INTUSSUSCEPTION INTUSSUSCEPTION A serious disorder in which part of the intestine slides into an adjacent part of the intestine.

. This "telescoping" often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected. Intussusception can lead to a tear in the bowel (perforation), infection and death of bowel tissue. Intussusception is the most common cause of intestinal obstruction in children younger than 3. Intussusception is rare in adults. Most cases of adult intussusception are the result of an underlying medical condition, such as a tumor. In contrast, the cause of most cases of intussusception in children is unknown. Is the invagination or telescoping of a portion of the intestine into a adjacent, more distal section of the intestine causing mechanical obstruction. 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.

CAUSE Intussusception is caused by part of the intestine being pulled inward into itself. This can block the passage of food through the intestine. If the blood supply is cut off, the segment of intestine pulled inside can die. The pressure created by the walls of the intestine pressing together causes: Decreased blood flow Irritation Swelling The intestine can die, and the patient can have significant bleeding. If a hole occurs, infection, shock, and dehydration can take place very rapidly. The cause of intussusception is not known, although viral infections may be responsible in some cases. Sometimes a lymph node, polyp, or tumor can trigger the problem. The older the child, the more likely such a trigger will be found. Intussusception can affect both children and adults, although most cases occur in children ages 6 months - 2 years. It affects boys four times as often as girls. Your intestine is shaped like a long tube. In intussusception, one part of your intestine usually the small intestine slides inside an adjacent part. This is sometimes called telescoping because it's similar to the way a collapsible telescope folds together. In some cases, the telescoping is caused by an abnormal growth in the intestine, such as a polyp or a tumor (called a lead point). The normal wave-like contractions of the intestine grab this lead point and pull it and the lining of the intestine into the bowel ahead of it. In most cases, however, no cause can be identified for intussusception. Children In the vast majority of cases of intussusception in children, the cause is unknown. Because intussusception seems to occur more often in the fall and winter and because many children with the problem also have flu-like symptoms, some suspect a virus may play a role in the condition. In a few instances, a lead point is identified as the cause of the condition most frequently Meckel's diverticulum (a pouch in the lining of the small intestine). Adults In adults, intussusception is usually the result of a medical condition, such as: A tumor Scar-like tissue in the intestine (adhesions) Surgical scars in the small intestine or colon Hematoma Inflammation, such as from Crohn's disease SYMPTOMS The first sign of intussusception is usually sudden, loud crying caused by abdominal pain. The pain is colicky (Severe abdominal pain caused by spasm, obstruction, or distention of any of the hollow viscera, such as the intestines) and not continuous (intermittent), but it comes back often, increasing in both intensity and duration. An infant with severe abdominal pain may draw the knees to the chest while crying. Other symptoms include: Bloody, mucus-like bowel movement, sometimes called a "currant jelly" stool Fever Shock (pale color, lethargy, sweating) Stool mixed with blood and mucus

Vomiting

Children The first sign of intussusception in an otherwise healthy infant may be sudden, loud crying caused by abdominal pain. Infants who have abdominal pain may pull their knees to their chests when they cry. The pain of intussusception comes and goes, usually every 15 to 20 minutes at first. These painful episodes last longer and happen more often as time passes. Other frequent signs and symptoms of intussusception include: Stool mixed with blood and mucus (sometimes referred to as "currant jelly" stool because of its appearance) Vomiting A lump in the abdomen Lethargy Less common signs and symptoms include: Diarrhea Fever Constipation Some infants have no obvious pain, don't pass blood or have a lump in the abdomen. Some older children have pain but no other symptoms. Adults Because intussusception is rare in adults and symptoms of the disorder are often nonspecific, it is more challenging to identify. Abdominal pain is the most common symptom, followed by nausea and vomiting and diarrhea. A significant percentage of people have no signs and symptoms.

RISK FACTORS Age. Children are much more likely to develop intussusception than adults are. It's the most common cause of bowel obstruction in children between the ages of 6 months and 3 years. Sex. Intussusception more often affects boys. Abnormal intestinal formation at birth. A condition present at birth (congenital) in which the intestine doesn't develop correctly (malrotation) also is a risk factor for intussusception. A prior history of intussusception. Once you've had intussusception, you're at increased risk to develop it again. AIDS. There is some evidence of an increased incidence of intussusception in people with acquired immune deficiency syndrome. COMPLICATIONS Intussusception can cut off the blood supply to the affected portion of the intestine. If left untreated, lack of blood causes tissue of the intestinal wall to die. Tissue death can lead to a tear (perforation) in the intestinal wall, which can cause an infection of the lining of the abdominal cavity (peritonitis). Peritonitis is a life-threatening condition that requires immediate medical attention. Signs and symptoms of peritonitis include: Abdominal pain Abdominal swelling Fever Thirst Low urine output Peritonitis may cause your child to go into shock. Signs and symptoms of shock include: Cool, clammy skin that may be pale or gray A weak and rapid pulse Abnormal breathing that may be either slow and shallow or very rapid Lackluster eyes that seem to stare blankly Profound listlessness A child who is in shock may be conscious or unconscious. If you suspect your child is in shock, seek emergency medical care right away. TESTS AND DIAGNOSIS Ultrasound or other abdominal imaging. An ultrasound, X-ray or computerized tomography (CT) scan may reveal intestinal obstruction caused by intussusception. Imaging will typically show a "bull's eye," representing the intestine coiled within the intestine. Abdominal imaging also can show if the intestine has been torn (perforated). Air or barium enema. An air or barium enema is basically a colon X-ray. During the procedure, the doctor will insert air (the preferred choice in most cases) or liquid barium into the colon through the rectum. This makes the images on the X-ray clearer. An air or barium enema will fix intussusception 90 percent of the time in children, and no further treatment is needed. A barium enema can't be used if the intestine is torn.

