Intussusception
Is the invagination or telescoping of a portion of the intestine into a adjacent, more distal section of the intestine causing mechanical obstruction.
- The cause may be idiopathic (unknown but following a viral infection); lead point (change in the mucosa from another condition such as cystic fibrosis, Meckel’s diverticulum, or hematoma); or post operative.
- It occurs in children younger than age 3, most commonly ages 5 to 10 months.
- Without prompt treatment, necrosis of the involved segment leads to shock, perforation, and peritonitis.
Assessment:
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Paroxysmal abdominal pain; legs drawn up, child is inconsolable; may be comfortable between episodes.
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Blood in stool, or later “currant jelly” stools containing sloughed mucosa, blood, and mucus.
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Vomiting.
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Increasing absence of stools.
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Abdominal distention, bowel sound diminished, absent or high pitch.
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Sausage like mass palpable in abdomen (Dance’s sign).
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Unusual looking anus; may look like rectal prolapse.
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Dehydration and fever
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Shock like state with rapid pulse, pallor, and marked sweating.
Diagnostic Evaluation:
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X-ray of abdomen may show absence of gas or mass in right upper quadrant.
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Barium enema is done if there is no appearance of peritonitis; shows a concave filling defect (will help reduce the invagination).
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Ultrasonogram may be done to locate area of telescoped bowel.
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Color Doppler sonography determines whether reducible. Absence of blood flow indicates ischemia and, therefore, enema reduction should be avoided.
Surgical Intervention:
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Intussusception can be surgically reduced, resection may be necessary if bowel is nonviable.
Nursing Intervention:
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Monitor I.V. fluids and intake and output to guide in fluid balance.
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Be alert for respiratory distress due to abdominal distention.
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Monitor vital signs, urine output, pain, distention, and general behavior preoperatively and postoperatively.
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Observe infant’s behavior as indicator of pain; may be irritable and very sensitive to handling or lethargic or unresponsive. Handle the infant gently.
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Explain cause of pain to parents, and reassure them about purpose of diagnostic tests and treatments.
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Administer analgesic as prescribed.
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Maintain NPO status as ordered.
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Insert nasogastric tube if ordered to decompress stomach.
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Continually reasses condition because increased pain and bloody stools may indicate perforation.
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After reduction by hydrostatic enema, monitor vital signs and general condition – especially abdominal tenderness, bowel sounds, lethargy, and tolerance to fluids – to watch recurrence.
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Encourage follow up care.
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Provide anticipatory guidance for developmental age of child.