Emergency Department Clinical Pathway for Children
with Suspected Ileocolic Intussusception
Team Assessment
- History and Physical
- Assess vital signs
- Mental status
- IV and labs as clinically indicated
- Differential Diagnosis
Signs of Peritonitis Surgical consult
Care as indicated
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
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
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
Review with Radiology and
Surgery for further evaluation
Intussusception Reduced
≤ 2 Attempts
≤ 2 Attempts
Intussusception Reduced
> 2 Attempts
> 2 Attempts
Unable to reduce
Concern for Perforation
Concern for Perforation
Begin PO clears 2 hrs
post reduction
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
Evidence
- Effectiveness of the Implementation of Pediatric Intussusception Clinical Pathway. A Pre and Postintervention Trial
- Early Discharge After Nonoperative Management of Intussusception is Both Safe and Cost-effective
- Management of Intussusception in Children: A Systematic Review
- Improving Quality and Efficiency for Intussusception Management After Successful Enema Reduction
- Intussusception: the Use of Delayed, Repeated Reduction Attempts and the Management of Intussusceptions Due to Pathologic Lead Points in Pediatric Patients
- Ileocolic Intussusception: Iterative Quality Improvement to Address a Recurring Problem