Intussusception Surgical Repair In Children

WHAT YOU SHOULD KNOW:

• Intussusception (n-tuh-suh-SEP-shun) happens when a part of the intestines (bowel) folds into or inside of itself. It may look like a collapsed telescope or have the "inside-out" look of a tight sock after you have pulled your foot out. Intussusception may become swollen and decrease the blood supply to the folded-in section of bowel. If the blood vessels cannot carry enough blood to the folded-in bowel, this section of bowel may get sick or die. Sick bowel may begin to bleed and rip or tear. If the bowel tears, this could cause your child's belly to become swollen and infected. Intussusception is a medical emergency.
  
  
• Sometimes, an intussusception will unfold by itself. More often, caregivers must fix the bowel. Your child's caregivers may give your child a barium or air enema (N-ih-muh) to unfold the bowel. Caregivers may do surgery if the enema does not work or if the intussusception makes your child very sick.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

Although most babies recover quickly from intussusception repair, there are always risks with surgery. Your child may bleed more than usual or get an infection (in-FEK-shun). Your child may have low blood sugar after going off the IV or have apnea (forgets to breathe sometime) after anesthesia. Your child could swallow fluid into his lungs and get pneumonia. The intestines could be cut or could tear during surgery. Your child's surgery wound could open up and need to be repaired by caregivers. The intussusception could happen again in the same or a different place in your child's intestines. Your child may need another surgery to fix these problems. Your child could die.

WHILE YOU ARE HERE:

Before Your Child's Surgery:

• Informed Consent:
  
  
  • You have the right to understand your child's health problem. You should understand what tests, treatments, or procedures may be done to treat your child's problem. Your child's caregiver should also tell you about the risks and benefits of each treatment.
    
    
  • You may be asked to sign a consent form. If you are unable to give your consent, someone who has permission can sign this form for your child. A consent form is a legal paper that gives a caregiver permission to do certain tests, treatments, or procedures. This form should tell you exactly what will be done to your child. Your child's caregiver should explain what the risks and benefits of each treatment are before you sign the form. Before giving your consent, make sure all your questions have been answered.
  
  
• Call Button: A call button will be in your child's hospital room. You should use the call button if your child is having problems and a caregiver is needed. You can also use the call button if you have questions for a caregiver. Be sure to keep the call button near your child's bed at all times.
  
  
• Heart Monitor: This is a machine used to see how your child's heart is handling the intussusception. 3 or 5 sticky pads are placed on your child's chest. Each pad has a wire that is hooked to a TV-type screen or to a small portable box. This screen or box shows a picture of your child's heartbeat. Caregivers watch this picture to make sure your child's heart is doing well.
  
  
• IV:
  
  
  • An IV is a tiny tube placed in your child's vein for giving medicine or liquids. The IV may be put in your child's arm, hand, ankle, foot, or head. This tube is connected to tubing and a bag of liquid near your child's bed.
    
    
  • If your child has been vomiting or his bowel has been blocked for a while, he may be low on body fluid and salts. Your child may need an IV to fill his blood full of enough fluid and salts. Your child must have a normal amount of fluids and salts before he can go to surgery. Caregivers may leave the IV in after surgery until your child is eating and drinking enough.
  
  
• Intake and Output (I&O):
  
  
  • Your child's caregiver may need to know how much liquid your child is getting and urinating. They will carefully keep track of all IV fluids that your child gets. They may need to know about any liquid that comes out of your child. This includes urine, bowel movements (BM), and vomit.
    
    
  • If your child wears diapers, save diapers with urine or BM so a caregiver can measure them. An older child may need to urinate into a container in bed or in the toilet. A caregiver will then measure the amount of urine. Do not throw away diapers of flush urine down the toilet before asking your child's caregiver.
  
  
• NPO:
  
  
  • Your child will be NPO while waiting for surgery. NPO means "nothing by mouth". Your child's IV has sugar in it that feeds your child. This may make your child a little less hungry. If your child is a baby, let him suck on a pacifier if he is fussy or acting hungry. Do not give your child anything to eat or drink if he is NPO.
    
    
  • If you are a breast feeding mother, pump your breasts while your child is NPO. This will help your breasts to keep making milk even while your child is not drinking it. Ask caregivers for information on expressing, collecting, and storing breast milk. Keep your breast milk in a freezer until your child is able to eat again.
  
