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Intussusception
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
If air enema successfully reduces the intussusception, patients are observed in the ED for four hours, then have a PO trial and can be discharged if clinically well. — Meera Kotagal, Intussusception Guideline · 4:30
Repeat Enema for Intussusception: Update Course 2016
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Should we repeat enemas for intussusception if the first enema is unsuccessful? Clip from the 2016 Pediatric Surgery Annual Update Course.
video3:21 · Jan 2019
Intussusception Guideline
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Dr. Meera Kotagal joins us again to discuss evaluation and management of patients with suspected intussusception, involving use of air enema, timing of surgical consult and role of early discharge after reduction.
video · Jul 2019
High-volume centers where non-radiologists (surgeons or ED physicians) perform frequent ultrasounds can achieve good diagnostic results for intussusception. — Todd Ponsky, Case-Based Journal Review- Intussusception in 2022 · 2:52
Reduction of intussusception with saline enema superior to air enema
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REDUCTION OF INTUSSUSCEPTION WITHOUT FLUOROSCOPY USING SALINE AND ULTRASOUND! No fluoroscopy for intussusception reduction? YES!!! Check out this article out of West China Hospital of Medical Sciences from Sichuan University! They conducted
video · Sep 2018
Discharge after Reduction of Intussusception Is Safe and Effective
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Do you routinely admit patients after radiologic reduction of intussusception in order to observe for recurrence? A new study out of Children's Mercy Hospital in Kansas City suggests that you don't have to!Check out this article by Joseph
video · Feb 2019
Case-Based Journal Review- Intussusception in 2022
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Dr. Jose Campos is back, this time helping us review some of the latest literature on the diagnosis and management of intussusception in children. In this podcast, we're reviewing a typical case with Dr. Todd Ponsky and incorporating litera
podcast20:19 · Feb 2022
Journal of Pediatric Surgery Article Review: The Disruption Score
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video12:11 · Jun 2026
One position is that stapling off a bleeding Meckel removes the acid source, so the ulcer will heal without needing bowel resection, similar to vagotomy for peptic ulcer disease. Intussusception - Soft Tissue Abscess - Pilonidal Cyst - Bleeding Meckel's... · 17:39
Intussusception - Soft Tissue Abscess - Pilonidal Cyst - Bleeding Meckel's...
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Dr. Nicholas Bruns gives a presentation on intussusception, soft tissue abscess, pilonidal cyst, bleeding Meckel's Diverticulum. His presentation generates discussion onreduced ileocolic intussusception and an appendectomy, age cutoff for a
video19:53 · Nov 2018
Early laparoscopic intussusception cases that appeared to be easy reductions were often already reduced by radiology but not called as such due to lack of ileal reflux — Todd Ponsky, Intussusception · 11:00
Intussusception
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At the 7th Annual Pediatric Surgery Update Course, Dr. Daniel von Allmen discusses the latest in management of intussusception.
video · Mar 2020
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Case-Based Journal Review- Intussusception in 2022
Point-of-care ultrasound for intussusception diagnosis achieved 95% sensitivity and 99% specificity in a 2019 American Journal of Emergency Medicine study.
Host summaryRod Gerardo summarizing a resource — not the host's own clinical position2:12 ↗
High-volume centers where non-radiologists (surgeons or ED physicians) perform frequent ultrasounds can achieve good diagnostic results for intussusception.
opinionTodd Ponsky2:52 ↗
It would be irresponsible for institutions to adopt POCUS for intussusception based solely on this study without adequate training and volume.
opinionTodd Ponsky3:50 ↗
Ultrasound-guided hydrostatic reduction had 95.8% success rate versus 93.1% for fluoroscopy-guided air reduction in a 2021 World Journal of Emergency Surgery study from China.
Host summaryRod Gerardo summarizing a resource — not the host's own clinical position5:08 ↗
The 2% difference in success rates between hydrostatic and air reduction is not clinically significant enough to justify changing established practice.
Host summaryEllen Encisco summarizing a resource — not the host's own clinical position6:04 ↗
The hydrostatic versus air reduction study validates an alternative reduction method showing at least equivalent results.
opinionTodd Ponsky6:04 ↗
Obstructive bowel gas pattern on radiograph is associated with decreased air enema success and increased need for surgical bowel resection in a 2020 Pediatric Radiology study.
Host summaryRod Gerardo summarizing a resource — not the host's own clinical position7:20 ↗
A 2018 Journal of Pediatric Surgery prediction model using clinical and sonographic data (free fluid, extension beyond splenic flexure, altered Doppler) identified 80% of failed saline enema reductions before the procedure.
