Intussusception: Causes, Symptoms, Emergency Management and Nursing Care

Intussusception is an acute bowel emergency in which one segment of intestine slides into the segment next to it. It is most common in infants and young children. The bowel can become obstructed, swollen and deprived of its blood supply; delayed treatment may lead to bowel necrosis, perforation, peritonitis and shock. Consider the diagnosis early when a child has episodes of severe abdominal pain, pallor, vomiting or unexplained lethargy, even if there is no bloody stool.

• Meaning: Invagination or telescoping of a proximal bowel segment (the intussusceptum) into the adjacent distal segment (the intussuscipiens).
• Typical child: An otherwise well infant or young child with sudden, repeated episodes of colicky pain or distress, often with pallor, vomiting or lethargy between episodes.
• Most common childhood pattern: Ileocolic intussusception, in which the terminal ileum passes through the ileocaecal valve into the colon.
• Classic triad: Intermittent abdominal pain, a palpable abdominal mass and red currant jelly stool. All three occur together in fewer than 15% of children, so absence of the full triad does not exclude the diagnosis.
• First-line imaging in children: Abdominal ultrasound. A normal abdominal X-ray does not rule out intussusception.
• Usual treatment in a suitable child: Resuscitation followed by image-guided air or contrast enema reduction where an experienced team and immediate surgical backup are available.
• Immediate escalation: Shock, peritonitis, suspected perforation, clinical deterioration or failed enema reduction requires urgent paediatric surgical assessment.
• Adults: Intussusception is less common and more often associated with an underlying structural lead point. CT and prompt surgical assessment are important when symptoms or obstruction are present.

By the end of this lesson, the learner should be able to:

• Define intussusception and explain the terms intussusceptum and intussuscipiens.
• Describe common types, causes and risk factors in children and adults.
• Explain how telescoping bowel causes obstruction, venous congestion, ischaemia and possible perforation.
• Recognise typical, atypical and late symptoms and signs, including presentations without bloody stool.
• Outline the initial assessment, investigations and emergency management of suspected intussusception.
• Describe the role and limitations of enema reduction and identify when urgent surgery is needed.
• Plan nursing care, observation, parent education and follow-up after reduction or surgery.

1. Introduction and definition

Intussusception is the telescoping of one part of the bowel into the lumen of an adjacent part. The inner, entering segment is called the intussusceptum; the receiving outer segment is the intussuscipiens. The mesentery attached to the entering bowel is drawn along with it.

In infants and young children, the commonest form is ileocolic intussusception: the terminal ileum passes through the ileocaecal valve into the caecum and colon. Other patterns include ileo-ileal, colo-colic and ileo-ileo-colic intussusception. The exact type is determined by imaging or operative findings.

Intussusception is a time-sensitive cause of bowel obstruction. Symptoms may begin intermittently and progress. Early recognition matters because the bowel may still be viable and reducible before prolonged pressure compromises its blood supply.

Clinical warning: Do not wait for the child to pass “currant jelly” stool or for a mass to be felt. Rectal bleeding and a palpable mass may be absent early and can be late findings.

2. Relevant anatomy and bowel function

The small intestine absorbs nutrients and fluid; the colon absorbs water and stores stool. The terminal ileum joins the caecum at the ileocaecal valve. In ileocolic intussusception, the bowel folds into itself at or near this junction. The mesentery, which carries blood vessels, lymphatics and nerves to the bowel, is compressed between the folded layers.

Normal bowel movement is produced by coordinated smooth-muscle contractions. In an intussusception, contractions may pull the entering segment further into the receiving bowel. Pressure on the mesenteric vessels first impairs lymphatic and venous drainage, causing congestion and oedema. If pressure continues, arterial blood flow falls and the bowel can become ischaemic.