  
• NG Tube: This may also be called a nasogastric (na-zo-GAS-trik) tube. A caregiver may place this tube in your child's nose and down to the stomach. This tube may be used for suction (gentle vacuum) and keeping your child's stomach empty. This is commonly used before, during and for a short time after surgery. Do not let your child pull on the NG tube. Tell a caregiver if the tube comes out of your child's nose.
  
  
• Pulse Oximeter (oks-IH-mih-ter): This is a machine that tells caregivers how much oxygen is in your child's blood. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe. Tell a caregiver if the sticky strip or clip comes off of your child. The machine will sound an alarm if the machine cannot read the oxygen level. It will also alarm if your child needs extra oxygen. Tell a caregiver if the machine is alarming. Never turn the pulse oximeter off.
  
  
• Restraints: These are cloth bands used to tie your child's wrists or ankles to the sides of the hospital bed. These restraints are used to keep your child from pulling or kicking out any special tubes he may have. Caregivers will check on you and your child often to make sure your child is safe. They will check to see that all your child's needs are being met while your child is restrained. Restraints should only be used for a short time. They will be taken off when there is less chance that your child will pull or kick the tubes out.
  
  
• Tests:
  
  
  • Abdominal (ab-DOM-n-ull) Ultrasound:
    
    
    • This test uses sound waves to show pictures of the inside of your child's abdomen (belly). Your child will lie down on a soft table in a quiet room. A caregiver will put warm, clear gel on your child's belly. The caregiver will gently move a small probe (camera) across your child's belly to take pictures. You can watch these pictures on a TV-like screen next to your child's bed.
      
      
    • During the ultrasound, caregivers will look at your child's intestines (bowel). If your child has intussusception, caregivers may see a section of bowel that looks like a coil. The ultrasound can help caregivers find the area of folded-in bowel and see if it looks healthy. It may also help them decide if they can fix the intussusception with an enema or with surgery. You may stay with your child during the test. You can help caregivers by keeping your child calm and still. If your child is a baby, bring a pacifier for him to suck on. Sucking is a way that babies comfort themselves.
    
    
  • Abdominal (ab-DOM-n-ull) X-ray: This is a picture of the inside of your child's belly area. Caregivers may use it to look for problems in your child's intestines. This x-ray can help caregivers see areas in the bowel that are blocked. It helps them to see if there is air or fluid in your child's belly. An intussusception may look like stair-steps or a coiled spring on x-rays.
    
    
  • Air or Barium Enema (N-ih-muh):
    
    
    • This test is done by putting a tube into your child's rectum (rear end). Caregivers may push air or pour barium into your child's rectum. Barium is a white, chalky liquid that helps the bowel show up on x-rays. During this test, caregivers will look for the area of the bowel that is blocked. It may look like stair-steps or a coil on an x-ray picture. They may also look for areas of bowel that are too narrow and for other bowel problems.
      
      
    • Caregivers may use an enema to try to unfold the intussusception so your child will not need surgery. If an enema does not fix the intussusception, or if your child is very sick, he will need surgery.
    
    
  • Blood Tests:
    
    
    • Your child may need blood taken for tests. The blood may be taken from your child's arm, hand, finger, heel, or foot. Caregivers will especially want to know about your child's electrolytes (e-LEK-tro-lites). Electrolytes are blood "salts". Some of these electrolytes are called sodium, potassium, and chloride. Electrolytes keep your child's body working normally.
      
      
    • Your child may lose too much body fluid and electrolytes from vomiting or from having a blocked bowel. Low body fluid and low or unbalanced electrolytes can cause serious problems with the heart and blood system. Your child may need an IV to get his fluid and electrolytes back to normal before surgery.
  
  
• Vital Signs: This may include taking your child's temperature, pulse (heartbeats), respiration (breaths), and blood pressure. Your child's temperature may be taken in the mouth, ear, armpit, or rectum (rear-end). Caregivers may also listen to your child's heart and lungs by using a stethoscope (STETH-uh-skop).
  
  
• PreOp Care: This is the care your child gets right before surgery. Your child may be given medicines right before surgery. One of the medicines may make your child feel sleepy and more relaxed. Your child may also be given antibiotics (an-ti-bi-AH-tiks) to help fight infection (in-FEK-shun). Your child will be taken on a cart or crib to the room where surgery will be done. Your child may have special tubes put in him and equipment attached to him during this time. Caregivers will stay with your child all the time to make sure he is warm, safe, and comfortable.
  
  
• General Anesthesia (an-iss-THEE-zuh): This medicine puts your child to sleep and makes him comfortable during surgery. It may be given in an IV or as a gas through a facemask. This medicine may also go through a tube placed in your child's mouth and throat. A mouth tube is called an endotracheal (end-o-TRA-kee-ull) tube or "ET tube".

