intus

• Intussusception is one of the most common causes of intestinal obstruction in children (3 months to 3 years)

  
  

  Boys are more affected than girls; there is a positive association with cystic fibrosis

  
  

  • Cause: unknown– Idiopathic: hypertrophy of intestinal lymphoid tissue 2˚ viral infection

  • Most common site: ileocecal valve (ileocolic) – Ileum invaginates into cecum

  • Other forms: – Ileoileal – colocolic
• Intussusception

  One segment of the bowel telescopes into another segment pulling the mesentery
• Pathophysiology of intussusception

  1. Mesentery is compressed and angled resulting in lymphatic and venous obstruction

  2. As edema from obstruction increases, pressure within the area of intussusception increases

  3. When pressure equals the arterial pressure, arterial blood flow stops resulting in ischemia and pouring of mucus into intestine

  4. Venous engorgement leads to leaking of blood and mucus into intestinal lumen forming the classic "currant jelly-like stools
• Intussusception

  • Most common site is the ileocecal valve (ileocolic)
  • Other forms include ileoileal and colocolic
• Assessment

  • Sudden drawing up of legs and crying with possible vomiting

  • Abdominal pain in regular intervals (every 15 to 20 minutes)

  • Vomiting contains bile

  • Currant jelly-like stools (after 12 hours)

  • Increased abdominal distention

  • As problem progresses: – Fever – Peritoneal irritation with tenderness and guarding– Tachycardia – Elevated WBC
• Diagnostics

  • Ultrasound

  • CBC with differential

  • Barium enema
• TREATMENT

  • Non-surgical: hydrostatic reduction by Barium enema

  – Initial Rx of choice

  – Force exerted by flowing Ba pushes invaginated portion of bowel into its original position

  – Not recommended if (+) shock, perforation

  • UTZ: diagnosis & assistance in hydrostatic reduction

  – Safe and accurate

  – Higher success rate

  – Avoid radiation risk

  • IVF, NGT, antibiotics

  – before hydrostatic reduction

  • Surgery: if procedure not successful
• Nursing considerations for intussusception

  1. Carefully listen to parent's description of child's physical & behavioural symptoms

  2. Prepare parents for immediate need for hospitalization, procedure to be done & possible surgery

  3. Pre-op: NPO, labs (CBC, UA), parental consent, preanesthetic sedation

  4. (+) pass out normal brown stool: intussusceptions has reduced itself → report to MD

  5. Post-op: VS, BP, intact suture & dressing

  6. Observe for passage of Barium enema or H2O soluble contrast material & stool pattern
• Intussusception recurrence

  • There may be recurrence
  • (-) recurrence hydrostatic reduction
  • Multiple recurrence: laparotomy