Intussusception

a. Definition

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.

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.

b. 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.
 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.
 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.
c. 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.

d. 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.

 Abdominal pain. In rare circumstances, the parents report 1 or more

previous attacks of abdominal pain within 10 days to 6 months prior to the
current episode; pain in intussusception is colicky, severe, and intermittent.
 Vomiting. Initially, vomiting is nonbilious and reflexive, but when the
intestinal obstruction occurs, vomiting becomes bilious.
 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.

e. Prevention:

Basically there are no direct guidelines for preventing intussusception but you can
make a Healthful lifestyle choices because overall they are a great way to lower the
risks of bowel obstruction.
 f. 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
ultrasonographic guidance; the technique chosen is not important as long as
the radiologist performing the enema is comfortable with the method.
 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

g. Nursing Management

Nursing management of a child with intussusception includes:

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.
Reference:

 https://nurseslabs.com/intussusception/
 https://www.winchesterhospital.org/health-library/article?id=11741
 UOTW #4 Answer - Ultrasound of the Week". Ultrasound of the Week.
Archived from the original on 5 November 2017. Retrieved 27 May 2017.
 Jump up to: a b Park NH, Park SI, Park CS, Lee EJ, Kim MS, Ryu JA, Bae JM
(2007). "Ultrasonographic findings of small bowel intussusception, focusing
on differentiation from ileocolic intussusception". Br J Radiol. 80 (958): 798–
802. doi:10.1259/bjr/61246651. ISSN 0007-1285. PMID 17875595.
 Charles, T.; Penninga, L.; Reurings, J. C.; Berry, M. C. J. (January 2015).
"Intussusception in Children: A Clinical Review". Acta Chirurgica Belgica. 115
(5): 327–333. doi:10.1080/00015458.2015.11681124. ISSN 0001-5458.
PMID 26559998. S2CID 21843245.