The most common cause of bowel obstruction in children is intussusception. This is a telescoping movement where part of the intestine slides over itself making the intestine shorter, as if closing a telescope. When this happens, the intestine begins to swell from inflammation, food can’t pass through and the blood supply is cut off. Tissue death, bowel perforation and infection may occur. This most often affects children between 3 months and 3 years of age and can be a serious, life-threatening emergency.
The cause is not known exactly. It is believed that oftentimes, the normal contraction movement of the intestine causes a portion to become stuck over the diverticulum, pulling the segment of intestine inside itself. Others suspect that a virus may be the cause.
Patient will have optimal pain management; patient will have adequate fluid balance
Fever is an accompanying symptom and can be a sign of infection
A hallmark sign of this condition is an obvious lump of bowel that is distended and tender to touch.
Assess for pain (including verbal and non-verbal cues)
Abdominal pain is associated with this condition, but may not be initially present or constant.
Depending on the age of the patient, they may be guarding the abdomen, or may appear colicky with bouts of inconsolable crying or fussiness
Initiate IV fluids
Children dehydrate quickly and easily. Vomiting and diarrhea can cause a significant fluid loss and dehydration.
Monitor stool for bloody diarrhea
“Red currant jelly” stools are common and consist of blood, mucus and stool. This is one of the most common symptoms and a hallmark sign of intussusception
Monitor intake and output
Take note of watery stools, emesis, urine output.
Insert nasogastric tube and perform gastric decompression
Reduces bowel stress and promotes bowel rest.
Perform or assist with therapeutic enema
Enemas may be given with barium, water-soluble solution or air.
While most often used as a diagnostic test, this procedure may help the intestine correct itself so the child can avoid surgery.
Prepare patient for surgery
In cases where there is tissue necrosis or perforation of the bowel, or where the intestine doesn’t self-correct, surgical repair will be necessary.
Provide education and support for patient and family members
Provide information and support for the parents and family members of patients. Answer questions, give resource information based on the child’s discharge needs.
Provide education on post-operative dietary requirements.
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