Intussusception
Everything in the library about intussusception — built automatically from the recorded discussions that name it
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
Acute Management
1 item
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
Evidence & Research
1 item
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
Case-Based Learning
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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
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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 Bruns2:01 ↗
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 Bruns2:44 ↗
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 Bruns5:28 ↗
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 Ponsky7:55 ↗
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_summary10:54 ↗
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 Glenn13:04 ↗
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 Ponsky14:26 ↗
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 Ponsky17:29 ↗
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 ↗
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