# Intussusception — GCMD Library living collection

Everything in the library about intussusception — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 37 cited statements

## Episodes
### Acute Management
- [Repeat Enema for Intussusception: Update Course 2016](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976) — video · 3:21 · [machine version](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976.md)

### Evidence & Research
- [Case-Based Journal Review- Intussusception in 2022](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092) — podcast · 20:19 · [machine version](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092.md)

### Case-Based Learning
- [Intussusception - Soft Tissue Abscess - Pilonidal Cyst - Bleeding Meckel's...](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678) — video · 19:53 · [machine version](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=0) Intussusception: Post-Reduction Management and Lead Point Concerns (Ep 1)
- [5:43](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=343) Soft Tissue Abscess: Drainage Location, Packing, and Discharge Criteria (Ep 1)
- [9:49](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=589) Pilonidal Disease: Timing of Definitive Surgery and Operative Techniques (Ep 1)
- [15:10](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=910) Meckel Diverticulum Bleeding: Diagnostic Workup and Surgical Approach (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976?t=0) Clinical scenario and initial management options (Ep 2)
- [1:01](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976?t=61) Evidence review for repeat enema success rates (Ep 2)
- [2:35](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976?t=155) Timing considerations and operative outcomes (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=0) Case presentation and initial diagnostic approach (Ep 3)
- [2:12](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=132) Point-of-care ultrasound accuracy and institutional considerations (Ep 3)
- [4:50](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=290) Reduction methods: air versus saline enema (Ep 3)
- [7:05](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=425) Predictors of failed reduction (Ep 3)
- [9:33](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=573) Sedation and analgesia strategies (Ep 3)
- [12:32](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=752) Post-reduction disposition and outpatient management (Ep 3)
- [14:21](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=861) Recurrence rates and risk factors (Ep 3)
- [17:07](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=1027) Summary and clinical practice implications (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Cincinnati changed practice 6-8 months ago to discharge intussusception patients home from the ER after a 4-hour observation period if they tolerate feeds and are hemodynamically stable." — Todd Ponsky (clinical) [Ep 1 · 0:57](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=57)
- "In a series of 48 intussusception patients discharged from the ED, only one recurred within 48 hours and that patient did not require operation, only repeat reduction." — Nick Bruns (host_summary) [Ep 1 · 2:01](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=121)
- "When contrast fills the appendix but does not reflux into small bowel after intussusception reduction, this is attributed to ileocecal edema; the recommendation is to observe and repeat the study in a few hours." — Nick Bruns (host_summary) [Ep 1 · 2:44](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=164)
- "The repeat enema study after initial reduction does not actually reduce the intussusception again; it proves the first reduction was successful because the edema has now resolved." (clinical) [Ep 1 · 3:04](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=184)
- "Ultrasound after intussusception reduction is difficult to interpret due to inflammation, so a contrast enema is preferred for confirmation." — Todd Ponsky (clinical) [Ep 1 · 3:19](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=199)
- "One surgeon previously removed the appendix during operative intussusception reduction but now leaves it in due to concern about appendiceal stump dehiscence if reoperation is needed." — Todd Ponsky (opinion) [Ep 1 · 3:43](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=223)
- "Age over 5 years is the inflection point for pathologic lead point in intussusception, with 30-60% of cases in this age group having a lead point depending on the series." — Nick Bruns (host_summary) [Ep 1 · 5:28](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=328)
- "For intussusception in a 6-year-old, one approach is to attempt radiologic reduction, then work up for lead point electively and perform resection in a non-inflamed setting." — Todd Ponsky (clinical) [Ep 1 · 4:22](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=262)
- "Many soft tissue abscesses are drained in the emergency department by ED physicians with sedation, not in the operating room." — Todd Ponsky (clinical) [Ep 1 · 6:50](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=410)
- "Vessel loops are used as wicks for abscess drainage instead of traditional packing by some surgeons." (clinical) [Ep 1 · 7:41](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=461)
- "A study at ABSA showed that packing abscesses did not make a difference in outcomes, yet surgeons continue to use packing or wicks." — Todd Ponsky (host_summary) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=475)
