Treatment of Intussusception: Surgical Management
Intussusception is primarily treated by pediatric surgeons, with radiologists often performing the initial non-surgical reduction attempts. 1
Types of Doctors Involved in Intussusception Management
Primary Treatment Team:
- Pediatric Surgeons: The primary specialists responsible for managing intussusception, especially when surgical intervention is required
- Radiologists: Often perform the initial non-surgical reduction procedures (hydrostatic or pneumatic reduction)
Treatment Algorithm:
Initial Assessment and Reduction Attempt:
- Radiologists typically perform the first attempt at non-surgical reduction using air or liquid enema under fluoroscopy
- If the first reduction attempt fails, referral to a pediatric surgical team significantly improves success rates (92.2% success when pediatric surgical teams perform reduction after failed attempts by radiologists) 2
Surgical Management:
- When non-surgical reduction fails or is contraindicated, pediatric surgeons perform the definitive surgical treatment
- Surgical exploration may be done via laparoscopy or laparotomy, depending on the patient's hemodynamic status 1
Age-Based Differences in Management
Pediatric Patients:
- Management primarily involves hydrostatic or pneumatic reduction
- Pediatric surgical teams achieve higher success rates (94.5%) when following standardized protocols 2
- Air enema may be superior to liquid enema for successful reduction (28% higher success rate) 3
Adult Patients:
- Almost always require surgical management rather than non-operative reduction 4
- Higher likelihood of underlying pathology requiring definitive surgical treatment
- Surgical exploration is the standard approach, with limited role for non-operative reduction 5
Important Clinical Considerations
- Delay in surgical intervention beyond 48 hours is associated with significantly increased mortality 1
- Dexamethasone as an adjunct to reduction procedures may reduce recurrence rates (86% reduction in recurrence) 3
- Duration of symptoms directly impacts success rates of non-surgical reduction:
- <18 hours: 97.3% success
- 18-24 hours: 86.4% success
24 hours: 33.3% success 6
Surgical Approaches for Intussusception
When surgical intervention is required, the pediatric surgeon will:
- Perform manual reduction of the intussusception when possible
- Resect non-viable intestinal segments when necessary
- Reconstruct the intestinal anastomosis if the jejuno-jejunostomy is involved 1
- Consider anchoring techniques to prevent recurrence in selected cases 1
In summary, while radiologists may perform the initial reduction attempt, the definitive management of intussusception, particularly cases requiring surgery, falls under the domain of pediatric surgeons who achieve the best outcomes with standardized protocols and surgical expertise.