Emergency Department Clinical Pathway for Children
with Suspected Ileocolic Intussusception

  • Front Line Ordering Clinician (FLOC)/RN Team Assessment
Signs of Peritonitis Surgical consultation
Care as indicated
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
Admit to Surgery
  • Observe 4 hrs from reduction