TREATMENT AND DRUGS Treatment of intussusception typically happens as a medical emergency. Emergency medical care is required to avoid severe dehydration and shock, as well as prevent infection that can occur when a portion of intestine dies due to lack of blood. Initial care When your child arrives at the hospital, the doctors will first stabilize his or her medical condition. This includes: Giving your child fluids through an intravenous (IV) line Helping the intestines decompress by putting a tube through the child's nose and into the stomach (nasogastric tube) Correcting the intussusception To treat the problem, your doctor may recommend: A barium or air enema. This is both a diagnostic procedure and a treatment. If an enema works, further treatment is usually not necessary. This treatment is highly effective in children, but rarely used in adults. Intussusception recurs as often as 15 to 20 percent of the time and the treatment will have to be repeated. Surgery. If the intestine is torn, if an enema is unsuccessful in correcting the problem or if a lead point is the cause, surgery is necessary. The surgeon will free the portion of the intestine that is trapped, clear the obstruction and, if necessary, remove any of the intestinal tissue that has died. Surgery is the main treatment for adults and for people who are acutely ill. In some cases, intussusception may be temporary and go away without treatment. SURGICAL INTERVENTION 1. Intussusception can be surgically reduced, resection may be necessary if bowel is nonviable.

NURSING MANAGAMENT 1. 2. 3. 4. Monitor I.V. fluids and intake and output to guide in fluid balance. Be alert for respiratory distress due to abdominal distention. Monitor vital signs, urine output, pain, distention, and general behavior preoperatively and postoperatively. Observe infants 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. UPDATES Update: Information on Rotarix - Labeling Revision Pertaining to Intussusception Background On September 22, 2010, FDA informed healthcare providers and the public that it had approved revised Prescribing Information and patient labeling for Rotarix, a vaccine manufactured by GlaxoSmithKline Biologicals (GSK) for the prevention of gastroenteritis caused by rotavirus infection in infants 6 weeks to 24 weeks of age. After FDA completed an evaluation of preliminary results from a postmarketing study conducted in Mexico, information was added to the existing intussusception (a form of blockage of the intestines) subsection of the Warnings and Precautions section. The interim analysis of this study suggested an increased risk of intussusception in the 31 day time period after the first dose of Rotarix (relative risk of 1.8 with a 99% confidence interval of 1.0 to 3.1). These findings translated to potentially 0-4 additional cases of intussusception hospitalizations per 100,000 vaccinated infants within 31 days after the first dose of Rotarix in the United States. This took into consideration the rate of the natural occurrence (without vaccination) of intussusception hospitalizations in the United States, which is approximately 34 in 100,000 infants in the first year of life. Further analysis showed that the increased number of intussusception cases occurred primarily within seven days after the first dose. This information was also included in the Postmarketing Experience subsection of the Adverse Reactions section of the prescribing information and in the information for the patient. Current status The study in Mexico has been completed and FDA has evaluated the final results. The results show that Mexican infants diagnosed with intussusception were more likely to have developed this condition within the first month following the first dose of Rotarix, but

particularly in the first week (7 days) following vaccination, compared to other points of time in the first year of life. FDA has approved revised Prescribing Information and patient labeling to reflect this information.

Trends in intussusception-associated hospitalizations and deaths among US infants. Abstract CONTEXT: The newly licensed tetravalent rhesus-human reassortant rotavirus vaccine has been withdrawn following reports of intussusception among vaccinated infants. OBJECTIVE: To describe the epidemiology of intussusception-associated hospitalizations and deaths among US infants. DESIGN: This retrospective cohort study examined hospital discharge data from the National Hospital Discharge Survey for 1988-1997, Indian Health Service (IHS) for 1980-1997, California for 1990-1997, Indiana for 1994-1998, Georgia for 1997-1998, and MarketScan for 1993-1996, and mortality data from the national multiple cause-of-death data for 1979-1997 and linked birth/infant death data for 1995-1997. PATIENTS: Infants (<1 year old) with an International Classification of Diseases, Ninth Revision, Clinical Modification code for intussusception (560.0) listed on their hospital discharge or mortality record, respectively. RESULTS: During 1994-1996, annual rates for intussusception-associated infant hospitalization varied among the data sets, being lowest for the IHS (18 per 100 000; 95% confidence interval [CI] = 9-35 per 100 000) and greatest for the National Hospital Discharge Survey (56 per 100 000; 95% CI = 33-79 per 100 000) data sets. Rates among IHS infants declined from 87 per 100 000 during 1980-1982 to 12 per 100 000 during 1995-1997 (relative risk =7.6, 95% CI = 3.2-18.2). Intussusception-associated hospitalizations were uncommon in the first 2 months of life, peaked from 5 to 7 months old, and showed no consistent seasonality. Intussusception-associated infant mortality rates declined from 6.4 per 1 000 000 live births during 1979-1981 to 2.3 per 1 000 000 live births during 1995-1997 (relative risk = 2.8, 95% CI = 1.8-4.3). Infants whose mothers were <20 years old, nonwhite, unmarried, and had an education level below grade 12 years were at an increased risk for intussusception-associated death. CONCLUSIONS: Intussusception-associated hospitalization rates varied among the data sets and decreased substantially over time in the IHS data. Although intussusception-associated infant deaths in the United States have declined substantially over the past 2 decades, some deaths seem to be related to reduced access to, or delays in seeking, health care and are potentially preventable.intussusception, hospitalizations, deaths, risk factors, infants.