- "Admission criteria for soft tissue abscess include cellulitis, fever, and leukocytosis in some combination; if the child appears sick, admission is warranted." — Todd Ponsky (clinical) [Ep 1 · 8:08](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=488)
- "Antibiotics are prescribed for soft tissue abscess only if cellulitis is present; otherwise patients go home without antibiotics." (clinical) [Ep 1 · 8:31](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=511)
- "In a retrospective review of abscess I&D cases discharged same-day from the OR, treatment failure (readmission or repeat I&D within 2 weeks) occurred in only 0.9% of patients." — Nick Bruns (epidemiological) [Ep 1 · 8:44](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=524)
- "Among patients with leukocytosis (white count up to 35), only 2 out of 138 had treatment failure after same-day discharge, and only one febrile patient had treatment failure." — Nick Bruns (epidemiological) [Ep 1 · 9:11](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=551)
- "For pilonidal disease, one surgeon operates after the second recurrence, though tries to delay as long as possible." — Todd Ponsky (opinion) [Ep 1 · 10:27](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=627)
- "The Bascom technique involves excising pits with an 11 blade at skin level under local anesthesia, allowing healing by secondary intention; 70% of patients do not recur, though there is no control group." (host_summary) [Ep 1 · 10:54](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=654)
- "For recurrent pilonidal disease or large draining sinuses, formal excision with off-midline layered closure and drain placement is performed." (clinical) [Ep 1 · 11:37](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=697)
- "Physical exam findings such as deep gluteal fold and excessive hair are high-risk factors that may influence timing and type of pilonidal surgery." — Todd Ponsky (clinical) [Ep 1 · 12:24](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=744)
- "For severe recurrent pilonidal disease, open excision with wet-to-dry dressing changes or wound vac is used." — Todd Ponsky (clinical) [Ep 1 · 12:50](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=770)
- "The Karydakis flap is superior to excision alone for pilonidal disease and comparable to the modified Limberg flap; the modified elliptical rotation flap has comparable short-term results." — Ian Glenn (host_summary) [Ep 1 · 13:04](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=784)
- "The key to preventing pilonidal recurrence is post-operative management: keeping the patient prone on bed rest until the wound heals, as it is primarily a wound healing problem from sitting on the surgical site." — Todd Ponsky (opinion) [Ep 1 · 13:43](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=823)
- "Plastic surgeons perform flap procedures for recurrent pilonidal disease and keep patients prone post-operatively." — Todd Ponsky (clinical) [Ep 1 · 14:02](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=842)
- "One patient reported laser hair removal for pilonidal disease was the most painful thing he had experienced and discontinued treatment after half a session." — Todd Ponsky (host_summary) [Ep 1 · 14:26](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=866)
- "Some surgeons have sent patients for laser hair removal without complaints, though ensuring adequate treatment area and obtaining insurance reimbursement remain challenges." — Todd Ponsky (clinical) [Ep 1 · 14:42](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=882)
- "After a negative Meckel scan in a child with hematochezia, one approach is colonoscopy with intent to proceed to laparoscopy if negative, ideally under the same anesthetic." (clinical) [Ep 1 · 15:34](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=934)
- "Starting a PPI for suspected Meckel diverticulum bleeding will stop the bleeding temporarily; it should never be an emergency operation." (clinical) [Ep 1 · 16:09](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=969)
- "For a bleeding Meckel diverticulum, if there is an ulcer at the base, segmental small bowel resection is performed rather than simple diverticulectomy." — Todd Ponsky (clinical) [Ep 1 · 17:00](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=1020)
- "Bill Gazetta taught at the fellows course that ulcers in Meckel bleeding are in the Meckel diverticulum itself, not in the adjacent small bowel." — Todd Ponsky (host_summary) [Ep 1 · 17:29](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=1049)
- "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." (opinion) [Ep 1 · 17:39](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=1059)
- "The ectopic gastric mucosa in Meckel diverticulum is almost always at the tip of the diverticulum." — Todd Ponsky (clinical) [Ep 1 · 18:09](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=1089)
- "When performing Meckel diverticulectomy by pulling the diverticulum out through the umbilicus, marking the bowel edge with a marker while it is relaxed (not under tension) helps avoid narrowing the bowel lumen." — Todd Ponsky (clinical) [Ep 1 · 18:48](https://library.globalcastmd.com/watch/intussusception-soft-tissue-abscess-pilonidal-cyst-bleeding-meckel-s-678?t=1128)
- "Point-of-care ultrasound for intussusception diagnosis achieved 95% sensitivity and 99% specificity in a 2019 American Journal of Emergency Medicine study." — Rod Gerardo (host_summary) [Ep 3 · 2:12](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=132)
- "High-volume centers where non-radiologists (surgeons or ED physicians) perform frequent ultrasounds can achieve good diagnostic results for intussusception." — Todd Ponsky (opinion) [Ep 3 · 2:52](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=172)
