Written by Jason Lesnick
Spoon Feed
Pediatric intussusception is a serious diagnosis that is often missed on the first visit (as high as 50% of the time). This paper reviews intussusception, with pearls for how to accurately diagnose this condition.
Is it better to be the intussusceptum or intussuscipiens?
Intussusception is when a proximal segment of bowel (the intussusceptum) telescopes into another segment (the intussuscipiens) leading to edema, obstruction, ischemia, perforation, and even shock.
Presentation: The classic triad of abdominal pain, sausage-shaped abdominal mass, and currant jelly stools is present in only 7.5-40% of patients. Abdominal pain is the most common symptom. It usually is sudden in onset, intermittent (every 15-20 minutes), and crampy, with a tendency to become increasingly severe and frequent. Non-bilious emesis is often present. Bloody stools are present about 25% of the time and usually occur late in the disease due to intestinal ischemia. This disease occurs most commonly between 3 months and 5 years of age. Mental status changes and even lethargy can occur, most often in younger patients.
ED Evaluation: Ultrasound is the most sensitive and specific test and shows a ‘target sign’. Over 90% of intussusception is ileocolic and found in the RLQ. X-ray of the abdomen can be utilized for ruling out perforation.
ED Management: Treatment depends on if the patient is critically ill or not.
– Critically ill: give IV antibiotics, IV fluids, and obtain surgery evaluation.
– Not critically ill: the patient will require pneumatic enema with sonographic or fluoroscopic guidance. If the patient is well appearing and tolerating PO after an observation period (hours), they can be discharged home with strict return precautions (~10% recurrence rate).
How will this change my practice?
After reading this article, I will have an even higher clinical suspicion for intussusception in pediatric patients with intermittent abdominal pain and vomiting. Given the common non-specific symptoms that lead to a high rate of initial misdiagnosis, I will have a lower threshold to ultrasound patients with these complaints.
Source
High risk and low incidence diseases: Pediatric intussusception. Am J Emerg Med. 2025 May;91:37-45. doi: 10.1016/j.ajem.2025.02.020. Epub 2025 Feb 17. PMID: 39987626
