This protocol addresses the management step taken after delayed repeat enema reduction — attempted up to four times in a medically stable child without peritonitis — has not achieved successful resolution of the intussusception. The following applies specifically to children who remain hemodynamically stable without critical illness at this juncture.
The child is hemodynamically stable without critical illness, clinically well, and has no signs of peritonitis. Ileocolic intussusception has been confirmed on positive abdominal ultrasound. All criteria for this management pathway require that the patient remains in this stable clinical state.
Prior approach: Delayed repeat enema reduction in a medically stable patient without peritonitis whose previous enema achieved only partial reduction — repeated up to four times with a waiting interval between attempts.
Failure condition: Successful reduction of the intussusception was not achieved, and escalation to operative management is now indicated.
For a hemodynamically stable patient at this point, operative management is the indicated direction. A minimally invasive surgical approach is the starting consideration, with the full sequence of intraoperative options and specific clinical decision points available in the structured protocol below.
DOI: 10.1016/j.jpedsurg.2020.09.055