Emergency Department Clinical Pathway for Children
with Suspected Ileocolic Intussusception
- Front Line Ordering Clinician (FLOC)/RN Team Assessment
- History and Physical Exam
- Assess vital signs
- Mental status
- IV and labs as clinically indicated
Signs of Peritonitis
Surgical consultation
Care as indicated
Care as indicated
Imaging
Order ultrasound abdomen for intussusception
Order ultrasound abdomen for intussusception
Ultrasound Negative
Ultrasound Positive
Ileocolic Intussusception
Ileocolic Intussusception
Consider alternative diagnoses
Further evaluation as indicated
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 Level of Illness
Review with Radiology and
Surgery for further evaluation
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 > 36 mos
- 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