Intussusception Guideline

The guideline is for evaluation and management of patients who present to the ER with a history suggestive of intussusception.

Indications for urgent surgery consult include acute abdomen, abnormal vital signs, ill-appearing patient, or other concerns from ED providers.

Once evaluated by a surgeon, a decision is made whether the patient needs emergent OR; if stable and not needing urgent intervention, the next step is ultrasound.

If ultrasound is positive for intussusception, a surgical consult is called if not previously obtained.

Patients with positive ultrasound undergo air enema, and surgeons must be aware of the patient prior to the enema.

In-person surgical evaluation can occur before or after the air enema if the patient is clinically stable.

If air enema successfully reduces the intussusception, patients are observed in the ED for four hours, then have a PO trial and can be discharged if clinically well.

If the first air enema attempt fails to reduce the intussusception, the enema can be repeated every hour for up to three times with monitoring in between, as long as the intussusceptum continues to reduce, there is no free air, and the patient remains clinically stable.

A fellow or attending surgeon should be notified if the patient is undergoing more than one air enema.

If the intussusceptum cannot be completely reduced after three air enema attempts, the patient goes to the OR for manual reduction.

This guideline may not apply to all patients.