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Intussusception clinical pathway: a survey of pediatric surgery practices

Sean M Stokes1, Joseph A Iocono, Samuel Brown

  • 1Department of Surgery, Division of Pediatric Surgery, University of Kentucky, Lexington, Kentucky, USA.

The American Surgeon
|September 9, 2014
PubMed

Insights

Pediatric surgical involvement in intussusception reduction lacks consensus. Many centers notify surgeons during enema reduction, but few require prior consultation or a surgical team member

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Radiology

Background:

  • Intussusception reduction via enema may necessitate surgery if irreducible or perforated.
  • Current pediatric surgical involvement in intussusception workup lacks standardized guidelines.

Purpose of the Study:

  • To survey regional clinical practices regarding pediatric surgeon involvement in intussusception management.
  • To establish a consensus on when pediatric surgical consultation or presence is required during imaging and reduction.

Main Methods:

  • A questionnaire was distributed to pediatric surgeons at 32 institutions.
  • Surgeons from 29 institutions (91%) responded regarding imaging, reduction, and surgical involvement protocols.

Main Results:

  • Ultrasound was used for diagnosis in 55% of cases, with 45% requiring a confirmed diagnosis before reduction.
  • 76% of institutions required surgeon notification during enema reduction, while 24% mandated prior surgical consultation.
  • Only 10% required a surgical team member's presence; 72% did not, and 18% considered it desirable but not essential.

Conclusions:

  • There is a significant lack of consensus among pediatric surgeons regarding their involvement before and during intussusception reduction.
  • Practices vary widely concerning notification, consultation, and the necessity of surgical team presence during enema reduction procedures.

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