INTUSSUSCEPTION

Prepared by:
Aisha H. Alagha
Definition:
Intussusception is a condition that occurs
when one portion of the intestine that
invaginates or telescopes into another
portion.
Etiology:
The cause of intussusception is not known.
Conditions that may lead to the problem
include:
 Viral infection.
 Enlarged lymph node in the intestine.
 Intestinal polyp or tumor.
 Abdominal surgery or injury or intubation.
 Acute gastroenteritis.
 Malabsorption disease as cystic fibrosis and
celiac disease.
Incidence:
 Common age of onset 4-10 months in
healthy well nourished child.
 Frequency of occurrence increase at 1-2
years old, rare at 1st months of life.
Classification according location:
1. Ileoceccal(most common): ileum
invaginates into cecum.
2. Ileo colic: ileum invaginates into cecum
then ascending colon.
3. Colocolic: colon invaginates into colon.
4. Ileoileal: ileum invaginates in ileum.
Signs and Symptoms
 Acute abdominal pain.
 Vomiting(1st gastric content then bile
stained).
 Fever.
 Dehydration.
 Abdominal distention.
 Lethargy.
 Grunting noises because of pain.
 Current jelly stool.
The classic symptomatic traid for intussusception
include:
 Paroxysmal, episodic abdominal pain with
vomiting every 5 to 30 minutes.
 Screaming and drawing up legs with
periods of calm, sleeping, or lethargy
between episodes.
 Stool, possibly diarrheal in nature, with
blood.
Diagnostic evaluation:
 History and clinical manifestation.
 X-ray examination.
 Flat plate of abdomen( appear like stair
steps).
 Barium enema( coil- like appearance).
 Ultrasonogram.
 PR( current jelly stool).
Treatment
 Hydrostatic reduction of affected portion
with barium enema( at 1st 48 hrs.).
 Surgical reduction of intussusception( if
more than 2 days because chance of
perforation increase).
Saline enema
 a salt-water enema. Hypertonic saline
enema is used to treat worm infestations
by inducing peristalsis and evacuation. A
normal saline enema of 1 teaspoonful of
salt per 0.5 L of water is instilled slowly
and retained as long as possible to
combat shock or replace lost fluids.
Barium enema
 A barium enema, also known as a lower
GI (gastrointestinal) exam, is a test that
uses x-ray examination to view the large
intestine. There are two types of this test:
the single-contrast technique where
barium sulfate is injected into the rectum
in order to gain a profile view of the large
intestine; and the double-contrast (or "air
contrast") technique where air is inserted
into the rectum.
Complication:
 Perforation.
 Peritonitis.
 Sepsis.
Nursing care :
 When the child has been diagnosed with
intussusception, the nurse can provide
information about the condition and
reassurance to the parents. The nurse is
responsible for monitoring the child for signs
of perforation, peritonitis(inflammation of
the abdominal cavity), or shock in addition
to evidence of increased pain. The nurse also
monitors and records the child’s stool. The
spontaneous passing of a stool may indicate
a resolution of the obstruction.
Pre-operative care:
 Maintain good hydration of child.
 Help parents and child to prevent vomiting
and prevent aspiration by NGT insertion.
 Keep child NPO and care of him( mouth
care).
 Prepare child to surgery.
 Take V/S especially respiration and temp.
 CBC, electrolytes level and urine analysis
should be done.
Post-operative care:
 Observe child condition, maintain airway
patency and respiratory pattern.
 Observe child post hydrostatic barium
enema( V/S, general condition, abd.
Distention, bowel sounds, lethargy).
 Sterile technique of dressing and separate
the diaper from incision site at the same
time observe if there is bleeding.
 Observe S&S of complication as(diarrhea,
shock, dehydration, fever, peritonitis and
toxicity).
Nursing management
 Intravenous fluids.
 Decompression: A nasogastric tube is
inserted to decompress the bowel.
 Monitor I&O: Replace volume lost as
ordered, and monitor the intake and
output accordingly.
 Education.
Nursing diagnosis
 Altered in comfort and pain related to
fever, paroxysmal abdominal pain as
evidence by crying and fatigue.
 Deficient fluid volume related to vomiting.
Nursing Interventions

 Assess pain level of the child.

 Maintain quite, comfortable environment
around the child.
 Gentle handling of child.
 Do measures that reduce fever.
References:

 Susan L. Ward and Shelton M. Hisley,

2016: Maternal-Child Nursing Care
Optimizing Outcomes for Mothers,
Children, and Families, 2nd Edition.
 Alkahloot A., abd elazeez M. ( 2013).
Pediatric Nursing, Islamic university.
 https://nurseslabs.com/intussusception/#n
ursing-management.