Dangerous complications of
The goal of starting therapy in the first 3 days from the onset of bloat symptoms is the possibility of avoiding complications. When they occur, the condition of the child deteriorates sharply, the prognosis of a successful outcome decreases.
Frequent painful vomiting contributes to the loss of a significant volume of fluid and electrolytes. There is no absorption of the liquid part of the stool in the large intestine when turning, which further aggravates the state of dehydration:
- blood condenses;
- decreases blood pressure;
- drops the power of the heart.
Due to the increased permeability of necrotic areas of the intestine through it, uncleared slags and toxic substances enter the bloodstream. The body reacts with fever, chills, muscle and headaches.
Perforation of the wall
Perforation( perforation) of the intestinal wall occurs as a result of its thinning with disturbed nutrition. Therefore, a wave of peristalsis causes a break in the bowel that has lost its strength. The contents of the loop( slags, poisons, stool, intestinal bacteria) enter the abdominal cavity. This is the formation of stony peritonitis. Peritoneal sheets have a high absorbing capacity. Through them, all toxic substances will additionally enter the bloodstream and further intensify intoxication.
Necrosis of the intestine with the termination of the blood supply is called gangrene. Dead tissues enter the abdominal cavity with peritonitis. Therefore, for treatment, it is important to remove( excise) nonviable tissues in time. Then rinse the abdominal cavity repeatedly with antimicrobials.
Sepsis is a pathological condition that causes pathogenic microbes penetrated into the bloodstream. They are carried throughout the body, form abscesses in any organ. It is manifested by severe intoxication, resistance to the action of antibiotics.
Adhesions called extensions of scar tissue at the site of the former inflammation. They begin with the deposition of a fibrin film. Next, adjacent loops are glued together, and scar tissue displaces and changes the normal position of the loops. During expansion, the loop can be squeezed. This contributes to a twist and poses a threat to life, as self-adhesions do not disappear.
Remote site with internal lumination of small intestine and gangrene
A small child is difficult to keep in front of the screen of an X-ray machine or to give him a drink of barium. The basis of diagnosis is the experience of surgeons. With palpation of the abdomen, the specialist probes the swollen soft formation of the leading loop, an empty space in the zone of the bowel.
Pay attention to asymmetric bloating of the baby's belly. In digital research, the empty rectum is determined. The absence of peristalsis is judged with auscultation of the abdomen, noise of splashing. To distinguish the curvature of the intestine from appendicitis in a small child is very difficult. Practically the final confidence in the diagnosis comes during the operation and a visual examination of the intestine.
If you see similar symptoms, you must call an ambulance. Children along with one of the parents are hospitalized in the surgical department and first observed. Remove the volvulus and pain trying to block the Novocaine blockade. The meaning of conservative measures is the removal of the increased voltage in the driving loop and the spontaneous deployment of the node.
Through the subclavian vein, saline solutions, anti-shock drugs, pain relievers, Hemodez are introduced to combat intoxication. Be sure to wash the intestine with a siphon enema. The condition improves when the stomach is washed, installing a thin gas pipe. The introduction of antibacterial drugs is carried out by intravenous or intramuscular route, depending on the condition of the child.
Surgical treatment consists in spreading loops, fixing the mesentery, if the intestinal tissues are viable. In the presence of necrotic sites, they must be removed( gut resection).
Undamaged ends are connected by one of the methods. Spikes dissect. In specialized clinics, surgery is performed using laparoscopic techniques.
In severe cases of peritonitis and inflammation of the intestinal loops, the ends can not be stitched until the inflammatory response is removed. Then it is necessary to operate step by step:
- first remove the necrotic area and remove the stoma on the skin of the abdomen( feces will enter the caloric intake);
- after curing peritonitis, after about 3 months, the second stage is performed - connect the ends of the intestine and remove the stoma.
The newborn for continuous transfusion of fluid is installed a permanent catheter in the umbilical vein
Features of nutrition
After successful conservative straightening of the curvature there is a danger of recurrence. Parents are informed about the prognosis and recommend to organize a baby diet food. Feeding should be done 6 times a day. All dishes should be wiped, easy to digest.
Liquid porridge of oatmeal, rice, buckwheat, jelly, mucilage soups are suitable. They can add milk, but not fat. Breastfeeding is best to continue breastfeeding. Do not allow dishes from raw vegetables, juices, flour products.
Why do relapses occur?
Successfully completed the operation, the vortex is straightened. But the patient or parents of the baby are warned about the danger of relapse( repetition).Surgeons believe that in the occurrence of relapses play a role:
- A reduced amount of surgery due to the severity of the patient's condition( loop "untwisted", but there remained a long mesentery, a mobile caecum).Relapse can be avoided by sewing a wrapped loop to the abdominal wall.
- Formation of adhesions between intestines, gluing different areas of the intestine and predisposing to a new twist.
In order to prevent relapse, it is advised:
- to control the diet, not to allow long breaks, overfeeding;
- prevent constipation, do not use laxatives;
- remember the importance of motor activity for the child, do joint exercises, walk more.
What should I do when a baby grows?
When growing up, children's anatomical abnormalities become not so dangerous or completely eliminated. The consistency of intestinal sphincters is being established. Become proportional to the size of the intestine. The organism adapts itself to life with its own characteristics.
But the threat can arise when there are chronic diseases in the adolescent period. Therefore, in the upbringing of the child, attention should be paid to proper nutrition, to refusal from any alcohol, soda, fast food. The disease does not spare any babies or old people. Seeking medical help gives a chance not only to maintain health, but also to survive.