How to Detect Intussusception

Let’s talk bowels! 💩 (Yup, I went there with that emoji, haha) Seriously though, the GI system is probably one of the most critical yet mysterious systems of the body. I say this because “abdominal pain” can literally indicate a vast majority of conditions. A clear and detailed triage is essential in narrowing down potential diagnoses.

When you think GI what do you think of? 🙇🏻‍♀️You probably have a few things that came to mind just now. Gastroenteritis…GERD…. Appendicitis… to name a few. But let’s not forget about those conditions that can be seen in the pediatric population.

✨Today we are discussing a condition that should never be overlooked. 𝐈𝐧𝐭𝐮𝐬𝐬𝐮𝐬𝐜𝐞𝐩𝐭𝐢𝐨𝐧. 𝙄𝙣𝙩𝙪𝙨𝙨𝙪𝙬𝙝𝙤?! Intussusception is when the proximal segment of the intestine telescopes (or slips) into a distal part of the intestine. Just imagine a telescope 🔭— when you close a telescope each compartment overlaps the other in order to become smaller, when you open it, it untelescopes and becomes longer. That’s exactly what happens to a portion of the intestine. Get it? Telescoping of the bowels is serious and will lead to lymphatic and venous obstruction causing edema if not corrected.

𝐂𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐦𝐚𝐧𝐢𝐟𝐞𝐬𝐭𝐚𝐭𝐢𝐨𝐧𝐬

▪️Sudden, intermittent abdominal pain: during moments of intermittent pain patient may scream and assume a knee to chest position. Pain may be mild at first and progress to moderate to severe. As pain gets worse (the longer the child has intussusception), the window between the episodes will get smaller leading to constant pain.

▪️Sausage- shaped abdominal mass

▪️Red currant jelly stools: These stools signify a mix of blood and mucous in the stool.

▪️Vomiting, tender/distended abdomen and fever (if sepsis is present) can also occur.

𝐃𝐢𝐚𝐠𝐧𝐨𝐬𝐭𝐢𝐜 𝐭𝐞𝐬𝐭𝐢𝐧𝐠

🩺 Ultrasound – an abdominal US will be able to visualize the telescoped bowel.

𝐍𝐮𝐫𝐬𝐢𝐧𝐠 𝐢𝐧𝐭𝐞𝐫𝐯𝐞𝐧𝐭𝐢𝐨𝐧𝐬

💉 I.V. placement – first thing you want to do as soon as you realize your patient has intussusception. Patient must be given fluids and stabilized prior to procedure, especially to correct/ prevent any dehydration.

💉 Nasogastric (NG) tube – depending on how severe the situation is a provider might order this to assist with decompression of the abdomen

𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭

▫️Air enema ➞ in most cases successfully resolves intussusception and air pressure will untelescope the bowels.

▫️Surgery ➞ they open up the abdomen and carefully “milk” the affected area of the intestine to reduce it. While doing this, they carefully inspect the intestine to ensure no gangrene or permanent damage is present. If there is gangrene they resect (remove) the affected area and perform anastomoses of both remaining ends of the intestine to connect it again. If there is no gangrene and the intestine is fine, they suture up and patient recovers.

Remember, during intussusception the intestine will have lymphatic and venous obstruction leading to edema. Due to this increase in inflammation the intestine will be constricted and lose even more blood flow leading to ischemia. When there is limited blood flow to a part of your body you are at risk for tissue death and gangrene.

’till next time,

The RN Educator