Intussusception

  • intussusception1Is 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:

  1. Paroxysmal abdominal pain; legs drawn up, child is inconsolable; may be comfortable between episodes.
  2. Blood in stool, or later “currant jelly” stools containing sloughed mucosa, blood, and mucus.
  3. Vomiting.
  4. Increasing absence of stools.
  5. Abdominal distention, bowel sound diminished, absent or high pitch.
  6. Sausage like mass palpable in abdomen (Dance’s sign).
  7. Unusual looking anus; may look like rectal prolapse.
  8. Dehydration and fever
  9. Shock like state with rapid pulse, pallor, and marked sweating.

Diagnostic Evaluation:

  1. X-ray of abdomen may show absence of gas or mass in right upper quadrant.
  2. Barium enema is done if there is no appearance of peritonitis; shows a concave filling defect (will help reduce the invagination).
  3. Ultrasonogram may be done to locate area of telescoped bowel.
  4. Color Doppler sonography determines whether reducible. Absence of blood flow indicates ischemia and, therefore, enema reduction should be avoided.

Surgical Intervention:

  1. Intussusception can be surgically reduced, resection may be necessary if bowel is nonviable.

Nursing Intervention:

  1. Monitor I.V. fluids and intake and output to guide in fluid balance.
  2. Be alert for respiratory distress due to abdominal distention.
  3. Monitor vital signs, urine output, pain, distention, and general behavior preoperatively and postoperatively.
  4. Observe infant’s behavior as indicator of pain; may be irritable and very sensitive to handling or lethargic or unresponsive. Handle the infant gently.
  5. Explain cause of pain to parents, and reassure them about purpose of diagnostic tests and treatments.
  6. Administer analgesic as prescribed.
  7. Maintain NPO status as ordered.
  8. Insert nasogastric tube if ordered to decompress stomach.
  9. Continually reasses condition because increased pain and bloody stools may indicate perforation.
  10. After reduction by hydrostatic enema, monitor vital signs and general condition – especially abdominal tenderness, bowel sounds, lethargy, and tolerance to fluids – to watch recurrence.
  11. Encourage follow up care.
  12. Provide anticipatory guidance for developmental age of child.

What Do You Think?