Host summaryRod Gerardo summarizing a resource — not the host's own clinical position8:29 ↗
Sedation for pneumatic reduction showed slightly better success rate but higher recurrence rate (5.1% vs 1.3%, non-significant) and more perforations (3 vs 0, non-significant) in a 2017 Pediatric Anesthesia study.
Host summaryEllen Encisco summarizing a resource — not the host's own clinical position9:54 ↗
S-ketamine sedation versus morphine analgesia showed non-significant differences in success rate (90% vs 70%) and recurrence (10% vs 15%) with no perforations in either group.
Host summaryRod Gerardo summarizing a resource — not the host's own clinical position10:59 ↗
If sedation shows no increased perforation risk compared to no sedation, then sedating children for comfort during reduction is justified.
Host summaryEllen Encisco summarizing a resource — not the host's own clinical position11:47 ↗
A 2019 JPS systematic review and meta-analysis of 10 studies found no significant difference in ED returns, recurrence, need for operation, or mortality between inpatient and outpatient management after successful air enema reduction.
Host summaryRod Gerardo summarizing a resource — not the host's own clinical position12:48 ↗
COVID-era hospital bed and staff scarcity is forcing reconsideration of routine admission practices, and intussusception is an example where evidence supports not admitting by default.
opinionTodd Ponsky13:46 ↗
A 2020 Journal of Pediatric Surgery database study of 8,289 patients found 3.7% readmission and recurrence rate after intussusception reduction.
Host summaryRod Gerardo summarizing a resource — not the host's own clinical position14:55 ↗
A 2020 Pediatric Emergency Care study of 200 cases found 13.5% overall recurrence rate with 7.3% recurring within 48 hours, with fever and female sex as risk factors for early recurrence.
Host summaryTodd Ponsky summarizing a resource — not the host's own clinical position15:31 ↗
Both recent studies show lower recurrence rates (3.7-13.5%) than the traditionally quoted 15-20% that surgeons have been telling families.
Host summaryEllen Encisco summarizing a resource — not the host's own clinical position16:17 ↗
Increasing tolerance for recurrence risk benefits the vast majority of children by avoiding unnecessary admission and its associated complications.
Host summaryEllen Encisco summarizing a resource — not the host's own clinical position16:59 ↗
In resource-limited settings without 24-hour radiology, unnecessary laparotomies are sometimes performed for intussusception diagnosis in the middle of the night.
Host summaryEllen Encisco summarizing a resource — not the host's own clinical position3:14 ↗
Standard practice in many US institutions is to admit intussusception patients overnight and discharge the next morning, not keep them for 48 hours.
clinicalTodd Ponsky16:50 ↗
Repeat Enema for Intussusception: Update Course 2016
Five studies examined repeat enema for intussusception, with four showing over 50% success rates
Host summaryThe host summarizing the discussion — not the host's own clinical position1:01 ↗
The mean success rate for repeat enema across studies is estimated at 60-70%
Host summaryThe host summarizing the discussion — not the host's own clinical position1:50 ↗
Repeat enema should be performed if the initial attempt made any progress and the patient is stable
Host summaryThe host summarizing the discussion — not the host's own clinical position2:05 ↗
More than likely the intussusception will be reduced on the second attempt if progress was made initially
Host summaryThe host summarizing the discussion — not the host's own clinical position2:25 ↗
Tony Sandler's Toronto Sick Kids study used a 2-4 hour interval between enemas
Host summaryThe host summarizing the discussion — not the host's own clinical position2:05 ↗
More recent studies used 6-12 hour intervals between enemas, typically waiting until morning
Host summaryThe host summarizing the discussion — not the host's own clinical position2:20 ↗
There was not a higher rate of operative resection if repeat enema was delayed and the patient ultimately required surgery
clinicalDavid2:35 ↗
The mean time interval between first and second enema in David's study was approximately 6 hours
Host summaryThe host summarizing the discussion — not the host's own clinical position3:00 ↗
Radiologists may be reluctant to attempt repeat enema after pushing 120 centimeters pressure on initial attempt
opinionAvi0:48 ↗
Success of repeat enema is radiology and system dependent
opinionAvi0:48 ↗
Journal of Pediatric Surgery Article Review: The Disruption Score
The disruption score is a bibliometric tool used to characterize pediatric surgery publications.
Host summaryMark Davenport summarizing the discussion — not the host's own clinical position1:59 ↗
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