Management of Perforated Intussusception in Children

Diagnostic Approach

The preferred imaging modality to confirm perforation is a CT scan, as it is more sensitive than standard abdominal radiographs for detecting free air, and laboratory tests should include white blood cell count and C-reactive protein to assess the severity of inflammation 1

Fluid resuscitation and broad-spectrum antibiotics, including carbapenems, piperacillin-tazobactam, or extended-spectrum cephalosporin with metronidazole, should be initiated immediately 2, 3
Patients with perforations who are hemodynamically unstable or have peritoneal signs require immediate surgical management 4
Surgery typically involves bowel resection with either primary anastomosis or stoma creation, depending on the extent of contamination 1
Laparoscopic approach may be considered in stable patients, but conversion to open surgery should be performed if the area of perforation cannot be adequately visualized or managed 5, 6

Continuous and strict clinical and biochemical follow-up is recommended for all patients with intussusception 1
Immunocompromised patients and transplant recipients with perforated intussusception should receive surgical management regardless of perforation size 1
Accurate documentation, prompt discussion with family, and reporting to the quality officer and risk management team are essential in cases of perforation 4