Intussusception

MARIA ZORAYDA JENNY VI G. BINGCANG, MSN

What is Intussusception?

 Intussusception usually appears in healthy babies

without any demonstrable cause.
 Intussusception is a process in which a segment
of intestine invaginates or telescopes into the
adjoining intestinal lumen, causing bowel
obstruction.
 What is Intussusception?

 It occurs most commonly at the juncture of the ileum

and the colon, although it can appear elsewhere in the
intestinal tract.
 The invagination is from above downward, the upper
portion slipping over the lower portion pulling the
mesentery along with it.
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Pathophysiology

 The pathogenesis of intussusception is not well

established.
 It is believed to be secondary to an imbalance in
the longitudinal forces along the intestinal wall.
Pathophysiology

 As a result of an imbalance in the forces of the intestinal wall, an

area of the intestine invaginates into the lumen of the adjacent
bowel.
 The invaginating portion of the intestine (ie, the intussusceptum)
completely “telescopes” into the receiving portion of the intestine
(ie, the intussuscipiens); this process continues and more proximal
areas follow, allowing the intussusceptum to proceed along the
lumen of the intussuscipiens.
Pathophysiology

 If the mesentery of the intussusceptum is lax and the

progression is rapid, the intussusceptum can proceed to the
distal colon or sigmoid and even prolapse out the anus.
 The mesentery of the intussusceptum is invaginated with
the intestine, leading to the classic pathophysiologic
process of any bowel obstruction.
Statistics and Incidences
 A wide geographic variation in the incidence of
intussusception among countries and cities within
countries makes determining a true prevalence of the
disease difficult.
 Its estimated incidence is approximately 1 case per 2000
live births.
 Overall, the male-to-female ratio is approximately 3:1.
Statistics and Incidences

 With advancing age, gender difference becomes marked;

in patients older than 4 years, the male-to-female ratio is
8:1.
 Two-thirds of children with intussusception are younger
than 1 year; most commonly, intussusception occurs in
infants aged 5-10 months.
Statistics and Incidences

 Intussusception is the most common cause of intestinal

obstruction in patients aged 5 months to 3 years.
 Intussusception can account for as many as 25% of
abdominal surgical emergencies in children younger than
5 years, exceeding the incidence of appendicitis.
 Causes
 In most cases, however, no cause can be identified for
intussusception.
 Hyperperistalsis. 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.
 Digestive system activities. The unusual mobility of the
cecum and ileum normally present in early life may also
cause intussusception.
Clinical Manifestations

 The constellation of signs and symptoms of

intussusception represents one of the most classic
presentations of any pediatric illness; however, the
classic triad of vomiting, abdominal pain, and
passage of blood per rectum occurs in only one-
third of patients.
Clinical Manifestations

 Abdominal pain. In rare circumstances, the parents report

1 or more previous attacks of abdominal pain within 10
days to 6 months before the current episode; pain in
intussusception is colicky, severe, and intermittent.
 Vomiting. Initially, vomiting is non-bilious and reflexive,
but when intestinal obstruction occurs, vomiting becomes
bilious.
Clinical Manifestations

 Currant jelly stool. Parents also report the passage of

stools that look like currant jelly; this is a mixture of
mucus, sloughed mucosa, and shed blood.
 Lethargy. Lethargy is a relatively common presenting
symptom with intussusception; the reason lethargy occurs
is unknown because lethargy has not been described with
other forms of intestinal obstruction.
 Assessment and Diagnostic Findings

 The care provider usually can make a diagnosis from:

 Rectal examination. The healthcare provider may perform
a rectal examination during a calm interval.
 Palpation. A baby is often unwilling to tolerate palpation,
and sedation may be ordered; a sausage-shaped mass can be
often felt through the abdominal wall.
 Assessment and Diagnostic Findings
 Radiographs. Plain abdominal radiography reveals signs that suggest
intussusception in only 60% of cases; as the disease progresses, the earliest
radiographic evidence includes an absence of air in the right lower and upper
quadrants and a right upper quadrant soft tissue density present in 25-60% of
patients.
 Ultrasonography. One study reported that the overall sensitivity and
specificity of ultrasonography for detecting ileocolic intussusception were
97.9% and 97.8%, respectively; the authors concluded that ultrasonography
should be used as a first-line examination for the assessment of possible
pediatric intussusception.
 Assessment and Diagnostic Findings

