INTUSSUSCEPTION

• Itis a process in which a segment of intestine

invaginates or telescopes into the adjoining
intestinal lumen, causing bowel obstruction. Also called “telescoping” • It occurs most
commonly at the juncture of the ileum and the colon, although it can appear elsewhere
in the intestinal tract.
• The invagination is from above downward, the upper portion slipping over the lower
portion pulling the mesentery along with it.
• Most common cause of intestinal obstruction in infants and young children.

ETIOLOGY

Types of intussusception
• Ileocolic - the small intestine “telescope” into the colon (most common intussesception)
• Ileoileal - small intestine “telescope” into itself
• Colocolic - long intestine “telescope” into itself

- ileoleal and colocolic occurs less frequently than ileocolic intussusception

Parts:
• Inner tube - the entering part
• Middle tube - returning part
• Outer tube - intussuscepiens

Intussusception signs and symptopms are

• Abdominal pain
• Vomiting
• Bleeding per rectum (85%)

Early symptoms include:

• Nausea
• Vomiting
• pulling legs to the chest area and intermittent moderate to severe cramping abdominal
pain

Later symptopms include:

• Rectal bleeding
• Bloody stool (currant jelly stool) and
• Palpable “sausage shaped” abdominal mass

Intussusception Risk factors

• Age (6 - 36 months)
• Male > female
• Abnormal intestinal formation at birth
• Certain condition: Cystic fibrosis, Henoch-Schonlein purpura (IgA vasculitis), crohn’s
disease and celiac disease
• Having had one previously
• Having a siblings with intussusception
• Having intestinal malrotation

Diagnostic Test
• Ultrasound
• Abdominal X-ray
• Palpation
• Radiographs
• CT scan
• Ultrasonography
• Contrast enema

Medical management
intussusception is an emergency in the sense that prolonged delay is
dangerous. • Intravenous Fluid -
• Therapeutic enema - Therapeutic enemas can be hydrostatic, with either barium or
water-soluble contrast, or pneumatic, with air insufflation; therapeutic enemas can be
performed under fluoroscopic or ultrasonographic guidance;
• Surgical reduction -
• Laparoscopy - has been added to the surgical armamentarium in the treatment of
intussusception; can be performed in all cases of intussusception; reduction of the
intussusception, confirmation of radiologic reduction, and detection of lead points
have all been reported.

Pharmacological Management
• Inthe immediate postoperative period, weight-adjusted intravenous morphine is
usually administered.
• Acetaminophen with codeine or ibuprofen is given orally
• Patients with HSP or hemophilia and intussusception require standard therapy for the
individual disease

Nursing management/assessment
• Physical
examination
• History

Nursing Diagnosis
• Acute pain
• Deficient fluid volume
• Ineffective breathing pattern
• Anxiety

Nursing intervention
• Intravenous fluid
• Decompression
• Monitor I&O
• Education

Evaluation
• The patient shows stable vital signs.
• The patient exhibits balanced intake and output.
• The patient’s pain decreases and is comfortable.
• The patient’s pattern of breathing is effective.
• The caregiver’s anxiety is resolved.

Health education
• Give your child lots of fluids.
• Have your child rest until your child feels better.
• Give your child sips of water or drinks such as Pedialyte or Gastrolyte. • Do not use
them as the only source of liquids or food for more than 12 to 24 hours. • Give your child
medicines exactly as directed. Call your doctor or nurse call line if you think your child is
having a problem with a medicine.

QUESTIONS WITH ANSWER

1. A patient is admitted to the hospital with complaints of nausea, vomiting, diarrhea,

and severe abdominal pain. Which of the following would immediately alert the nurse
that the patient has bleeding from the GI tract?
A. Complete blood count.
B. Guaiac test.
C. Vital signs.
C. Abdominal girth.

2. A nurse is preparing to care for a child with a diagnosis of intussusception. The

nurse reviews the child’s record and expects to note which symptom of this disorder
documented?
A. Watery diarrhea
B. Ribbon-like stools
C. Profuse projectile vomiting
D Bright red blood and mucus in the stools

3. Which question would be most helpful in obtaining a nursing history from the
mother of an infant with suspected intussusception?
A. Is your child eating normally?
B. How often has your child been vomiting?
C. What do your child’s stools look like?
D. When did your child last urinate?

4. A 2-year-old is hospitalized with suspected intussusception. Which finding is

associated with intussusception?
A. “Ribbon-like” stools
B. “Currant jelly” stools
C. Palpable mass over the flank
D. Projectile vomiting

5 Will is being assessed by Nurse Lucas for possible intussusception; which of the
following would be least likely to provide valuable information?
A. Abdominal palpation
B. Pain pattern
C. Family history
D. Stool inspection