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?YesObservation in ED x 4 hours thenPO Trial Discharge NoCan repeat Q1H x 3 times with monitoring between attempts as long as intussusceptumcontinues 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 providerSurgical Consult Sources:•Applegate KE, et al. Intussusception in children: evidence-based diagnosis and treatment. PediatrRadiol2009;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 Roentgenol2004;182:1169-1176.•Daneman A, et al. Intussusception. Part 1: a review of diagnostic approaches. PediatrRadiol2003;33(2•Daneman A, et al. Intussusception. Part 2: An update on the evolution of management. PediatrRadiol2004;34(2):97-108.•SujkaJA, et al. Emergency department discharge following successful radiologic reduction of ileocolic intussusception in children:Aprotocol based prospective observational study. J PediatrSurg2018; epubahead of print. Updated 2/2019 v1.0
Intussusception Guideline
Guideline · Aug 2019 · 1 min read
In brief
In brief
Clinical guideline for emergency department evaluation and management of pediatric patients presenting with suspected intussusception. Outlines diagnostic approach and treatment protocols including imaging criteria and reduction procedures.
- Surgery must be aware of intussusception patient before air enema attempt, even if in-person evaluation occurs after reduction.
- Air enema can be repeated every hour up to 3 times if intussusceptum continues reducing, no free air present, and patient stable.
- Successful complete reduction requires 4-hour ED observation with PO trial before discharge.
- Urgent surgical consultation indicated for acute abdomen, abnormal vitals, ill appearance, or ED provider concern.
- Ultrasound confirmation guides air enema attempt; negative study returns patient to ED for alternative workup.
Written by the GCMD Library team from the guideline.
Initial Assessment and Surgical Notification
Patients presenting to the ED with suspected intussusception require immediate surgical consultation prior to air enema reduction. Surgery must be aware of the patient before the procedure, though in-person evaluation timing depends on clinical stability. Urgent surgical consultation is indicated for patients with acute abdomen, abnormal vital signs, ill appearance, or other provider concerns.
Diagnostic Ultrasound
Ultrasound serves as the initial diagnostic modality to confirm intussusception. A positive ultrasound finding proceeds to air enema reduction, while negative studies return to the ED for further workup or observation.
Air Enema Reduction Protocol
Air enema is the primary therapeutic intervention for confirmed intussusception. If complete reduction is achieved, the patient undergoes 4-hour ED observation followed by oral trial before discharge. Incomplete reduction can be repeated every hour up to 3 times with monitoring between attempts, provided the intussusceptum continues to reduce, no free air is present, and the patient remains stable.
Failed Reduction Management
Patients with unsuccessful reduction after repeated attempts require surgical intervention and proceed to the operating room. The fellow or attending must be notified of failed reduction attempts.
Post-Reduction Observation and Discharge
Successfully reduced patients require 4-hour observation in the ED followed by oral intake trial. Discharge is appropriate only after successful completion of both observation period and oral trial without recurrence.
Statements in this guideline
Surgery must be aware of the patient prior to air enema.
In-person surgical evaluation can occur before or after enema if the patient is clinically stable.
Ultrasound should be performed in patients with history suggestive of intussusception.
Air enema reduction can be repeated every 1 hour up to 3 times with monitoring between attempts as long as the intussusceptum continues to reduce, there is no free air, and the patient remains stable.
A fellow or attending should be notified if air enema reduction is not completely successful after repeated attempts.
Following complete reduction, patients should be observed in the emergency department for 4 hours then undergo a PO trial before discharge.
Indications for urgent surgery consultation include acute abdomen, abnormal vital signs, ill-appearing patient, or other concerns per emergency department provider.