Intussusception Guideline

Hi, my name is Mira Kodagali and I'm a pediatric surgeon here at Cincinnati Children's. Today we're going to be talking about treatment guidelines for the management of intussusception. So this guideline is for the evaluation and management of patients who present to the ER with a history suggestive of intussusception. The first question is whether or not these patients need an urgent surgery consult. Indications for an urgent surgery consult include an acute abdomen, abnormal vital signs, if the patient's ill appearing or if there are other concerns from the ED providers. Once the patient's evaluated by a surgeon, a decision can be made whether or not the patient needs to go to the operating room emergently. If they are deemed to be stable and to not need an urgent intervention, then our next step is for those patients to undergo an ultrasound. If that ultrasound is positive for intussusception, then that surgical consult is called if it hasn't previously been obtained. Patients with a positive ultrasound would then undergo an air enema. Surgeons must be aware of the patient prior to obtaining the air enema, and in-person evaluation can occur before or after the enema if the patient is clinically stable. Patients undergo an air enema and if they're able to reduce the intussusception, then those patients are observed in the emergency department for four hours, after which they have a PO trial and can be discharged if they're doing well clinically. If on the first attempt we're not able to reduce the intussusception, then the air enema can be repeated every hour for three times with monitoring in between the attempts as long as the intussusceptum continues to reduce, the patient doesn't have free air, and they remain clinically stable. In our protocol, a fellow or an attending surgeon should be notified if the patient is undergoing more than one air enema. If the intussusceptum is unable to be reduced completely after three attempts, then those patients would go to the operating room for a manual reduction in the OR. And this guideline may not apply to all patients. If you have any questions or we can be of any help, please don't hesitate to contact us.