The essence of pathology
In cases of volvulus, the intestinal loops twist around their axis or the mesenteric one. Transport of food is disrupted even when the baby's intestinal loop deviates 90 degrees from its normal direction. A larger angle causes compression of the arterial vessels and nerve branches passing between the layers of the mesentery. Volvulus can be observed in several areas or in one place.
As a result, a section of the intestine stops receiving nutrition, and the wall becomes necrotic. Following necrosis, vascular permeability increases, and effusion into the abdominal cavity begins. The intestinal wall ruptures and the contents exit into the abdominal cavity. This means that fecal peritonitis is developing. This creates a mortal danger for the baby. The only way to save the child is urgent surgery.
Complications
Peritonitis in children and adults is dangerous due to the development of multiple organ failure and intoxication of the body. Among the complications of the acute process:
- dehydration;
- renal failure;
- toxic shock;
- pulmonary pathologies;
- liver failure;
- secondary inflammatory processes.
Peritonitis after surgery may be accompanied by the formation of fistulas and abscesses of internal organs, and suppuration of postoperative sutures. The appearance of a number of complications is possible far beyond the abdominal cavity - occlusion of deep veins, inflammation of the lungs and pleura, mediastinitis.
Why does it occur in infants?
The most common cause of intestinal volvulus, as observed by pediatric surgeons, is congenital developmental anomalies. They are more concerned with the small intestine. Determined in a newborn or under one year of age.
If the intrauterine formation of the fetus is disrupted, anatomical deviations are possible:
- excessively long mesentery (the most common cause of small intestinal volvulus);
- violation of the size of the initial and final sections of the intestine;
- internal hernia;
- formation of a cyst or tumor on the mesentery;
- functional insufficiency of the sphincter system and valves of the gastrointestinal tract;
- connection of intestinal loops by the common mesentery.
The development of anomalies is associated with:
- with a complicated pregnancy;
- forced treatment of the expectant mother with antibacterial drugs;
- malnutrition;
- hereditary disorders.
In infants, the first signs of obstruction may begin with the introduction of complementary foods or a sudden transition to artificial feeding
What matters is the unpreparedness of the underdeveloped digestive system to accept a new food substance. A reaction occurs in the form of impaired peristalsis: instead of alternating contractions of the circular and longitudinal fibers, pronounced spasms and a reverse wave are formed. Volvulus is caused by constipation in infants and stagnation of feces.
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What it is?
Volvulus is an acute intestinal obstruction that begins to progress due to rotation of the intestine around the mesenteric axis. This can also occur due to twisting of a certain section of the intestine together with the mesentery around the axis (the process is accompanied by severe circulatory disorders).
Most often, this pathology is diagnosed in children under one year of age. This is due to the fact that their peristalsis has not yet fully normalized, so some part of the small intestine may enter the large intestine.
Pathological conditions that contribute to bloat in a child
At the age of 6 years, a common cause is the formation of a helminthic ball in the intestines to the point of complete obstruction. Other reasons include:
- dehydration of the body due to lack of drinking, in the heat, in cases of severe intoxication;
- abdominal injury;
- functional or pathological spasm and intestinal paresis;
- adhesions after surgery or untreated enterocolitis;
- compression of intestinal loops by a tumor formation or cyst;
- Hirschsprung's disease is a rare congenital disease, determined by the absence of nerve endings in the wall of the large intestine, in these areas peristalsis is impossible, constipation occurs; but the overlying intestine actively contracts, this creates conditions for volvulus of the sigmoid colon in newborns;
- megacolon is a congenital anomaly, expressed in a significant enlargement of the large intestine and underdevelopment of the system of nerve endings, manifested by persistent constipation from the first month of life.
Symptoms of volvulus in children
Clinically, volvulus is manifested by mechanical obstruction at the site of torsion. Attentive parents can notice the initial symptoms. The pain syndrome occurs suddenly, the child screams. Older children describe the cramping nature of the pain. Pain shock may develop.
Repeated painful vomiting with an unpleasant odor. In case of small intestinal obstruction, first the food eaten, then the intestinal stool. Vomiting does not bring relief; it is more pronounced with volvulus of the small intestine. A rare gag reflex indicates a lesion in the large intestine.
Asymmetrical bloating of the abdomen due to overinflation of the adductor colon and collapse of the efferent colon, tension in the muscles of the abdominal wall. In the initial period, the passage of feces, then complete retention of stool and gases. When giving an enema, if a volvulus occurs in the small intestine, feces are released from the lower sections, and blood may be included.