During Your Child's Surgery:

• A caregiver will clean your child's chest and belly with special soap. This soap may make your child's skin yellow, but it is cleaned off later. Sheets are put over your child to keep the surgery area clean. Caregivers will make an incision (cut) usually in the right lower area of the belly. They will gently unfold the bowel. They will look at the bowel to make sure it is healthy. Sometime, caregivers cannot unfold the bowel or they may find a sick piece of bowel. If this happens, caregivers will cut out the folded or sick bowel and sew the ends back together.
  
  
• Caregivers may close the wound underneath the skin with stitches. These stitches will dissolve (melt away) in time and do not need to be removed. Your child may get stitches steristrips (thin strips of tape) to hold the skin on the outside of his belly together.

Waiting Room:

This room is where you and your family can wait until your child is ready for visitors after surgery. Your child's caregiver will find you there to let you know how the surgery went. If you or your family leave the hospital, leave a phone number where you can be reached.

After Your Child's Surgery:

Your child will be taken to the recovery room until he wakes up and is comfortable. You may be able to visit your child in the recovery room after caregivers get him settled. Your child may then be taken to a room on one of the units in the hospital. Your child may be sleepy and have some pain after surgery. Your child should not get out of bed until caregivers say it is OK. You should leave any bandages on your child until a caregiver takes them off.

• Activity: Your child may be sleepy after surgery, then wake up hungry. Let your child's caregivers know when your child is awake and acting hungry.
  
  
• Eating and Drinking:
  
  
  • Your child may be able to eat when bowel sounds (stomach growling) are heard. A caregiver will listen for bowel sounds by putting a stethoscope (STETH-uh-skop) on top of your child's belly. A caregiver will then let you know what your child can eat. If you are a breast feeding mother, ask caregivers when you can breast feed your child after surgery.
    
    
  • If your child is very young, caregivers will start with small feedings and increase the amounts with each feeding. If your child is older, ice chips are usually given first. Then liquids like water, broth, apple juice, or clear soda are given. If your child does not have problems after drinking liquids, a caregiver may let your child eat soft foods. Some examples of soft foods are ice cream, applesauce, baby food, or pudding. If your child can eat soft food without problems, he may begin eating his regular diet.
  
  
• Emotional Support: You may stay with your child for comfort and support. Your child may need to stay in the hospital for more than a day. Ask caregivers if another family member can stay with your child when you cannot be there. If you or another family member cannot stay, bring in something from home that your child likes. Your child may like to have his favorite blanket, toy, or clothing with him.
  
  
• Intake and Output (I&O):
  
  
  • Caregivers may keep your child on I&O after surgery. They may need to measure all liquid that goes in your child's body. This includes breast milk or formula, foods, drinks, and IV fluid. If you feed your child with a bottle, tell caregivers how much formula or breast milk your child eats. Save the bottle for the caregiver to look at after the feeding. If you breast feed your child, tell caregivers how long you fed your child from each breast. Write down the amount of time per breast plus what time you started the feeding. This way, you will not forget.
    
    
  • Caregivers will need to measure all fluid that goes out of your child's body. This includes urine, BMs, and vomit. If your child wears diapers, save any diapers you change so caregivers can weigh and measure them. Tell caregivers if your child vomits during or after a feeding. They may need to estimate (guess) how much your child vomited.
  
  
• Medicines:
  
  
  • Antibiotics (an-ti-bi-AH-tiks): This may be given to help your child fight an infection caused by a germ called bacteria (bak-TEER-e-uh). Antibiotics are usually given through an IV or your child's mouth. They are sometimes given as a shot. Some people are allergic to antibiotics. Tell a caregiver if your child is allergic to antibiotics.
    
    
  • Fever Medicine: This medicine is given to help lower a fever. Some examples are acetaminophen (uh-c-tuh-MIN-o-fin) and ibuprofen (i-bew-PRO-fin). This medicine may be given in your child's mouth. The acetaminophen may also be given in your child's rectum (rear end). Bringing down the fever should help your child feel better. Talk to a caregiver before using these medicines together for your child's fever.
    
    
  • Pain Medicine: Caregivers may give medicine to help your child's pain decrease or go away. Tell a caregiver if you think your child's pain does not go away or comes back after taking this medicine. Pain medicine can have some side effects. Tell a caregiver if your child has trouble breathing, is very sleepy, or has an upset stomach. Tell a caregiver if you know your child is allergic to pain medicine.