Definition

• A telescopic invagination of a portion of the intestine into an adjacent part, producing mechanical and vascular impairment.

Discussion

• Invagination is the insertion of one part of a structure within another part of the same structure, which is what happens with intussusception.
• This defect can be relieved by either reduction via hydrostatic pressure (usually barium enema) or by a laparotomy with manual manipulation if the defected segment.
• The most common site for intussusception is around the ileocecal valve, in which the terminal ileum becomes invaginated into the cecum.
• If not reduced, either spontaneously or by hydrostatic pressure, gangrene will ultimately ensue unless surgical intervention is prompt.

Positioning

• Supine, with arms restrained at the sides.

Packs/ Drapes

• Pediatric laparotomy drape with basic pack.

Instrumentation

• Pediatric laparotomy tray
• Internal sampling devices.

Supplies/ Equipment

• Thermal blanket
• Suction
• Blades
• Needle counter
• Vessel loops
• Internal staples
• Solutions
• Sutures
• Basin set
• Needle counter
• Dissector sponges

Procedure

1. A transverse or low right paramedian incision is made and the peritoneum is entered.
2. Manual manipulation is attempted to reduce the intussusception.
3. Should the viability of the bowel be in question, however, a resection is performed in a fashion similar to that of an adult bowel resection, with a primary anastomosis or the ends of the bowel brought out as a stoma through separate incisions.
4. With the latter, the anastomosis is performed as a secondary procedure.
5. The abdomen is closed in a routine manner.

Perioperative Nursing Consideration

1. The surgeon may require a clean closure set-up.
2. If the bowel resection is performed, isolate all instruments, following bowel technique.
3. When part of another procedure, the small bowel segment will be performed following the revision of the diseases area, and appropriate instrumentation for that procedure should be available.
4. Bowel technique requires the total changeover of gowns, gloves, and instruments.