Menoufia University

Faculty of Nursing
 ‫‪Under supervision of :‬‬

‫‪Assist prof : Hanaa Mabrouk‬‬

‫‪A.L : Hadeer Hamdy‬‬

‫‪Prepared by :‬‬

‫‪ .1‬محمد محمود سعد فاضل‬

‫‪ .2‬محمد محمود محمد سعيد‬
‫‪ .3‬محمد حمىي ادلين مصطفى رسالن‬
‫‪ .4‬محمد حمىي جرب عبود‬
‫‪ .5‬محمد مدحي عبدالهادى عبدالعزيز قرقش‬
‫‪ .6‬محمد مسعد محمد ذىك‬
‫‪ .7‬محمد مصطفى محمد ساملان‬
‫‪ .8‬محمد همدى محمد املهر‬
‫‪ .9‬محمد نبوى الس يد سالم‬
‫‪ .10‬محمد نبوى محمد فراج‬
‫‪ .11‬محمد نبيل محمد حسن عىل‬
‫‪ .12‬محمد نفازى جحازى عبدامحليد جاد‬
 OUT LINES
1-INTRODUCTION
2-DEFINTION
3-PASOPHYSIOLOGY
4-CAUSE
5-TYPES
7-MANIFESTATIONS
8-COMPLICATIONS
9-DIAGNOSIS
10-MEDICAL MANAGEMENT
11-SURGICAL MANAGEMENT
12-NURSING MANAGEMENT
 Introduction
Intussusception is a common surgical emergency in infants and young
children and consists of a telescoping of a segment of bowel
(intussusceptum) into a more distal segment (intussusceptions). This
condition usually occurs in children under 1, with a peak incidence
between 5 and 9 months of age; however, it may occur up to school age.

Definition:
Intussusception is a painful form of bowel blockage in which one part of
your intestine slides inside another part. It can cause swelling that can
lead to intestinal damage.

Pathophysiology;
+ It occurs when a segment of small bowel "telescopes" on itself, thus
causing swelling, obstruction, and eventually intestinal gangrene.
+ Intussusception preventing the passage of food that is being digested
through the intestine.
+ The walls of the two "telescoped" sections of intestine press on each
other, causing irritation and swelling.
+ Eventually, the blood supply to that area is cut off, which can cause
damage to the intestine.
Causes: -
The cause not usually known
It occurs due to one part of intestine slides inside an adjacent part
(telescoping)
Because it similar to the way a collapsible telescope slides together
Some of the risk factors are :-
Age. Children — especially young 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. Intestinal melioration is a
condition in which the intestine doesn't develop or rotate correctly, and it
increases the risk of intussusception.
Certain conditions. Some disorders — such as Acute gastroenteritis cystic
fibrosis, Henoch-Schonlein purpura (also known as IgA vasculitis),
Crohn's disease ,Meckel celiac disease .

Types: -
Ileocolic: - The small intestine telescope into the colon
(The most common type)
Ileoileal :- the small intestine telescope into it self
Colocolic:- The large intestine telescope into it self

Clinical manifestation
• Early signs/symptoms
(1) Intermittent episodes of sudden onset of severe Abdominal pain that
lasts only a few minutes. Infants may pull up their legs during
Episodes of pain
(2) Vomiting;
(3) Abdominal mass in the right upper side of the Abdomen;
(4) Lethargy due to dehydration.
• Later signs/symptoms:
(1) Bloody stools with a mucus-like texture that resemble Currant jelly;
(2) Bilious (green) vomiting from intestinal obstruction;
(3) Fever, low Blood pressure, and fast heart rate can be signs of bowel
perforation.

Investigations
Plain X-ray
Ultra sound
Barium enema

Complications
Perforation of bowel, with peritonitis
Necrosis of bowel requiring bowel resection
Shock and sepsis
Re-intussusception after spontaneous or active reduction.

Medical management
Intussusception is not usually immediately life-threatening. It can be
treated with either a water-soluble contrast enema or an air-contrast
enema, which both confirms the diagnosis of an intussusception, and in
most cases successfully reduces it.
Enema
An enema is done by placing a small tube into the rectum. Fluid or air is
gradually added into the tube to allow clinicians to see the
intussusception that is blocking the intestine via X-ray or ultrasound.
The pressure of the fluid or air pushes the telescoping bowel back to its
normal position, fixing the problem.
There is a chance the intussusception can recur within 24 hours. For that
reason, after the bowel is reduced, your child will stay in the hospital for
an additional day to ensure there is not a recurrence.
Most of the time the enema will take care of the bowel problem.
However, in 10-15 percent of cases, the bowel cannot be reduced and
surgery is necessary.

Surgical management
In a reduction of the bowel surgery, the surgeon may choose to do the
procedure with one larger incision (called an open procedure) or
laparoscopically, with tiny incisions and a camera. Which surgical
procedure is used will depend on your child’s condition.
Whether open surgery or laparoscopic, the intussusception is carefully
reduced by gently pushing the leading portion of the intussusceptions
back upstream to reduce the telescoping of the bowel.
If the surgeon is unable to successfully reduce the bowel, then the
afflicted section will need to be removed. When this happens, the surgeon
must remove the affected part of the intestine and sew the two healthy
sections back together.
The intestines will be stitched with sutures that dissolve. The outside skin
is usually closed with stitches that will dissolve and then covered with
gauze and/or a clear dressing.

Nursing management
*Pre-operative Care
1. Baseline observations include heart rate, respiratory rate, temperature
and pain score. Blood pressure, oxygen saturations and neurological
observations if clinically indicated.
2.NPO status,
3. routine laboratory testing (CBC and urinalysis)
4. signed parental
Consent
5. pre anesthetic sedation, are performed.
6.Children with perforation will require IV fluids .
7.systemic antibiotics, and bowel decompression before undergoing
surgery
8.Fluid volume replacement and restoration of electrolytes may be
required in such children before surgery.
9. Before surgery, the nurse monitors all stools.

*Post-procedural care includes

1.observations of vital signs, blood pressure
2. intact sutures and
Dressing, and the return of bowel sounds.
3. After spontaneous or hydrostatic reduction, the nurse observes for
passage of water-soluble contrast material (if used) and the stool patterns
because the
Intussusception may recur.
4.Children may be admitted to the hospital or monitored on an outpatient
Basis.
5. recurrence of intussusception is treated with the conservative
reduction techniques
Described earlier, but a laparotomy is considered for multiple
recurrences.