Intussusception: Causes, Symptoms, and Effective Management

What is Intussusception

Intussusception refers to as the invagination of one segment of a bowel into itself or an immediately adjacent segment, causing bowel obstruction. Or intussusception occurs when one segment of the bowel is pulled into itself or folds into the section next to it. The proximal segment that invaginates into the distal segment is called the intussusceptum and the distal segment of bowel receiving the intussusceptum is referred to as intussuscipiens.
Intussusception usually involves the small bowel which is more common and rarely involving the large bowel. Symptoms include abdominal pain, vomiting, bloating, and bloody stool It is the most common cause of intestinal obstruction in children younger than 3 years old and the cause in children is idiopathic. Intussusception is rarely in adult's cases but occurs as a result of an underlying medical condition, such as a neoplasm. This disorder in pediatric cases, the intestines can be pushed back into position with a minor procedure unlike in adults, where surgery is often required to correct the invagination.

Invagination of a bowel

Causes & Risk factors

The causes of intussusception are not entirely known in children and may arise from an infection, anatomical factors, etc. Intussusception in adult usually as the result of a medical conditions. Known causes and risk factors include:

• Age, especially young children between the ages of 6 months and 3 years.
• Sex, more often affects boys.
• Irregular intestinal formation at birth (Intestinal malrotation).
• Swelling in the intestines due to diseases such as Crohn's disease.
• Meckel's diverticulum.
• Inflammatory bowel disease (IBD).
• Cystic fibrosis.
• Infections
• A polyp or tumor.
• Adhesions.
• Celiac disease.
• Immunoglobulin A (IgA) vasculitis.
• Endometriosis.
• Altered motility
• Duplication
• Hyperplasia of Peyer patches

Pathophysiology of Intussusception

The pathophysiology of intussusception is believed to be secondary to an imbalance in the longitudinal forces along the intestinal wall. If the mesentery of the intussusceptum is lax and the progression is rapid, the intussusceptum can proceed to the distal colon or sigmoid and even prolapse out the anus When the proximal part of the bowel is pulled into the distal lumen, venous return is compromised, resulting in oedema and further restriction of blood flow.
The mucosa is sensitive to ischemia and responds by causing sloughing off into the lumen of the intestine. This creates a red currant jelly stool. Eventually, arterial supply to the bowel is interrupted, and ischaemia and necrosis ensue, leading to the classic pathophysiologic process of any bowel obstruction.

Signs & Symptoms of Intussusception

In pediatrics, intussusception presents the classic clinical triad of vomiting, abdominal pain, and passage of blood per rectum. Other symptoms of intussusception include:

• Abdominal mass
• Lethargy
• Diarrhea
• Nausea and vomiting also may occur
• Hematochezia (stool containing blood) or currant jelly stool

Diagnosis & Test

• History and physical examination
• air or contrast enema
• Abdominal Ultrasound
• X-ray or computerized tomography scan may reveal intestinal obstruction caused by intussusception

Management of Intussusception

Non operative management is the first line management. Surgery is required if there are signs of bowel necrosis and perforations. Intravenous fluid resuscitation is given to correct dehydration before treatment. Nasogastric tube may be passed to vent any air that has built up and drain off the stomach and bowel contents. Antibiotics is given to treat infections.

Non operative reduction by ultrasound-guided or fluoroscopic pneumatic (air) or hydrostatic (saline or contrast) enema is the treatment of choice in pediatrics with Ileocolic intussusception, which is the most common type of intussusception in children. An air enema is initiated as the first treatment with the help of X-ray to correct the intussusception

Nursing Care of Intussusception

• Auscultate patient bowel sounds to identify changes in motility and potential bowel obstruction
• Examine stools for the presence of blood or currant jelly-like consistency, which can be indicative of intestinal ischemia
• Perform a thorough abdominal examination to assess for signs of tenderness, distension, and palpable masses.
• Monitor vital signs
• Assess patient for signs of shock such as tachycardia and hypotension
• Monitor patient intake and output and manage fluid balance
• Administer intravenous fluids as prescribed to prevent dehydration.
• Assess the intensity and location of abdominal pain appropriate pain rating scale
• Administer prescribed pain medications as ordered
• Maintain NPO as ordered
• Assist and prepare patient for surgery if required
• Educate patient and caregivers on intussusception and about the surgery and the importance of follow-up care.
• Assess the patient's and family's understanding of the condition

Differential diagnosis

• Primary bowel tumour
• Meckel diverticulum
• Abdominal hernias
• Appendicitis
• Internal hernia
• Testicular torsion
• Volvulus