Initial Treatment for Intussusception in a 2-Month-Old Baby
For a 2-month-old infant with suspected intussusception, immediate diagnostic confirmation with ultrasound is critical, followed by prompt hydrostatic or pneumatic reduction if the infant is stable without signs of perforation or peritonitis. 1
Critical Age Consideration
Intussusception is unusual in the first 3 months of life, making this presentation atypical and requiring heightened clinical suspicion. 2 The typical age range is 3 months to 5 years, so a 2-month-old represents an uncommon presentation that may have different underlying pathology. 1, 3
Diagnostic Approach
Clinical Presentation to Recognize
- Intermittent abdominal pain is the most common presenting symptom, though the classic triad (intermittent pain, currant jelly stool, sausage-shaped mass) is uncommon. 1
- Atypical presentations are critical to recognize in young infants, particularly lethargy or altered mental status, which may be the predominant feature even without obvious abdominal pain. 1, 3
- Nonbilious emesis and bloody stools (gross or guaiac-positive) are common findings. 1
- A palpable sausage-shaped abdominal mass may be present on examination. 2, 1
Imaging
- Ultrasound is the diagnostic modality of choice for confirming intussusception. 1
- Plain radiography may assist in evaluating for bowel obstruction and perforation but should not delay definitive imaging. 1
Initial Treatment Algorithm
For Stable Patients Without Perforation
Non-operative reduction should be attempted first using either hydrostatic or pneumatic enema reduction. 1, 4 This is the preferred initial approach when:
- The infant is hemodynamically stable
- No signs of peritonitis are present
- No evidence of bowel perforation exists 1
For Unstable or Complicated Cases
Immediate surgical intervention is necessary when: 1
- The infant appears toxic or unstable
- Signs of peritonitis are present
- Evidence of bowel perforation exists
- A focal lead point is identified (10-25% of cases have an anatomical lead point) 1
Critical Pitfalls to Avoid
- Do not delay diagnosis in young infants presenting with lethargy alone—intussusception should be in the differential even without classic abdominal symptoms. 1, 3
- Recognize that delay in diagnosis frequently leads to bowel necrosis, making surgical intervention necessary even when hydrostatic reduction might have been successful earlier. 5
- In extremely premature or young infants, intussusception may be confused with necrotizing enterocolitis, delaying appropriate diagnosis. 6
- Untreated intussusception progresses to obstruction, ischemia, necrosis, and perforation, making prompt recognition and treatment essential for preventing morbidity and mortality. 1
Post-Reduction Management
Following successful non-operative reduction, discharge may be appropriate only if: 1
- The patient can tolerate clear fluids
- The patient is completely asymptomatic
- Reliable follow-up is ensured with clear instructions to return immediately for any recurrence of symptoms 1