Our neighbor's 1-year-old son was recently diagnosed with intussusception. What is this and how is it treated?-EG, WASH.

Alec Wallace, BSN, RN; Austin Friedheim, BSN, RN; and Bridget Parsh, MSN, EdD, RN, CNS respond-Intussusception is the invagination (telescoping) of the gastrointestinal tract that results from the proximal bowel being forced into the distal bowel.1 It is the most common abdominal emergency in early childhood, particularly in children younger than 2 years of age, and is the most common cause of intestinal obstruction in children between 6 and 36 months of age.1,2 Intussusception is more common in males than females, as males comprise roughly 70% of cases.3

Most pediatric cases of intussusception are idiopathic but causes can include intestinal tumors, polyps, cysts, and Meckel diverticulum.4

Pathophysiology

Ileocolic intussusception involves the ileocecal junction and accounts for 90% of all cases. Once the pressure within the intussusception is equal to the arterial pressure, the flow of arterial blood ceases, causing an influx of mucus into the intestine.5 Venous drainage obstruction leads to the engorgement of the mucosal lining, causing blood to leak into the lumen.5 As time passes, edema compromises the intestinal arterial blood supply, leading to bowel necrosis, perforation, peritonitis, and shock.6

Signs and symptoms

Intussusception typically presents with the sudden onset of intermittent, severe, crampy, progressive abdominal pain, sometimes with vomiting and grossly bloody stools, alternating with relatively pain-free periods. The classic triad of abdominal pain, palpable mass, and currant jelly stools is found in approximately 15% of cases. Intussusception in an infant is usually identified when the infant cries unprovoked while intermittently drawing their knees up to their chest to relieve the abdominal pain that recurs frequently and increases in intensity and duration over time.1,7 As the disorder progresses, the infant becomes weaker and develops additional signs and symptoms such as pallor, lethargy, and fever.1

Diagnosis

Prompt diagnosis of intussusception is essential for effective prevention of complications such as intestinal necrosis and sepsis.1 Ultrasonography is the method of choice to detect intussusception. A "bull's eye" or "coiled spring" lesion is seen, representing layers of the intestine within the intestine.

Management

Patients with a high clinical suspicion or imaging evidence of ileocolic intussusception, normal vital signs, and no evidence of bowel perforation should be treated with nonoperative reduction. Nonoperative reduction using hydrostatic or pneumatic pressure by enema is the treatment of choice for an infant or child with ileocolic intussusception who is clinically stable and has no evidence of bowel perforation or shock. While hydrostatic and pneumatic enemas have a success rate of 69% to 83%, respectively, close monitoring is required for 24 hours postprocedure to assess for recurrence.8-10 Surgical management is typically reserved for incidences of peritonitis, shock, or bowel perforation, or in the case of a failed nonoperative reduction.9,11

Nursing considerations

Nurses should be aware of key signs and symptoms because early recognition is key to avoiding complications. Once diagnosed, educate the family about the disorder and treatment. Posttreatment, children are at risk for recurrent intussusception or, rarely, bowel perforation.12 Instruct caregivers to contact the healthcare provider or specialist for any pain, fever, or other concerns.

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