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
Resources
3 items
Intussusception - Soft Tissue Abscess - Pilonidal Cyst - Bleeding Meckel's...
Watch →
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
Repeat Enema for Intussusception: Update Course 2016
Watch →
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
Case-Based Journal Review- Intussusception in 2022
Listen →
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
Summaries and takeaways+ Show
Summary of this collection+ Show
Key points, with the moment each was said+ Show
Featured picks for families are being prepared — the summaries above are written for you.
Takeaways+ Show
Radiologic reduction remains first-line therapy, with repeat enema achieving 60–70% success when initial attempts show progress [e976-c1, e976-c2, e976-c3, e976-c4]. Intervals of 6–12 hours between attempts do not increase operative resection rates [e976-c6, e976-c7]. Ultrasound-guided hydrostatic and fluoroscopy-guided air reduction show equivalent efficacy (95.8% vs 93.1%) [e5092-c4, e5092-c5]. Point-of-care ultrasound achieves 95% sensitivity and 99% specificity in high-volume centers, though adoption requires adequate training [e5092-c1, e5092-c2, e5092-c3]. Predictors of failed reduction include obstructive bowel gas pattern, free fluid, extension beyond splenic flexure, and altered Doppler [e5092-c7, e5092-c8]. Post-reduction management is evolving: meta-analysis shows no difference in recurrence or operative need between inpatient and outpatient protocols . Recurrence occurs in 3.7–13.5% of cases—lower than traditionally quoted—with 7.3% recurring within 48 hours [e5092-c14, e5092-c15, e5092-c16]. Some centers now discharge after 4-hour ED observation if hemodynamically stable and tolerating feeds, with minimal early recurrence [e678-c1, e678-c2]. Age >5 years warrants lead-point evaluation, as 30–60% harbor pathology in this cohort .
- Repeat enema succeeds in 60–70% when initial reduction shows progress; 6–12 hour intervals do not increase resection rates.
- Ultrasound-guided hydrostatic and air reduction show equivalent success (≈95%); POCUS diagnosis requires high volume and training.
- Recurrence is 3.7–13.5% (lower than traditional 15–20%), with 7.3% within 48 hours; fever and female sex predict early recurrence.
- Four-hour ED observation with feeds is safe for discharge; meta-analysis shows no benefit to routine admission.
- Age >5 years: 30–60% have lead points. Consider elective workup and resection after successful reduction in non-inflamed setting.
For patients & families
Intussusception happens when one part of the intestine slides into another, like a telescope collapsing. Doctors can often fix this without surgery by using air or liquid pressure during an X-ray or ultrasound procedure — this works about 90–95% of the time. If the first attempt doesn't fully work but makes progress, doctors may wait a few hours and try again; the second attempt succeeds in roughly 60–70% of cases. After a successful reduction, some hospitals now send children home from the emergency department after a short observation period if they can eat and drink normally, rather than admitting them overnight. The chance of it happening again is lower than doctors used to think — recent studies show 4–14% recurrence, and most happen within the first two days. If the non-surgical methods don't work or if your child is older (over age 5), surgery may be needed because there's a higher chance something else is causing the blockage.
Intussusception happens when one part of the intestine slides into another, like a telescope collapsing. Doctors can often fix this without surgery by using air or liquid pressure during an X-ray or ultrasound procedure — this works about 90–95% of the time. If the first attempt doesn't fully work but makes progress, doctors may wait a few hours and try again; the second attempt succeeds in roughly 60–70% of cases. After a successful reduction, some hospitals now send children home from the emergency department after a short observation period if they can eat and drink normally, rather than admitting them overnight. The chance of it happening again is lower than doctors used to think — recent studies show 4–14% recurrence, and most happen within the first two days. If the non-surgical methods don't work or if your child is older (over age 5), surgery may be needed because there's a higher chance something else is causing the blockage.
