EM Quick Hits Video on Intussusception with Sarah Reid

• Intussusception involves the invagination of bowel into the adjoining segment and is one of the most common pediatric abdominal emergencies that recurs at a rate of 10%
• Intussusception typically presents with intermittent episodes of severe abdominal pain/crying episodes every 15-20 mins with intercurrent periods of wellness, slight discomfort or lethargy
• However, the presentation of intussusception is variable and must be considered in patients presenting with:
  • The classic triad of intermittent abdominal pain, vomiting, and bloody stools (currant jelly stool is rare and a late finding)
  • Isolated altered LOA including recurrent crying episodes
  • Isolated bilious or nonbilious vomiting
  • Isolated atypical patterns of abdominal pain
• Ultrasound is the preferred diagnostic tool for intussusception:
  • Radiology department ultrasound has a sensitivity and specificity of 100% with the classic finding of a target or bull’s eye lesion
  • PoCUS has a sensitivity and specificity >90%, and may be a valuable tool to decrease ED length of stay
  • Abdominal X-ray is much less sensitive, but may identify complications such as obstruction or perforation
• The management of intussusception includes:
  • IV maintenance and bolus fluids to treat hypotension or shock, early analgesia
  • Empiric antibiotics if perforation/peritonitis are suspected
  • Consultation with Pediatric Radiology and/or Pediatric Surgery for air enema reduction under fluoroscopy or ultrasound guidance
  • Laparotomy is considered if reduction is unsuccessful
  • Newer data suggests it is safe and reasonable to discharge patients post reduction of intussusception if they are observed to be stable in the ED for 4 hours

The Podcast: EM Quick Hits 49 Stroke Management Update, Intussusception, 5 Penetrating Trauma Tips, Skin Foreign Body Hack, CT Radiation Risk, Emergency Fund