- "It would be irresponsible for institutions to adopt POCUS for intussusception based solely on this study without adequate training and volume." — Todd Ponsky (opinion) [Ep 3 · 3:50](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=230)
- "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." — Rod Gerardo (host_summary) [Ep 3 · 5:08](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=308)
- "The 2% difference in success rates between hydrostatic and air reduction is not clinically significant enough to justify changing established practice." — Ellen Encisco (opinion) [Ep 3 · 6:04](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=364)
- "The hydrostatic versus air reduction study validates an alternative reduction method showing at least equivalent results." — Todd Ponsky (opinion) [Ep 3 · 6:04](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=364)
- "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." — Rod Gerardo (host_summary) [Ep 3 · 7:20](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=440)
- "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." — Rod Gerardo (host_summary) [Ep 3 · 8:29](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=509)
- "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." — Ellen Encisco (host_summary) [Ep 3 · 9:54](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=594)
- "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." — Rod Gerardo (host_summary) [Ep 3 · 10:59](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=659)
- "If sedation shows no increased perforation risk compared to no sedation, then sedating children for comfort during reduction is justified." — Ellen Encisco (opinion) [Ep 3 · 11:47](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=707)
- "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." — Rod Gerardo (host_summary) [Ep 3 · 12:48](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=768)
- "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." — Todd Ponsky (opinion) [Ep 3 · 13:46](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=826)
- "A 2020 Journal of Pediatric Surgery database study of 8,289 patients found 3.7% readmission and recurrence rate after intussusception reduction." — Rod Gerardo (host_summary) [Ep 3 · 14:55](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=895)
- "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." — Todd Ponsky (host_summary) [Ep 3 · 15:31](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=931)
- "Both recent studies show lower recurrence rates (3.7-13.5%) than the traditionally quoted 15-20% that surgeons have been telling families." — Ellen Encisco (clinical) [Ep 3 · 16:17](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=977)
- "Increasing tolerance for recurrence risk benefits the vast majority of children by avoiding unnecessary admission and its associated complications." — Ellen Encisco (opinion) [Ep 3 · 16:59](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=1019)
- "In resource-limited settings without 24-hour radiology, unnecessary laparotomies are sometimes performed for intussusception diagnosis in the middle of the night." — Ellen Encisco (clinical) [Ep 3 · 3:14](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=194)
- "Standard practice in many US institutions is to admit intussusception patients overnight and discharge the next morning, not keep them for 48 hours." — Todd Ponsky (clinical) [Ep 3 · 16:50](https://library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=1010)
- "Five studies examined repeat enema for intussusception, with four showing over 50% success rates" (host_summary) [Ep 2 · 1:01](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976?t=61)
- "The mean success rate for repeat enema across studies is estimated at 60-70%" (host_summary) [Ep 2 · 1:50](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976?t=110)
- "Repeat enema should be performed if the initial attempt made any progress and the patient is stable" (host_summary) [Ep 2 · 2:05](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976?t=125)
- "More than likely the intussusception will be reduced on the second attempt if progress was made initially" (host_summary) [Ep 2 · 2:25](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976?t=145)
- "Tony Sandler's Toronto Sick Kids study used a 2-4 hour interval between enemas" (host_summary) [Ep 2 · 2:05](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976?t=125)
- "More recent studies used 6-12 hour intervals between enemas, typically waiting until morning" (host_summary) [Ep 2 · 2:20](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976?t=140)
- "There was not a higher rate of operative resection if repeat enema was delayed and the patient ultimately required surgery" — David (clinical) [Ep 2 · 2:35](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976?t=155)
- "The mean time interval between first and second enema in David's study was approximately 6 hours" (host_summary) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976?t=180)
- "Radiologists may be reluctant to attempt repeat enema after pushing 120 centimeters pressure on initial attempt" — Avi (opinion) [Ep 2 · 0:48](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976?t=48)
- "Success of repeat enema is radiology and system dependent" — Avi (opinion) [Ep 2 · 0:48](https://library.globalcastmd.com/watch/repeat-enema-for-intussusception-update-course-2016-976?t=48)

## Changelog
- Sep 16: 3 items added automatically

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