Opening line/ Definition: Mitch

Good morning everyone! Today we are going to discuss the disorder

“Intussusception”.

By definition, intussusception is a rare and serious condition wherein a part of an

intestine folds or slides into an adjacent part of the intestine. This usually occurs in
the small intestine and only a few rare cases happen in the large intestine. Once this
condition happens it often blocks food or fluid from entering or passing through, it
also has the possibility to cut off the blood supply to the part of the intestine that’s
affected. Intussusception typically occurs in children, especially those who are very
young.

Predisposing/ precipitating factors: Raz

Intussusception, although may arise from differing causes, have an identified

set of predisposing factors. This includes age, sex, malformations of the intestinal
tract at birth, and certain underlying conditions of the individual. Age is a factor of
this as it has a higher chance of developing in children ages 6 months to 3 years
old. Following this, sex is a factor since intussusception has a three to four times
higher chance of occurring in males than in females. Cases where the child has
intestinal malformations are also prone to this condition due to the defective
formation or rotation of the intestines. Lastly, underlying genetic conditions
particularly Cystic Fibrosis, inflammatory bowel diseases, and immune system
disorders are a risk factor of Intussusception Cystic fibrosis accounts for a build-up
of mucus, which leads to blockage in the intestinal tract. Meanwhile, inflammatory
bowel diseases such as Crohn’s disease leads to a chronic inflammation and
narrowing of the intestinal tract. Both of these increase the development of
Intussusception in the child

Meanwhile, precipitating factors of Intussusception include bacterial and viral

infections such as bacterial enteritis, adenovirus, and rotavirus. Consequently,
seasons where viral gastroenteritis cases increase in cold weather such as fall and
winter are also factors. Particularly, some forms of the rotavirus vaccine were
removed from the market due to the higher incidence of Intussusception after
receiving it
Disease Process 1: Mitch

Moving on, we will now discuss the disease pathology. The small intestine is
responsible for the absorption of nutrients. Most absorption occurs in the first two
portions of the intestine, namely the duodenum and the jejunum. From there, the
intestinal contents present as an acidic chyme due to its passing from the stomach
and into the small intestine. The mucosa of the small intestine is made up of ­simple
columnar epithelium with four major cell types: absorptive, goblet, granular, and
endocrine cells. These cells produce digestive enzymes (by absorptive cells),
protective mucus (by goblet cells), and regulatory hormones (by endocrine glands).
Furthermore, these intestinal secretions lubricate and protect the intestinal wall from
the chyme and the action of digestive enzymes. The movement of chyme is assisted
by the body’s peristaltic contractions that mix and propel chyme further toward the
ileum, the third portion of the small intestine that is responsible for receiving the
intestinal contents and delivering it to the large bowel. The site where the ileum
connects to the large intestine is termed as the ileocecal junction in which it has a
ring of smooth muscle that propels chyme forward, not allowing it to traverse the
opposite direction due to the function of the ileocecal valve.

The disorder is almost always recognized at the ileum which tends to fold
towards the cecum, a portion of the large intestine, due to peristaltic movement. The
process of obstruction starts when the proximal ileum projects into cecum, prolapsing
into its lumen. A diagnostic test that can be performed to ascertain the extent of the
prolapse is ultrasound. This painless test uses sound waves to create images of the
intestines. It is the most effective tool for diagnosing intussusception, as it can often
visualize the telescoped segment. The appearance of a target sign, also known as a
doughnut sign, on ultrasonography is indicative of intussusception. These
symptoms are very specific for the diagnosis of intussusception and symptomatic of
the telescoping of the intestinal loops.

