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Suspected Ileocolic Intussusception Clinical Pathway – Emergency Department

Emergency Department Clinical Pathway for Children
with Suspected Ileocolic Intussusception

 
 
 
 

Team Assessment

 
 
Signs of Peritonitis Surgical consult
Care as indicated
 
 

Imaging

  • Ultrasound abdomen for intussusception
  • OSH transfer: Repeat imaging
  • KOPH transfer: Repeat imaging if clinical change or significant time elapsed
 
 
 
 
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 High Acuity
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 > 3 yrs
  • Inability to tolerate PO
  • Concern for access to follow-up care
 
 
 
 
Discharge
Admit to Surgery
OR
Observe 4 hrs from reduction
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