This protocol applies to children with ileocolic intussusception confirmed on abdominal ultrasound who are hemodynamically stable, clinically well, and without signs of peritonitis — specifically in the situation where an initial enema reduction did not achieve full success.
The child is hemodynamically stable without critical illness, clinically well, and has no signs of peritonitis. Ileocolic intussusception has been confirmed by positive abdominal ultrasound. This management algorithm applies only when all of these criteria are met.
The prior step — enema reduction of the ileocolic intussusception — was carried out. The goals of that step were: successful reduction of the intussusception, with symptoms resolved and the child tolerating an oral regimen within 4 hours of observation. When those targets were not achieved but the child remains stable and without peritonitis, this protocol defines the next course of action.
For the medically stable child without peritonitis whose previous enema achieved only partial reduction, a delayed repeat enema strategy is the approach. The full protocol specifies the maximum number of attempts permitted and the required waiting interval between each attempt — complete details are behind the link below.
Successful reduction of the intussusception.
DOI: 10.1016/j.jpedsurg.2020.09.055
Of note, this management algorithm should only be applied in children who are hemodynamically stable without critical illness.
No peritonitis, clinically well.
Positive U/S.
Repeat enema if patient is stable, without peritonitis.
While there are no definitive protocols for DRE, the available evidence indicates that safe criteria for selecting patients appropriate for DRE are 1) a medically stable patient, 2) without peritonitis, and 3) whose previous enema achieved a partial reduction.
Waiting for an interval between 30 minutes and 4 hours is likely to be safe for repeated attempts at delayed enema reduction, but further study must be done to determine if there is an optimal time frame between reduction attempts.
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