Intussusceptions

When one section of the intestine slips into an adjacent section of the intestine, a condition known as intussusception occurs. This "telescoping" typically prevents anything from going through, whether it food or fluid. Intussusception can cause a perforation (a hole) in the gut, infection, and the death of intestinal tissue by cutting off blood flow to the afflicted area of the intestine.

As with the sections of a collapsible telescope, intussusception occurs when one piece of the intestine invaginates (folds into) into another section of the intestine. This frequently causes a blockage. The intussusceptum is the prolapsing organ, while the intussusception is the receiving organ.

Causes

• Unknown
• Due to increased mobility of the intestine in young children.
• Lymphoid hyperplasia
• Meckel diverticulum (a fibrous band that connects the small intestine to the umbilicus.)
• The present of cysts in the bowel
• Acute enteritis abdomen injury and surgery

Pathophysiology

The most common kind of intussusception occurs when the ileum twists around and enters the cecum. H however, there are many variants, such as when the jejunum or ileum prolapses into the abdominal cavity. The intussusceptum is typically close to the intussuscipiens in cases of intussusception. This is because the proximal portion of the intestine is drawn into the distal section by the peristaltic motion of the gut. Nonetheless, there are occasional claims that the contrary is true.

An anatomic lead point (that is, a piece of intestinal tissue that protrudes into the bowel lumen) is present in approximately 10% of intussusceptions.

Ischemia (lack of oxygen in the tissues) occurs when blood flow is blocked to the confined bowel segment . Ischemia causes mucosa (the gut lining) to peel off into the digestive tract. This results in a stool that is a combination of sloughed mucosa, blood, and mucus, typically characterized as "red currant jelly." According to research, only a small percentage of kids with intussusception actually have bloody stools that look like "red currant jelly." Nonetheless, intussusception should be examined in the differential diagnosis of kids passing any kind of bloody stool.

Clinical presentation

• Classical triad signs:
  • abdominal pain, palpable sausage-shaped tender abdominal mass and currant jelly stool (blood and mucus).
• Sudden onset of paroxysmal abdominal pain which is manifested by the inconsolable crying of the child, in between the episodes the child looks normal.
• Tender distended abdomen
• Vomiting of gastric content initially and progressing to bilious vomiting.
• If the problem persists without management, necrosis and perforation of the affected part may occur.

Diagnosis

• Abdominal x-ray:
  • contrast enema in which barium, air, or water-soluble contrast will show obstruction to the flow.
• Rectal examination:
  • reveals mucus, and blood in the anus
• Serum electrolyte:
  • altered electrolyte levels

Nursing management

• Assessment of child condition: physical symptoms + behavioral symptoms.
• General nursing interventions
• Helps in an establishment of a diagnosis.
• Explanation to parents regarding defects and their treatment.
• Prepare for non-surgical and surgical intervention as per need
• Correction of fluids and electrolytes
• Nasogastric tube insertion and suctioning if indicated.1
• Additional medical preparation.
• Vitals monitoring.
• General health care of the child.
• Consent from the parents.
• Family support to reduce parents and child separation anxiety.

Preoperative care:

Surgical intervention if a reduction is not successful. Surgery involves manually reducing the invagination and resection of the nonviable segment of the intestine – laparotomy.

• Pain management.
• Physical preparation (skin, bowel, dress up).
• Preoperative medication if prescribed.
• Maintain intake and output and administration of intravenous fluids as per prescription.
• Observe signs of infection.
• Send lab specimens and collect lab reports.
• Informed written consent.
• Counseling to parents.

Postoperative care

• Place a child in a bed with a rail to prevent from fall.
• Assess airways, breathing, and circulation.
• Place in a side-lying position to prevent aspiration and do suction if needed.
• Pain management by providing painkillers.
• Observe wound for soakage and care to prevent infection.
• Place diapers below the abdominal dressing to prevent contamination.
• Keep nil per oral child is fully awake and bowel sound is regained.
• Administer prescribed fluid and maintain intake output charting.
• Maintain a calm comfortable environment.
• Provide physical care such as oral care, and sponging.
• Encourage parental presence as soon as permitted to minimize stress.
• Initiate feeding as tolerated by a child. In a case of a young baby, encourage breastfeeding.
• Maintain abdominal decompression, chest tube, or others equipment, if prescribed.
• Administer antibiotics as prescribed.
• Family supports by giving details about the child’s condition.