The doctors in this collection+ Show
All expert statements+ Show
Every expert statement below comes from the recorded discussions, with its speaker and moment.
Intussusception - Soft Tissue Abscess - Pilonidal Cyst - Bleeding Meckel's...
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.
clinicalTodd Ponsky0:57 ↗
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.
Host summaryNick Bruns summarizing the discussion — not the host's own clinical position2:01 ↗
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.
Host summaryNick Bruns summarizing the discussion — not the host's own clinical position2:44 ↗
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.
clinical3:04 ↗
Ultrasound after intussusception reduction is difficult to interpret due to inflammation, so a contrast enema is preferred for confirmation.
clinicalTodd Ponsky3:19 ↗
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.
opinionTodd Ponsky3:43 ↗
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.
Host summaryNick Bruns summarizing the discussion — not the host's own clinical position5:28 ↗
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.
clinicalTodd Ponsky4:22 ↗
Many soft tissue abscesses are drained in the emergency department by ED physicians with sedation, not in the operating room.
clinicalTodd Ponsky6:50 ↗
Vessel loops are used as wicks for abscess drainage instead of traditional packing by some surgeons.
clinical7:41 ↗
A study at ABSA showed that packing abscesses did not make a difference in outcomes, yet surgeons continue to use packing or wicks.
Host summaryTodd Ponsky summarizing the discussion — not the host's own clinical position7:55 ↗
Admission criteria for soft tissue abscess include cellulitis, fever, and leukocytosis in some combination; if the child appears sick, admission is warranted.
clinicalTodd Ponsky8:08 ↗
Antibiotics are prescribed for soft tissue abscess only if cellulitis is present; otherwise patients go home without antibiotics.
clinical8:31 ↗
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.
epidemiologicalNick Bruns8:44 ↗
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.
epidemiologicalNick Bruns9:11 ↗
For pilonidal disease, one surgeon operates after the second recurrence, though tries to delay as long as possible.
opinionTodd Ponsky10:27 ↗
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 summaryThe host summarizing the discussion — not the host's own clinical position10:54 ↗
For recurrent pilonidal disease or large draining sinuses, formal excision with off-midline layered closure and drain placement is performed.
clinical11:37 ↗
Physical exam findings such as deep gluteal fold and excessive hair are high-risk factors that may influence timing and type of pilonidal surgery.
clinicalTodd Ponsky12:24 ↗
For severe recurrent pilonidal disease, open excision with wet-to-dry dressing changes or wound vac is used.
clinicalTodd Ponsky12:50 ↗
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.
Host summaryIan Glenn summarizing the discussion — not the host's own clinical position13:04 ↗
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.
opinionTodd Ponsky13:43 ↗
Plastic surgeons perform flap procedures for recurrent pilonidal disease and keep patients prone post-operatively.
clinicalTodd Ponsky14:02 ↗
One patient reported laser hair removal for pilonidal disease was the most painful thing he had experienced and discontinued treatment after half a session.
Host summaryTodd Ponsky summarizing the discussion — not the host's own clinical position14:26 ↗
Some surgeons have sent patients for laser hair removal without complaints, though ensuring adequate treatment area and obtaining insurance reimbursement remain challenges.
clinicalTodd Ponsky14:42 ↗
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.
clinical15:34 ↗
Starting a PPI for suspected Meckel diverticulum bleeding will stop the bleeding temporarily; it should never be an emergency operation.
clinical16:09 ↗
For a bleeding Meckel diverticulum, if there is an ulcer at the base, segmental small bowel resection is performed rather than simple diverticulectomy.
clinicalTodd Ponsky17:00 ↗
Bill Gazetta taught at the fellows course that ulcers in Meckel bleeding are in the Meckel diverticulum itself, not in the adjacent small bowel.
Host summaryTodd Ponsky summarizing the discussion — not the host's own clinical position17:29 ↗
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.
opinion17:39 ↗
What's new+ Show