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Pain and irritability in Pediatric ileocolic and small bowel intussusception: A comparative study

Yarden Shlomovitz1, Rebecca Brooks2, David Rekhtman3

  • 1Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

The American Journal of Emergency Medicine
|February 20, 2026
PubMed

Insights

Pediatric intussusception diagnosis can be challenging. While irritability was more common in small bowel intussusception (SMBI), neither pain nor irritability reliably distinguished SMBI from ileocolic intussusception (ILIC).

Area of Science:

  • Pediatric Emergency Medicine
  • Gastroenterology
  • Diagnostic Imaging

Background:

  • Ileocolic intussusception (ILIC) is a pediatric emergency.
  • Small bowel intussusception (SMBI) can mimic ILIC clinically.
  • Ultrasound is key to differentiating ILIC from SMBI.

Purpose of the Study:

  • Compare pain and irritability in children with ILIC versus SMBI.
  • Identify clinical indicators for differentiating intussusception types.
  • Evaluate the diagnostic utility of pain and irritability scores.

Main Methods:

  • Retrospective cohort study of children aged 4 months to 4 years.
  • Included patients diagnosed with ILIC or SMBI.
  • Assessed pain using FLACC scale and irritability via caregiver/staff reports.
  • Used multivariable regression to analyze outcomes.

Main Results:

  • 141 patients included: 84 (59.6%) ILIC, 57 (40.4%) SMBI.
  • Pain at triage was comparable between ILIC (37.0%) and SMBI (35.1%).
  • Irritability was significantly more common in SMBI (aOR 7.9).
  • Lethargy was more frequent in ILIC; vomiting rates were similar.

Conclusions:

  • Triage pain is mild and similar for both ILIC and SMBI.
  • Irritability is more prevalent in SMBI but not a reliable differentiator.
  • Neither pain nor irritability reliably distinguishes between ILIC and SMBI.
Abstract

Keywords:
IleocolicIntussusceptionIrritabilityPainSmall bowel

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