Intussusception

 Intussusception

Intussusception is telescoping of one segment of intestine into another adjacent distal segment of intestine.

It is bowel obstruction in which one segment of intestine telescopes inside of another segment of intestine.

For example; small intestine is in large intestine

Etiology

1. Hyperperistalsis 

2. Gastroenteritis

3. Lesion/polyp/tumor

4. Children with cystic fibrosis or celiac disease

Classification of Intussusception

Depending on parts of intestine involved;

1. Ileocolic

Where ileum invaginates into caecum and then into ascending colon.

2. Cecocolic

Caecum invaginates into colon.

3. IIeoileal 

One portion of ileum invaginates into other portion of ileum.

Pathophysiology

Segment of bowel telescopes into other segment of intestine.

Drags associated mesentery, vessels and nerve with it.

Results compression of veins, swelling of region 

Blood supply to affected portion is cut off

Oedema occurs

Leading to intestinal obstruction

Clinical manifestations

1. Triad of symptoms;

Colicky abdominal pain

Bilious vomiting

Currant jelly like stool (Stool mixed with blood and mucus)

2. Paroxysmal crampy abdominal pain

(Infant sudden loud crying)

3. Progressively weaker and lethargic and shock like state develops

4. Body temperature rise to 106 degree fahrenheit

5. Episodes of vomiting 

6. Currant jelly like stool

7. Abdominal tenderness and distension

8. Tender felt in right upper quadrant

9. On rectal examination; a ring of intestine may felt if intussusception part reached rectum.

Diagnostic Evaluation

1. Barium enema

Diagnosing level of obstruction

2. Abdominal ultrasound

Management

Non surgical 

1. Hydrostatic reduction using barium or air enema, air insufflation (blowing air into cavity)

Surgical 

2. Resection of affected portion and end to end anastomosis of normal bowel 

Nursing Management

Pre-Operative Nursing Care

1. Keep NPO 6-8 hours prior to surgery.

2. If necessary, administered parenteral fluid and electrolytes and whole blood or plasma.

3. To decompress bowel, nasogastric suction done

4. Intake and output chart monitored

5. To treat infections due to intestinal obstruction, prescribed antibiotics are administered.

Post-Operative Nursing Care

1. Non-surgical management

Barium enema under hydrostatic pressure includes;

1. Assess general condition of infants

2. Observe and record passage of barium in stool

Surgical Management

1. Monitor vital signs of infants

2. Observe the incision site for any discharge or leakage or swelling

3. Dressing the incision site using strict aseptic technique

4. Monitor abdominal girth and observe abdominal distension, notify the surgeon

5. Parental fluids administerd till bowel sounds return and oral feeds started

6. Gastrointestinal suctioning done, keep stomach and Intestine empty, so that healing may occur.

7. Monitor urine output

8. Palpate for bladder distension

9. Auscultate for bowel sounds and palpate the abdomen, record it

10. After bowel sound returned, administer electrolyte solution or glucose water, orally then sart breast feed or formula feeding.