Intussusception (Pediatric) — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Peritonitis/perforation/shock?
   Any peritonitis/perforation/shock? (Telescoping of bowel (usually ileocolic), the most common cause of bowel obstruction in infants/toddlers 6 months–3 years. The triad (intermittent abdominal pain + currant-jelly stool + vomiting/sausage-shaped mass) is complete in only ~15–25%; lethargy may be the only feature; vomiting turns from non-bilious to bilious, currant-jelly stool is a late sign. Diagnosis: ultrasound first-line — target/doughnut sign (CT for the lead point in adults).)
   • Peritonitis/perforation/shock → Peritonitis/perforation → surgery
   • Stable, no perforation signs → Stable · air enema reduction
2. [End] Stable · air enema reduction
   Stable, no perforation/peritonitis: fluids, NG decompression if needed; non-operative reduction — air (pneumatic) enema first-line (higher success than contrast) or hydrostatic/contrast enema, fluoroscopy/ultrasound-guided; the main risk is perforation (low). Failed reduction/recurrence (~10%) or a pathological lead point → surgery.
3. [End] Peritonitis/perforation → surgery
   Peritonitis/perforation/hemodynamic instability/failed enema/pathological lead point: emergency surgery (laparoscopic or open reduction, resect necrotic bowel); preoperative fluid resuscitation, NG decompression, broad-spectrum antibiotics (with anaerobic cover).

Source guidelines & references

• Intussusception (Merck Manuals; UpToDate; ACEP)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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