Suspected Ileocolic Intussusception Clinical Pathway — Emergency Department

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Child with Suspected Ileocolic Intussusception

KOPH Transfer Guidelines

Exclusion Criteria

Triage

Front Line Ordering Clinician (FLOC)/RN Team Assessment
- History and Physical Exam
- Assess vital signs
- Mental status
- IV and labs as clinically indicated

Signs of Peritonitis Surgical consultation
Care as indicated

Imaging
Order ultrasound abdomen for intussusception

Ultrasound Negative

Ultrasound Positive
Ileocolic Intussusception

Consider alternative diagnoses
Further evaluation as indicated

Radiology
- Notify the ordering clinician
ED Team
- Order FL enema for intussusception
- Communication with Fluoro
  and General Surgery

Air or Contrast Enema
May require multiple attempts
Number of attempts is included in the Radiology Read

Concern for Pathologic Lead Point or Level of Illness

Review with Radiology and
Surgery for further evaluation

Intussusception Reduced
≤ 2 Attempts

Intussusception Reduced
> 2 Attempts

Unable to reduce
Concern for Perforation

Begin PO clears 2 hrs
post reduction

Consider Admission

< 6 mos and > 36 mos
Inability to tolerate PO
Concern for access to follow-up care

Discharge

Admit to Surgery

Observe 4 hrs from reduction

Posted: August 2023
Revised: November 2023

Authors:
- M. Allukian, MD;
- J. C. Davis, MD;
- S. Myers, MD;
- L. Wilson, CRNP;
- D. Karasko, CRNP;
- S. Fesnak, MD;
- R. Hwang, BS;
- G. Nace, MD;
- A. Mak, MD

Editors: Clinical Pathways Team

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Emergency Department Clinical Pathway for Children
with Suspected Ileocolic Intussusception

Evidence

Emergency Department Clinical Pathway for Childrenwith Suspected Ileocolic Intussusception

Evidence

Emergency Department Clinical Pathway for Children
with Suspected Ileocolic Intussusception