Assessment

HISTORY. The child, usually a healthy male with no previous illness, experiences severe, intermittent abdominal pain; children often draw their legs up to the abdomen, turn pale and clammy, and cry sharply. In addition, the child may vomit and appear restless. The attack is followed by a period of normal behavior and then developing symptoms (see below). Adults may report general, chronic, intermittent symptoms such as abdominal tenderness; vomiting; and changes in bowel habits such as diarrhea, bloody stools, or constipation.

PHYSICAL EXAMINATION. As the condition continues, the child may have bile-stained or fecal vomiting and may pass bloody stools. The stool is often called "currant jelly stool" because of the mucus and blood from the injured bowel. The child may show some guarding of the abdomen, and a sausage-like mass may be palpable in the abdomen. Location of the mass and the guarding vary, depending on the location of the intussusception. Bloody mucus may be found on rectal examination. Hyperperistaltic rushes may be heard on auscultation.

Adult patients may have a distended abdomen and often pain in the right lower quadrant of the abdomen. Extremely severe pain, abdominal distension, rapid heart rate, and diaphoresis may indicate that intussusception has led to strangulation of the bowel.

536 Intussusception

PSYCHOSOCIAL. The sudden onset of intussusception and the severity of the pain and symptoms can provoke anxiety in the parents and the child. Assess the parents' coping ability and their support systems. Note that, because the child experiences an emergency condition, the child has not been prepared for hospitalization, separation from the parents and the home environment, and possible surgery.

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