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Learning Objective 1. Define and explore things about intussusception 3. Study the anatomy and physiology of digestive system 5. Identify signs and symptoms of intussusception 10. Determine different laboratory and diagnostic procedure done in patient with Intussusception 14.Discuss the pathophysiological basis of the disease 16.Determine the course of medical intervention for patient with intussusception

ALTERATION IN DIGESTIVE FUNCTION ILLEOCOLONIC INTUSSUSCEPTION

ANATOMY AND PHYSIOLOGY OF DIGESTIVE SYSTEM

DIGESTIVE SYTEM

Gastric secretions:

•pepsin, •hydrochloric acid •mucus

Specific enzymes

Salivary amylase Precursor pepsinogen Pancreatic amylase Pancreatic trypsin

Specific enzymes

•Pancreatic lipase •Small intestine peptidases •Small intestine maltase •Small intestine lactase

Hormones secreted by one organ into the bloodstream triggered activity in other tissues.

• gastrin • secretin • cholecystokinin • GIP (gastric inhibitory peptide)

CASE REPORT

A 51-year-old white woman with no significant past medical history presented to the emergency department (ED) with a 2-day history of progressive nausea, vomiting, watery diarrhea, and subsequent right lower quadrant abdominal pain. The pain was dull, aching, not related to food intake, and not exacerbated with exercise. She took

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daily multivitamins and denied a family history of colon cancer or inflammatory bowel disease (IBD). The patient had undergone an open appendectomy about 14 years ago. Her vital signs on admission to the ED were stable. The physical exam was remarkable for right lower quadrant tenderness with mild guarding;

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there was no rebound tenderness or palpable mass. Results of laboratory studies were within the normal range, including complete blood

count,

chemistry

panel

with

liver

function tests, and urinalysis. She underwent a CT scan of the abdomen and pelvis in the ED,

which

showed

a

intussusception (Figure 1).

large

ileocolonic

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She received intravenous fluid infusion, antiemetic medications, and was admitted to the in-patient service.

CT scan showing ileocolonic intussusception ( FIGURE 1)

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The patient's right lower quadrant pain subsided and she was asymptomatic with normal bowel sounds. The gastroenterology service was consulted to evaluate the intussusception and to rule out colonic malignancy

prior

to

an

elective

surgery.

A

colonoscopy exam performed on day 1 of admission showed a segment of intussuscepted terminal ileum into the cecal area, about 10 cm long, with few ulcerative lesions on the surface and without ischemic changes

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FIGURE 2

Colonoscopy exam of patient with ileocolonic intussusception at the cecal region, showing few ulcerative lesions on the left and normal appearance of the mucosa on the right.

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The patient underwent an urgent laparoscopic right hemicolectomy with ileocolonic anastomosis within 24 hours of the colonoscopy. A large ileocolonic intussusception was identified, about 10 × 4 × 4 cm in size, without any gross mass lesions seen at the leading point and without any evidence of bowel ischemia or adhesion.

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The microscopic pathology exam revealed prominent regenerative changes in the intussuscepted ileum, without evidence of malignancy or IBD. Multiple reactive lymph nodes about 0.5 cm in size were seen at the attached serosal tissue around the leading point, without any pathologic significance.

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The patient recovered uneventfully after the surgery, and was discharged on postoperative day 4.

PATHOPHYSIOLOGY

MEDICAL MANAGEMENT

• Insert a nasogastric tube • Administer intravenous fluids according to body weight

Diagnostic Procedures • Monitor serum electrolytes • Blood chemistry • X-ray or other abdominal imaging • Ultrasound • colonoscopy • Air or barium enema.

Hydrostatic reduction

Surgical Intervention

•Ultrasound

Reduction

Laparotomy Resection and anastomosis

REFERENCES 1.Brunner and Suddarth’s (2008)Text book of Medical Surgical Nursing(11th ed.) Lippincot, Williams And Wilkins 2.The Essential of Human Anatomy and Physiology, 7th ed. Elaine N. Marieb 3. http//www.medline plus. com 4. http://www.cinahl.com/library/.htm 5.Porth C M (2005) Pathophysiology:Concept of Altered Health States(7th.ed) Philadelphia:Lippincott, Williams and Wilkins