A strangulated umbilical hernia creates conditions for intestinal torsion
Temperature rises to high levels with an abrupt decline. Babies often hiccup for three days, even after surgery. In a newborn baby, during volvulus, attention is paid to the cyanosis of the nasolabial triangle and the tendency to pull the knees towards the body. In the subacute course, attacks are accompanied by breaks and improvement. At the height of the illness, the baby becomes weak, lethargic, and restless. These are signs of increasing intoxication.
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Symptoms
Among the first symptoms of volvulus are cramping pain of varying intensity that increases over time, nausea and vomiting. After some time, the reflux of feces into the stomach develops and the vomit acquires a characteristic odor. The patient passes gas, but does not have stool. Intestinal motility does not disappear at the onset of the disease, and peristalsis can be seen through the abdominal wall. The abdomen takes on an asymmetrical shape, and bloating rapidly increases. During the medical examination, other symptoms of intestinal volvulus become obvious: tachycardia, drop in blood pressure, increase in body temperature (with the formation of intestinal necrosis or peritonitis), dry mouth, during fluoroscopy, intestinal loops swollen with gas or accumulated fluid (Kloiber cups) are noticeable ). During palpation, abdominal bloating, local compaction or abnormal softness of certain areas of the abdomen, pain are noted, and characteristic dripping sounds can be heard on auscalation.
Dangerous complications
The goal of starting therapy within the first 3 days from the onset of volvulus symptoms is to avoid complications. When they occur, the child’s condition sharply worsens and the prognosis for a successful outcome decreases.
Dehydration
Frequent, painful vomiting contributes to the loss of a significant amount of fluid and electrolytes. There is no absorption of the liquid part of feces in the colon during volvulus, which further aggravates the state of dehydration:
- blood thickens;
- blood pressure decreases;
- the strength of heart contractions decreases.
First of all, the brain suffers (dizziness, drowsiness, loss of consciousness). If 15% of fluid is lost, the patient dies.
Intoxication
Due to the increased permeability of necrotic areas of the intestine, non-neutralized waste and toxic substances enter the bloodstream through it. The body reacts with an increase in temperature, chills, muscle pain and headaches.
Wall perforation
Perforation (perforation) of the intestinal wall occurs as a result of its thinning due to poor nutrition. Therefore, a wave of peristalsis causes rupture of the intestine that has lost its strength. The contents of the loop (waste, poisons, feces, intestinal bacteria) enter the abdominal cavity. This is how fecal peritonitis is formed. The leaves of the peritoneum have a high absorption capacity. Through them, all toxic substances will additionally enter the bloodstream and further increase intoxication.
Gangrene of the wall
Necrosis of an area of the intestine with cessation of blood supply is called gangrene. Dead tissue enters the abdominal cavity during peritonitis. Therefore, for treatment it is so important to remove (excise) non-viable tissue in a timely manner. Then rinse the abdominal cavity repeatedly with antimicrobial agents.
Sepsis
Sepsis is a pathological condition caused by pathogenic microbes entering the bloodstream. They spread throughout the body, forming ulcers in any organ. Manifests itself as severe intoxication and resistance to antibiotics.
Adhesive disease
Adhesions are the growth of scar tissue at the site of former inflammation. They begin with the loss of fibrin film. The adjacent loops then become glued together, and the scar tissue displaces and changes the normal position of the loops. When it grows, the loop may be compressed. This promotes volvulus and poses a threat to life, since the adhesions will not disappear on their own.
Removed area with internal volvulus of the small intestine and gangrene
Danger of intestinal obstruction
With advanced obstruction, feces are sometimes thrown into the stomach. In this case, intussusception in children makes itself known by vomiting with a characteristic odor. The phenomenon is considered extremely unfavorable for the body, because it is poisoned by waste and toxins. If parents hesitate to go to the clinic, twisting of the intestine will lead to such consequences as:
- sepsis;
- peritonitis;
- dehydration;
- necrosis of intestinal tissues;
- rupture of the problematic intestine;
- violation of water-salt balance.
In the worst cases, death occurs from volvulus of the large or small intestine. But even if the child survives, intussusception affects his further development and causes diarrhea or constipation.
Diagnostics
It is difficult to hold a small child in front of the X-ray screen or give him barium to drink. The basis of diagnosis is the experience of surgeons. When palpating the abdomen, the specialist palpates the swollen soft formation of the afferent loop, an empty space in the area of the efferent intestine.
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Pay attention to the asymmetrical bloating of the child’s abdomen. A digital examination reveals an empty rectum. The absence of peristalsis is judged by auscultation of the abdomen and splashing noise. It is very difficult to distinguish intestinal volvulus from appendicitis in a small child. Almost final confidence in the diagnosis comes during surgery and visual examination of the intestine.
Tests suggest inflammation: leukocytosis and ESR are increasing. In the severe stage, the hematocrit drops due to dehydration, and electrolytes decrease.
