What is the treatment for intususception in a baby?

Treatment of Intussusception in Babies

The first-line treatment for intussusception in a hemodynamically stable baby without evidence of peritonitis or perforation is non-operative reduction using air or hydrostatic enema under radiologic guidance. 1, 2

Initial Assessment and Diagnosis

• Presentation: Most common in children 3 months to 5 years of age, typically presenting with:

  • Intermittent abdominal pain (most common symptom)
  • Vomiting (often non-bilious)
  • "Currant jelly" stools (bloody stools)
  • Palpable "sausage-shaped" abdominal mass (less common)
  • Atypical presentations in younger infants may include lethargy or altered mental status 1

• Diagnostic imaging:

  • Ultrasound is the diagnostic modality of choice 1
  • Plain abdominal radiographs may help evaluate for obstruction and perforation

Treatment Algorithm

1. Initial Stabilization

• Intravenous fluid resuscitation
• Nasogastric tube insertion for decompression
• Anti-emetics as needed
• Foley catheter to monitor urine output 2

2. Non-operative Reduction (First-line treatment)

• Indications:

  • Symptoms less than 48 hours
  • Hemodynamically stable patient
  • No signs of peritonitis or perforation
  • Reasonable electrolyte levels 3

• Reduction methods (in order of preference):

  1. Air reduction (90% success rate) - preferred method due to highest success rate and lowest complication rate 3
  2. Barium enema reduction (70% success rate)
  3. Saline reduction under ultrasound guidance (67% success rate)

3. Surgical Management

• Indications:

  • Failed non-operative reduction
  • Hemodynamic instability
  • Signs of peritonitis
  • Bowel perforation
  • Presence of a pathologic lead point 2, 1

• Surgical approach:

  • Laparoscopic approach for stable patients
  • Open surgery for unstable patients 2

• Surgical procedures:

  • For viable bowel: Manual reduction with resection of lead point if present
  • For non-viable bowel: Resection of affected segment with primary anastomosis 2

Important Considerations

• Timing is critical: Delay in treatment beyond 48 hours significantly increases mortality 2
• Perforation risk: Occurs in approximately 1.2% of reduction attempts 4
• Recurrence: Can occur in 5-10% of cases, typically within 24-48 hours after successful reduction
• Post-reduction care: Patients may be discharged after successful non-operative reduction if they can tolerate clear fluids, are asymptomatic, and have reliable follow-up 1

Special Situations

• Idiopathic vs. Pathologic: Most cases in infants are idiopathic (90%), but 10-25% have a pathologic lead point 1
• Recurrent intussusception: May require more definitive surgical management to prevent further episodes 2

Pitfalls to Avoid

• Delaying diagnosis and treatment (increases risk of bowel ischemia and perforation)
• Missing atypical presentations in young infants (lethargy without obvious abdominal symptoms)
• Attempting reduction when contraindicated (peritonitis, perforation, prolonged symptoms >48 hours)
• Failure to recognize post-reduction complications (perforation, recurrence)

The success rates for non-operative reduction are high when performed in appropriate candidates, with air reduction showing the best outcomes and lowest complication rates compared to other methods 3.