Intussusception occurs when a segment of bowel telescopes (similar to closing of a telescope) into a segment just distal to it. It is the most common cause of intestinal (bowel) obstruction (blockage) between 3 months and 6 years of age. The ileocolic (small bowel into the colon) intussusception is the most common type although it may occur anywhere in the small bowel and colon.
Anatomy
- The demarcation between the duodenum (1st part of small bowel) and the jejunum (2nd part of small bowel) is the ligament of Treitz (see Surgery of the Duodenum) (Figure 1)
- The jejunum makes up about one third of the proximal small bowel
- The ileum is the distal two thirds of the small bowel
- The jejunum, ileum, and associated mesenteries (supporting and suspending structures) are attached to the back wall of the abdomen. They are completely covered with peritoneum (single layer of cells that line the surface of the abdomen and bowel)
- The ileum joins the cecum (first part of the colon) in the right lower quadrant at the ileocecal valve near the appendix
- The small bowel possesses an extensive lymphatic network that aids in the absorption of nutrients. It drains from the bowel wall into adjacent lymph vessels and lymph nodes and ultimately getting into larger lymphatics that finally empty into the left subclavian vein. The lymphatics of the small bowel play a major role in immune response (response to infection)
- The telescoping process is known as intussusception (Figure 2)
- The leading proximal segment (intussusceptum) almost always telescopes into the distal segment (intussuscipens)
- There may be a leading edge in the form of a polyp, inverted appendiceal stump, Meckel's diverticulum (See Surgery of the Jejunum and Ileum) or tumor
- The leading edge gets caught up in the downstream peristalsis (wavelike action of the bowel wall that propels food) and is pulled into the distal bowel
- In most cases the cause is unknown but viruses are thought to induce hyperplasia (increased size) of Peyer's patches (lymphoid tissue) in the end of the ileum
Intussusception Preoperative Nursing Diagnosis and Interventions
Acute pain related to intestinal invagination
Goal: reduction in pain according to the perceived tolerance of children.
Results Criteria : The child shows no signs of pain or discomfort to a minimum.
Intervention:
- Observation of baby behavior as an indicator of pain, can be sensitive excitatory and highly sensitive to treatment or lethargic or unresponsive.
- Treatment of infants with very soft.
- Explain the causes of pain and reassure parents about the purpose of diagnostic tests and treatment.
- Reassure your child that analgesics are given to reduce pain that is felt.
- Explain about intussusception and intestinal hydrostatic reduction can reduce the intussusception.
- Explain the risk of recurrent pain.
- Collaboration: give analgesics to relieve pain.
Postoperative Intussusception Nursing Diagnosis and Interventions
Acute pain related to surgical incision
.
Goal: reduction in pain according to the tolerance in children.
Results Criteria : The child shows no signs of pain or discomfort to a minimum.
Intervention:
- Avoid palpation operating area when not needed.
- Insert rectal tube if indicated, to free air.
- Push for waste water to prevent distention of urinary vesicles.
- Give oral care to provide comfort.
- Lubrication of the nostrils to reduce irritation.
- Provide a comfortable position on the child if there are no contraindications.
- collaboration:
- Give an analgesic to treat pain.
- Give antiemetics to order for nausea and vomiting.