Disease Process 2: Raz

Furthermore, intestinal contents including chyme, fluid, flatus, or gas

accumulate proximal to the obstruction which causes the bowel preceding the
ileocecal junction to dilate and be bloated, leading to abdominal distention and fluid
retention. This can be determined through Abdominal X-ray. While not definitive, an
X-ray can reveal signs of intestinal obstruction, such as gas and fluid buildup in
abnormal patterns. Because of this, there is now a reduction of fluid absorption in the
intestinal lumen which stimulates more gastric secretion. Moreover, the ileocecal
sphincter at the juncture of the ileum remains mildly contracted most of the time,
leading to compression of the mesenteric vessels. Due to this obstruction, an NGT
may be placed in order to release air that is trapped in the bowel. With this, we have
come up with a nursing diagnosis of Risk for Impaired Skin Integrity related to
prolonged NG tube placement This can be managed by: (1) Applying skin barrier
cream around the insertion site to prevent irritation. (2) Secure the NG tube properly
to minimize accidental pulling. (3) Assess for redness, pressure sores, or infection at
the insertion site.

Disease Process 3: Mitch

With increasing distention, pressure within the intestinal lumen increases,

causing a decrease in venous and arteriolar capillary pressure. As a result, venous
congestion and tissue edema occurs. Since the disorder appears to be idiopathic,
this is called primary intussusception. Primary intussusception disrupts the normal
flow of intestinal contents and leads to a series of characteristic signs and symptoms,
which include:

● Abdominal pain: This is the most common symptom and often presents as
severe, localized pain that comes and goes. Children may suddenly draw
their legs and cry in response to the pain.

This gives us a nursing diagnosis of Acute Pain related to bowel

obstruction and inflammation. This can be managed by: (1) Assessing pain using
age-appropriate tools and monitoring response to pain medication. (2) Administer
pain medication as prescribed, considering non-opioid options first. (3) Provide
comfort measures like positioning and distraction techniques.

● Constipation: Since the blockage prevents stool from passing normally, the
child may not have a bowel movement for a while.

Another sign and symptom would be: Vomiting as the body tries to expel the
blockage, leading to forceful vomiting of stomach contents and sometimes bile. This
leads us to a nursing diagnosis of Deficient Fluid Volume related to vomiting and
inability to absorb fluids. This can be managed by: (1) Monitoring vital signs and
intake and output (I&O) closely. (2) Administer intravenous (IV) fluids as ordered to
maintain hydration. (3) Monitor for signs of dehydration like dry mucous membranes
and sunken fontanels in infants.

Lastly, a child with intussusception may have Bloody stools: This is a

hallmark sign of intussusception. Blood and mucus mix with stool, giving it a red,
jelly-like appearance, often described as “currant jelly stools”.

Disease Process 4: Raz

Untreated intussusception can lead to severe complications like ischemia,

tissue death, bowel perforation, peritonitis, and sepsis, a life-threatening condition
involving organ failure and shock

In addition, those children with intussusception, aged 6 months to 2 years old,

particularly among Asian populations, have a history of intestinal vasculitis,
Peutz-Jegher disease, Meckel diverticulum, and intestinal polyps as a resultant
secondary vector of intussusception. These pathological “lead-points” result in a
secondary intussusception.

Secondary intussusception is mostly preceded by polyp growth, inflammation,

or even congenital deformities such as diverticulum. Intestinal vasculitis is the
inflammation of mesenteric blood vessels that may cause invagination due to bowel
wall ischemia precipitated by impeded vascular flow (Gnanapandithan & Sharma,
2023). On the other hand, Peutz-Jeghers syndrome is a rare inherited disorder in
which polyps grow in the small intestine. The presence of polyps creates a lead point
that acts as a focal area of traction that draws the proximal bowel within the
peristalsing distal bowel. Surgical intervention is often necessary to remove the lead
point and repair the intestine. Therefore, two possible nursing diagnoses can be
formulated for children with secondary intussusception:

Anxiety related to hospitalization and invasive procedures (for

parents/caregivers)

This can be managed by: (1) Providing clear and concise information about
the condition and treatment plan. (2) Encourage open communication and address
any concerns promptly. (3) Offer emotional support and resources to help them cope
with the situation.
Risk for Deficient Knowledge related to intussusception and post-operative
care (for parents/caregivers)
This can be managed by: (1) Educating parents about intussusception
symptoms, causes, and treatment options. (2) Instruct on post-operative care,
including monitoring for signs of infection and feeding guidelines. (3) Provide
resources and contacts for further information and support.