Intussusception

Description: An intussusception is a medical condition in which a part of the intestine has invaginated into another section of intestine, similar to the way in which the parts of a collapsible telescope slide into one another. This can often result in an obstruction. The part that prolapses into the other is called theintussusceptum, and the part that receives it is called the intussuscipiens. Assessment: Colicky abdominal pain that causes the child to scream and draw the knees to the abdomen, similar to the fetal position. Vomiting of gastric contents Bile-stained fecal emesis Current jelly-like stools containing blood and mucus Hypoactive or hyperactive bowel sounds Tender distended abdomen, possibly with palpable sausage-shaped mass in the upper right quadrant Test and Diagnosis: Ultrasound or other abdominal imaging Air or barium enema Treatments and drugs: 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. Nursing Intervention: Monitor for signs of perforation and shock as evidenced by fever, increased heart rate, changes in level of consciousness or blood pressure, and respiratory distress and report immediately. Administer Antibiotics, IV fluids and decompression via nasogastric tube may be prescribed. Monitor for the passage of normal, brown stool, which indicates that the intussusceptions has reduced itself. Prepare for hydrostatic reduction as prescribed, if no signs of perforation or shock occur (in hydrostatic reduction, air and fluid is used to exert pressure on area involved to lessen, diminish or rid the intestine of prolapsed) Posthydrostatic reduction a. Monitor for the return of normal bowel sounds, for the passage of barium, and the characteristics of stool. b. Administer clear fluids and advance the diet gradually as prescribed. If surgery is required, postoperative care is similar to care after abdominal surgery.