When non-surgical interventions for intussusception fail, surgical options include open surgery and laparoscopic surgery. In an open procedure, a surgeon makes a single larger incision to access the abdomen and manually reduces the intussusception by pushing the telescoped bowel back into its original position. Alternatively, laparoscopic surgery uses small incisions and a camera to visualize and reduce the bowel in a minimally invasive manner . If reduction is not possible or viable, the affected section of the bowel is resected, and the healthy ends are sewn together . The choice of technique depends on factors such as the patient's condition, the exact location and nature of the intussusception, and the presence of any complicating factors such as necrosis or perforation . Surgery addresses the condition by directly resolving the obstruction and restoring normal bowel function while preventing further tissue damage or recurrence .

Nursing management for intussusception involves both pre-operative and post-operative care. Pre-operatively, nurses monitor baseline observations including heart rate, respiratory rate, temperature, and pain score, and ensure that the child is NPO (nil per os) with routine laboratory tests such as CBC and urinalysis done. Signed parental consent and pre-anesthetic sedation are obtained, and if bowel perforation is present, IV fluids, systemic antibiotics, and bowel decompression are administered . Post-operatively, nurses observe vital signs, inspect sutures, ensure dressings remain intact, and monitor for the return of bowel sounds. In cases of spontaneous or hydrostatic reduction, nurses check for passage of water-soluble contrast material and monitor stool patterns for recurrence .

Medical treatment of intussusception often involves non-surgical procedures such as a water-soluble contrast enema or an air-contrast enema, which both confirm the diagnosis and can successfully reduce the intussusception in most cases . If the bowel cannot be reduced by enema, which occurs in 10-15% of cases, surgery becomes necessary. Surgical management can be performed either as an open procedure or laparoscopically, depending on the child's condition and involves physically reducing the telescoping bowel or removing the affected section if reduction is unsuccessful . The choice between these approaches depends on the success of the enema, the recurrence of intussusception, or complications requiring direct intervention such as necrosis or perforation .

If intussusception is not promptly treated, several serious complications can arise, including perforation of the bowel leading to peritonitis, necrosis of bowel tissue that may require resection, shock and sepsis, and the potential for re-intussusception after either spontaneous or active reduction . These complications stem from the ongoing obstruction and resultant interruption in blood supply to the affected intestinal segments, leading to tissue death and increased risk of infection and systemic reaction .

Early signs of intussusception in young children include intermittent episodes of sudden severe abdominal pain that last only a few minutes, where infants may pull up their legs during these episodes. Vomiting, an abdominal mass in the right upper side of the abdomen, and lethargy due to dehydration are also early symptoms . As the condition progresses, later signs include bloody stools with a mucus-like texture resembling currant jelly, bilious (green) vomiting due to intestinal obstruction, fever, low blood pressure, and fast heart rate, which can indicate bowel perforation .

Pre-operatively, nurses must prioritize monitoring vital signs such as heart rate, respiratory rate, temperature, and pain levels, ensuring the patient maintains NPO status, facilitating routine laboratory tests, and obtaining signed parental consent for procedures . They need to assess if the child requires IV fluids, systemic antibiotics, or bowel decompression to manage dehydration or perforation risk before surgery . Post-operatively, nurses focus on observing vital signs, checking the integrity of sutures and dressings, ensuring the timely return of bowel sounds, and monitoring stool patterns for any signs of recurrence . They must maintain vigilance for complications such as perforation or shock and ensure appropriate pain management and fluid balance to support recovery. Close observation immediately after reduction or surgery is crucial to detecting rhinvention quickly and determining the necessity for additional intervention .

Recurrence of intussusception may occur due to incomplete reduction during initial treatment or due to underlying conditions that predispose the bowel to telescope again. Recurrence is observed within 24 hours in some cases following successful reduction by enema . When intussusception recurs, conservative reduction techniques, such as enemas, are initially considered; however, multiple recurrences may necessitate surgical intervention, often via laparotomy, to ensure full resolution . Factors influencing recurrence include anatomical or functional bowel anomalies and improper closure or healing from previous interventions .

Intussusception causes obstruction and potential bowel damage through the telescoping action of one segment of the intestine into a more distal segment, often described as the intussusceptum moving into the intussuscipiens . This telescoping action causes overlapping of bowel walls which leads to irritation, swelling, and eventually obstruction, preventing the passage of food through the intestine. As the condition progresses, the bowel's blood supply is compromised, leading to ischemia, swelling, and possible necrosis if the blockage is not relieved . If left untreated, the lack of blood supply induces gangrene and can lead to perforation of the bowel, resulting in peritonitis and systemic infection .

Key risk factors for developing intussusception in children include being under the age of 3, as it is most common between 6 months and 3 years old, and male gender, as boys are more frequently affected than girls. Additionally, certain conditions such as abnormal intestinal formation at birth, acute gastroenteritis, cystic fibrosis, Henoch-Schonlein purpura, Crohn's disease, Meckel’s diverticulum, and celiac disease can increase the risk . These factors are believed to contribute to or exacerbate the telescoping of the bowel that characterizes intussusception .

Diagnosis of intussusception in children typically involves imaging techniques such as plain X-ray, ultrasound, and barium enema. Ultrasound is often the first imaging technique used due to its non-invasive nature and lack of radiation, allowing visualization of the telescoped bowel sections . A barium enema not only confirms the diagnosis by showing the blockage but also serves as a therapeutic procedure that can reduce the intussusception by applying pressure to the affected area . Imaging helps clinicians to confirm the diagnosis, assess the extent of bowel involvement, and decide whether non-surgical or surgical treatment should be pursued. In some cases, CT scans may also be used, although they are less common in younger children .