 CT scanning. Computed tomography (CT) scanning has also been

proposed as a useful tool to diagnose intussusception; however, CT
scan findings are unreliable, and CT scanning carries risks associated
with intravenous contrast administration, radiation exposure, and
sedation.
 Contrast enema. The traditional and most reliable way to make the
diagnosis of intussusception in children is to obtain a contrast enema
(either barium or air); contrast enema is quick and reliable and has the
potential to be therapeutic.
 Medical Management
 Unlike pyloric stenosis, intussusception is an emergency in the sense that
prolonged delay is dangerous.
 Intravenous fluid. For all children, start intravenous fluid resuscitation
and nasogastric decompression as soon as possible.
 Therapeutic enema. Therapeutic enemas can be hydrostatic, with either
barium or water-soluble contrast, or pneumatic, with air insufflation;
therapeutic enemas can be performed under fluoroscopic or ultra-
sonographic guidance; the technique chosen is not important as long as the
radiologist performing the enema is comfortable with the method.
Medical Management

 Surgical reduction. If a nonoperative reduction is unsuccessful or

if obvious perforation is present, promptly refer the infant for
surgical care; risk of recurrence of the intussusception after
operative reduction is less than 5%.
 Laparoscopy. Laparoscopy has been added to the surgical
armamentarium in the treatment of intussusception; laparoscopy can
be performed in all cases of intussusception; reduction of the
intussusception, confirmation of radiologic reduction, and detection
of lead points have all been reported.
Pharmacologic Management

 Drug therapy is not currently a component of the standard

of care for intussusception. Medications are limited to
those used for pain control after surgery. In the immediate
postoperative period, weight-adjusted
intravenous morphine is usually administered.
Nursing Management

 Nursing management of a child with intussusception includes:

 Nursing Assessment
 Nursing Diagnoses
 Nursing Care Planning and Goals
 Nursing Interventions
Nursing Assessment

 Assessment of a child with intussusception includes:

 Physical examination. The hallmark physical findings in
intussusception are a right hypochondrium sausage-shaped mass and
emptiness in the right lower quadrant (Dance sign).
 History. The patient with intussusception is usually an infant, often
one who has had an upper respiratory infection, who presents with
vomiting, abdominal pain, passage of blood and mucus, lethargy, and
palpable abdominal mass.
 Nursing Diagnoses

 Based on the assessment data, the major nursing

diagnoses are:
 Acute pain related to bowel invagination.
 Deficient fluid volume related to vomiting, nausea, fever,
and diaphoresis.
 Ineffective breathing pattern related to abdominal
distention and rigidity.
 Anxiety related to change in health status.
Nursing Care Planning and Goals

 The major nursing care planning goals for a child with

intussusception are:
 The patient will have stable vital signs.
Nursing Care Planning and Goals

 The patient will exhibit balanced intake and output.

 The patient’s pain will decrease and will be comfortable.
 The patient’s pattern of breathing will become effective.
 The caregiver‘s anxiety will be resolved.
Nursing Interventions

 Nursing interventions appropriate for the infant are:

 Intravenous fluids. Administer IV fluids as ordered; if the
patient is in shock, give blood or plasma as ordered.
 Decompression. A nasogastric tube is inserted to
decompress the bowel.
Nursing Interventions

 Monitor I&O. Replace volume lost as ordered, and

monitor the intake and output accordingly.
 Education. Educate the family caregivers on what
happens during intussusception and about the surgery, and
answer questions to reduce the anxiety.
 Evaluation

 Goals are met as evidenced by:

 The patient shows stable vital signs.
 The patient exhibits balanced intake and output.
 The patient’s pain decreases and is comfortable.
 The patient’s pattern of breathing is effective.
 The caregiver’s anxiety is resolved.
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