Ileocolic Intussusception, Suspected — Air or Contrast Enema — Clinical Pathway: Emergency Department

Suspected Ileocolic Intussusception Clinical Pathway — Emergency Department

Air or Contrast Enema

  • Reduction of the intussusceptum may take several attempts.
  • Success rate ranges from 80-95%.
  • Children with progressive movement of the intussusceptum on the prior reduction attempt, who are stable and without concern for peritonitis, may benefit from delayed repeat enema. Reviews suggest that approximately 50% of children with delayed reduction are successful, and surgery is avoided without increasing complications.
  • The radiologist interpretation will include the number of attempts as defined below. The decision to pursue delayed enema reduction is a joint decision between Radiology and Surgery.
  • New Radiology Read Template includes the Number of Attempts as the last line in Findings.

Definitions

Successful Reduction Complete reduction with reflux of air or contrast into small bowel
Unsuccessful Reduction
  • No movement of the intussusception
  • or
  • Partial reduction
    • Movement of intussusception without full reduction
  • Number of attempts
    • Sessions of active pushing/contrast flowing without a break defines an attempt
    • Several attempts can occur in one trip to fluoroscopy
    • Occasionally, a child may return to the ED between attempts; a 2nd order for enema is required