Intussusception on the NCLEX
Currant jelly stools, sausage-shaped mass, episodic pain, and the air enema that both diagnoses and treats.
Intussusception is the telescoping bowel of infancy, and the exam loves its two named findings. Recognize it fast because bowel is dying while you wait.
Recognize it
Most common in roughly 6 months to 3 years, often a previously healthy infant. Sudden episodes of severe crampy abdominal pain: screaming and drawing the knees to the chest, then a calm or lethargic interval, then it repeats. Currant jelly stools (blood and mucus) are classic but late. Sausage-shaped mass, typically right upper quadrant, with vomiting that may become bilious. Lethargy alone can be the presentation in infants.
Air enema: diagnosis and treatment
Air (or contrast) enema under fluoroscopy confirms and usually reduces the intussusception in one step. Success rate is high; most children need no surgery. Before the enema: NPO, IV fluids, NG decompression as ordered. Contraindicated with perforation or peritonitis (fever, rigid distended abdomen, shock) - that child goes to surgery. Surgery also follows a failed enema or recurrence.
The finding to report
Passage of a normal brown stool can mean the intussusception reduced itself. Report it immediately - it changes the plan and may cancel the enema. After reduction, observe per protocol: recurrence risk is real in the first days. Return precautions for parents: the same episodic pain, vomiting, bloody stool.
Frequently asked
Is currant jelly stool an early sign?
No. It is a late sign of vascular compromise. Suspect intussusception from the episodic pain pattern before stools change.
Why NPO before the enema?
Perforation and surgery are both possible. An empty stomach is safer for anesthesia and reduces aspiration risk.
Child passes normal stool while awaiting the enema?
Notify the provider now. Spontaneous reduction may have occurred and the enema may no longer be needed.
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