Intussusception Management

Patient in ED with history suggestive of intussusception Surgical Consult (if not previously obtained) Surgery must be aware of patient prior to air enema; in-person evaluation can occur before or after enema if patient clinically stable Ultrasound Need for urgent surgery consult? Yes No Negative Positive Air Enema Return to ER for further work-up/observation To OR if indicated Reduced Completely? Yes Observation in ED x 4 hours then PO Trial Discharge No Can repeat Q1H x 3 times with monitoring between attempts as long as intussusceptum continues to reduce, no free air, and patient stable. Reduced Completely? No (Fellow or Attending should be notified) Indications for urgent surgery consultation: • Acute abdomen • Abnormal vital signs • Ill-appearing • Other concerns per ED provider Surgical Consult Sources: • Applegate KE, et al. Intussusception in children: evidence-based diagnosis and treatment. Pediatr Radiol 2009;39:S140-143. • Navarro OM, et al. Intussusception: the use of delayed, repeated reduction attempts and the management of intussusceptions due to pathologic lead points in pediatric patients. Am J Roentgenol 2004;182:1169-1176. • Daneman A, et al. Intussusception. Part 1: a review of diagnostic approaches. Pediatr Radiol 2003;33(2): 79-85. • Daneman A, et al. Intussusception. Part 2: An update on the evolution of management. Pediatr Radiol 2004;34(2):97-108. • Sujka JA, et al. Emergency department discharge following successful radiologic reduction of ileocolic intussusception in children: A protocol based prospective observational study. J Pediatr Surg 2018; epub ahead of print print. Updated 2/2019 v1.0