Treatment
If similar symptoms appear, you must call an ambulance. Children, together with one of their parents, are hospitalized in the surgical department and are first observed. They are trying to relieve the volvulus and pain with novocaine blockade. The meaning of conservative measures is to relieve increased tension in the adductor loop and spontaneous deployment of the node.
Saline solutions, anti-shock drugs, painkillers, and Hemodez are administered through the subclavian vein to combat intoxication. Be sure to wash the intestines with a siphon enema. The condition improves with gastric lavage and installation of a thin gas outlet tube. Antibacterial drugs are administered intravenously or intramuscularly, depending on the child’s condition.
Symptoms and treatment of intestinal diverticulosis
Surgical treatment consists of straightening the loops and securing the mesentery if the intestinal tissue is viable. If necrotic areas are present, they must be removed (bowel resection).
The undamaged ends are connected using one of the methods. The adhesions are dissected. In specialized clinics, surgery is performed using laparoscopic technology.
In severe cases of peritonitis and inflammation of the intestinal loops, the ends cannot be sutured until the inflammatory reaction has resolved. Then you have to operate step by step:
- First, the necrotic area is removed and the stoma is placed on the skin of the abdomen (feces will flow into the colostomy bag);
- after the peritonitis is cured, about 3 months later, the second stage is carried out - the ends of the intestine are connected and the stoma is removed.
For newborns, a permanent catheter is installed in the umbilical vein for long-term fluid transfusion.
Nutritional Features
After successful conservative straightening of the volvulus, the risk of recurrence remains. Parents are informed about the prognosis and are recommended to organize dietary meals for the baby. Feeding must be done 6 times a day. All dishes should be pureed and easy to digest.
Liquid porridges made from oatmeal, rice, buckwheat, jelly, and slimy soups are suitable. You can add milk to them, but not fat. It is best for infants to continue breastfeeding. Dishes made from raw vegetables, juices, and flour products should not be allowed.
Why do relapses occur?
The operation was successful, the volvulus was straightened. But the patient or the baby’s parents are warned about the danger of relapse (repetition). Surgeons believe that the following play a role in the occurrence of relapses:
- Reduced scope of surgical intervention due to the severity of the patient’s condition (the loop was “untwisted”, but a long mesentery and a mobile cecum remained). Relapse can be avoided by suturing the wrapped loop to the abdominal wall.
- The formation of adhesions between the intestines, gluing together different parts of the intestine and predisposing to a new volvulus.
To prevent relapse, it is recommended:
- control the diet, avoid long breaks and overfeeding;
- prevent constipation, do not use laxatives;
- remember the importance of physical activity for a child, do joint exercises, and take more walks.
Reasons for development
The cause of intestinal obstruction may be intestinal spasm or paresis. Increased peristalsis can lead to intestinal volvulus, which requires mandatory surgical intervention. Increased peristalsis, in turn, can be caused by eating foods rich in plant fiber. Intestinal motility also becomes more pronounced during intestinal infection and overdose of certain medications.
A foreign body may enter the intestinal lumen; in some cases, the passage of the contents is prevented by a tumor. Sometimes the cause of intestinal volvulus is adhesive disease - a complication after suffering peritonitis. In early childhood, intestinal obstruction can be accompanied by developmental defects and nutritional disorders.
The causes of volvulus are divided into several types. Mechanical intestinal obstruction can be caused by a foreign body blocking the intestinal lumen (obstructive obstruction) and compression of a separate area of the intestine from the outside (strangulation).
Strangulation intestinal obstruction is accompanied by compression of the mesentery and the vessels through which blood flows to this part of the intestine, which can cause gangrene. In pediatrics, cases of intussusception are common, accompanied by the entry of a separate section of the intestine into an adjacent one with the formation of a circular fold. In addition, volvulus in children can develop due to strong motor skills and a long mesentery.
Spasm or paresis of muscle fibers can lead to dynamic and paralytic obstruction, respectively. Such changes in muscle tone may be associated with certain diseases of internal organs: urolithiasis, myocardial infarction. Also, disturbances in the contraction of muscle fibers can occur after surgery in the intestinal area, after taking potent medications, as a result of lead poisoning, and in certain diseases of the central nervous system.
In rare cases, spastic volvulus in children may develop due to massive helminthic infestation.
What to do when the baby grows?
As children grow older, anatomical anomalies become less dangerous or are completely eliminated. The consistency of the intestinal sphincters is improved. The size of the intestines becomes proportional. The body adapts quite well to life with its own characteristics.
But a threat can arise when chronic diseases appear during adolescence. Therefore, when raising a child, you need to pay attention to proper nutrition, avoiding any alcohol, soda, or fast food. The disease spares neither children nor the elderly. Seeking medical help gives you a chance not only to stay healthy, but also to survive.
