What is Intussusception?
Intussusception is a telescoping of one portion of bowel into another, obstructing the passage of intestinal contents and compromising blood flow to the walls pressed against each other. Left untreated, it leads to tissue necrosis, perforation, and peritonitis. Symptoms include colicky abdominal pain, nausea, vomiting, lethargy, and blood or mucus in the stool (currant jelly stool).
It occurs most often in infants 3 to 12 months old, less often in children 12 to 24 months. The cause is usually unknown, but Meckel's diverticulum, celiac disease, cystic fibrosis, diarrhea, and constipation all raise the risk. Surgery is indicated when the involved segment does not resolve with manual reduction or hydrostatic (enema) pressure, or when the bowel has become necrotic.
Nursing Care Plans and Management
The priorities are straightforward: keep the parents informed, restore fluid volume and prevent dehydration, and watch for resolution (pain relief, return of normal bowel sounds and brown stool).
Nursing Problem Priorities
- Manage pain and discomfort.
- Monitor for bowel obstruction or ischemia.
- Maintain hydration with appropriate fluids.
- Prepare for nonsurgical reduction.
- Plan for surgery if reduction fails or perforation occurs.
Nursing Assessment
Assess for the following subjective and objective data:
- Vomiting
- Decreased urine output
- Inadequate fluid intake
- Signs of dehydration or electrolyte imbalance
Nursing Diagnosis
Form your diagnosis from the assessment and your clinical judgment. The label matters less than acting on what you find.
Nursing Goals
The child will tolerate age-appropriate foods and fluids without vomiting or recurrence and stay free of fluid and electrolyte imbalance.
Nursing Interventions and Actions
1. Restoring Fluid Volume and Preventing Dehydration
Assess for dehydration: poor skin turgor, dry mucous membranes, irritability, delayed capillary refill. Repeated vomiting plus poor intake drives fluid loss fast in infants.
Track intake and output. It is your best running indicator of the child's fluid status.
Monitor vital signs frequently. Hypotension, tachycardia, and rising temperature point to hypovolemia.
Watch stool consistency and color. Early on the child may pass a normal stool; the mucus-filled, blood-filled, jelly-like stool comes later.
Offer a pacifier. Sucking promotes peristalsis and passage of gas.
Provide frequent oral hygiene. Poor intake leaves the mouth dry and sticky; mouth care eases that discomfort and renews interest in drinking.
Give IV fluids as ordered. Postoperatively, IV fluids continue to correct electrolytes and maintain intake.
Advance the diet on order: clear liquids first, then soft foods. Hold the progression until normal bowel function returns.
2. Promoting Safety and Preventing Injury
Watch for the classic presentation: acute abdominal pain with loud crying and knees drawn to the chest, often episodic, with vomiting, a brown stool followed by red currant jelly stool, pallor, and irritability. This confirms intussusception, which obstructs the bowel and, untreated, progresses to peritonitis.
In older children, watch for diarrhea, constipation, and vomiting. These point to intussusception and warrant further assessment.
After reduction, observe bowel elimination, stool characteristics, and the ability to pass the barium. This confirms the reduction worked. The condition can recur within 36 hours.
Keep the NG tube to suction and IV fluids running to decompress the bowel and maintain hydration. This prevents vomiting and dehydration and preps the child for the barium enema that both diagnoses and reduces the invagination.
Explain the plan and let parents ask questions. It cuts anxiety and the fear of the unknown.
Reassure the parents and let them stay with the child during the procedure. Their presence builds trust and lowers the child's distress.
Explain the purpose of the IV, NG tube, and NPO status. Parents who understand the treatment are less anxious.
Tell parents that surgical reduction may be needed if the barium enema fails. This prepares them for the possibility of surgery.
Reinforce the physician's explanation of surgery when barium reduction is unsuccessful or when obstruction and necrosis are present.
3. Patient Education and Health Teachings
Assess what the parents already know about the condition, its signs, and the treatment plan. This shapes an effective teaching plan.
Keep teaching clear and brief; use teaching aids and invite questions. Match the content to how the parents learn best.
Teach the signs of incision infection and demonstrate a dressing change, then have parents return the demonstration. Catching wound infection early speeds intervention.
Tell parents to report any blood in the stool, change in stool, diarrhea, constipation, or absence of stool. These signal GI bleeding or recurrence.
Walk parents through the prep for barium enema or surgery and the antibiotic and postoperative care. They will know what to expect during the hospital stay.
Explain that the child will be NPO at first, then start clear fluids and slowly return to the usual diet once cleared. This prevents vomiting and abdominal distention until the condition resolves.
Review activity restrictions. They let the bowel and any wound heal without complications.
Tell parents that brown stool means the condition has improved. It is the marker of successful resolution.
Frequently Asked Questions
What age group gets intussusception?
It occurs most often in infants 3 to 12 months old and less often in children 12 to 24 months. It is one of the most common causes of intestinal obstruction in this age group. The cause is usually unknown, though Meckel's diverticulum, celiac disease, cystic fibrosis, diarrhea, and constipation all raise the risk.
What is currant jelly stool and when does it appear?
Currant jelly stool is a mixture of blood and mucus from the bowel wall that is losing its blood supply. It is a classic sign but a later one. Early on the child may pass a normal brown stool, and the jelly-like, blood-streaked stool appears as ischemia develops. The full triad of colicky pain, vomiting, and currant jelly stool is present in only about a fifth of cases, so its absence does not rule out intussusception.
Why is intussusception a time emergency?
Because the telescoped segment chokes off blood flow to the trapped bowel wall. Left untreated, the tissue progresses to necrosis, perforation, and peritonitis, which can be fatal. Prognosis is excellent when reduction happens quickly, which is why early recognition and prompt treatment matter so much.
How is intussusception treated?
Most cases are reduced nonsurgically with an enema that uses air or hydrostatic (fluid) pressure to push the telescoped bowel back into place, which is both diagnostic and therapeutic. Surgery is indicated when the enema fails to reduce the segment, when the bowel is already necrotic, or when perforation has occurred.
Can intussusception come back after it is reduced?
Yes. Recurrence can happen, often within about 36 hours of reduction, so the child is monitored closely afterward. Nurses watch bowel elimination and stool characteristics and teach parents to report any blood in the stool, change in stool pattern, diarrhea, constipation, or absence of stool.
What tells the nurse the reduction worked?
Return of normal bowel function: pain relief, the return of normal bowel sounds, and passage of a normal brown stool. Brown stool is the marker that the condition has resolved, while a return of currant jelly stool or worsening pain signals possible recurrence.