Management of Suspected Intussusception

Clinical Presentation

The American College of Radiology notes that intussusception may be diagnosed clinically by crampy, intermittent abdominal pain sometimes progressing to bloody stools and lethargy, in a population of young children, with a peak incidence between 3 months to 3 years, most common at 5-9 months 1, 2
Intussusception presents with a classic triad of abdominal discomfort with apparent colicky pain, vomiting, and bloody mucous per rectum ("currant jelly" stools), in infants and young children, with a high success rate of enema reduction 1, 3
The age-appropriate presentation for intussusception is between 3 months to 3 years, with most cases occurring at 5-9 months, but it can also occur at 15 months, with a diagnostic approach that includes clinical evaluation and imaging studies 1, 2

The World Journal of Emergency Surgery guidelines recommend that supportive treatment, including intravenous crystalloids, anti-emetics, and bowel rest, must begin as soon as possible, but is adjunctive, not definitive, in a population of infants and young children with suspected intussusception 4
Obstructive pattern on abdominal film consistent with intestinal obstruction is a diagnostic finding in intussusception, in a population of young children, with a high sensitivity and specificity 4

The American College of Radiology recommends enema reduction as a diagnostic and therapeutic approach for intussusception, with a high success rate, in a population of infants and young children, with a low risk of complications 1, 2
Immediate resuscitation, including IV access, fluid resuscitation with isotonic crystalloids, nasogastric tube insertion, and electrolyte correction, is essential before proceeding to enema reduction, in a population of infants and young children with suspected intussusception 4
Delaying definitive intervention increases the risk of bowel necrosis and perforation, and missing contraindications to enema reduction, such as free air or peritonitis, requires immediate surgery, in a population of infants and young children with suspected intussusception 4

The American Academy of Pediatrics and other guideline societies recommend against the use of antibiotics for uncomplicated intussusception without evidence of perforation or peritonitis, as stated by the Infectious Diseases Society of America 5

Antibiotics are not indicated for intussusception treatment in patients without signs of peritonitis or free air, according to the Clinical Infectious Diseases journal 5