• Obstruction: The folded bowel narrows the lumen and blocks the passage of intestinal contents.
• Vascular compromise: The mesenteric vessels are squeezed, so venous congestion can progress to reduced arterial supply.
• Mucosal injury: Oedema and ischaemia damage the bowel lining and can cause mucus and blood to enter the stool.
• Perforation and peritonitis: If the bowel wall dies, it may perforate and release intestinal contents into the abdominal cavity.

3. Classification and common patterns

“Primary” or idiopathic intussusception means no definite structural lead point is identified. A lead point is a lesion or abnormal area that catches the bowel and is pulled forward by peristalsis. The age of the patient, the bowel segment involved and the clinical course help the surgical team decide whether a lead point is likely.

4. Causes and risk factors

A. Children

Many childhood cases have no identifiable structural cause. The condition is most common during infancy and early childhood, particularly in the first two years of life. In some cases, enlarged lymphoid tissue in the bowel wall after a recent infection may contribute to a lead point. A recent viral illness may be reported, but it does not prove the cause in an individual child.

• Meckel diverticulum: A congenital pouch in the small intestine that may act as a lead point.
• Enlarged lymphoid tissue: Peyer patches or other lymphoid tissue can be prominent after infection.
• Polyps or benign tumours: Uncommon in young children but possible.
• Henoch–Schönlein purpura (IgA vasculitis): Bowel-wall swelling or bleeding may be associated with intussusception.
• Cystic fibrosis or other bowel disorders: These are less common associations and should be assessed in the clinical context.
• Older age or recurrent episodes: A structural lead point is more likely to be investigated in an older child or when intussusception recurs.

B. Adults

Adult intussusception is uncommon. It is more often associated with a structural lead point than childhood ileocolic disease. Possible causes include benign or malignant tumours, polyps, Meckel diverticulum, adhesions, inflammatory bowel disease, previous surgery and other bowel lesions. The likelihood of a lead point varies by bowel location and patient group; it should not be assumed that every adult case is malignant.

Adults may have intermittent, vague abdominal pain, nausea, altered bowel habit or symptoms of partial or complete obstruction. CT may show the telescoping bowel and help identify obstruction, a mass or complications. A symptomatic adult, especially one with obstruction, peritonism or a suspected lead point, needs prompt surgical review.

5. Pathophysiology

1. A segment begins to telescope. Peristaltic movement, sometimes acting on a lead point, draws a proximal segment of bowel into the adjacent distal segment.
2. The mesentery follows the bowel. Mesenteric vessels, lymphatics and nerves are pulled between the folded layers.
3. The bowel lumen narrows. Intestinal contents and gas accumulate above the obstruction, causing distension, colicky pain and vomiting.
4. Venous and lymphatic drainage are impaired. Congestion causes oedema and swelling, which can make the intussusception tighter and more difficult to reduce.
5. Arterial perfusion falls. Ongoing compression deprives the bowel wall of oxygen; mucosal damage leads to bleeding and mucus in the stool.
6. Necrosis, perforation and systemic illness may follow. Untreated ischaemia can cause bowel necrosis, perforation, peritonitis, sepsis, dehydration and shock.

6. Clinical manifestations

A. Typical presentation in infants and young children

• Intermittent colicky abdominal pain or distress: The child may suddenly cry, draw up the legs, become pale or appear severely uncomfortable. Episodes may last a few minutes and recur, with periods of relative calm in between.
• Vomiting: May occur early. Bilious (green) vomiting is a concerning sign of bowel obstruction and requires urgent assessment.
• Pallor and lethargy: Some children become unusually sleepy, floppy or difficult to engage. Lethargy may be prominent even when the caregiver has not noticed clear abdominal pain.
• Abdominal mass: A sausage-shaped mass may sometimes be felt, often in the upper abdomen. It is not present in every patient and should not be repeatedly or forcefully sought.
• Blood and mucus in stool: “Red currant jelly” stool reflects mucosal injury and blood mixed with mucus. It is a late or less common feature, not a screening requirement.
• Abdominal distension and tenderness: More likely as obstruction and bowel injury progress.
• Periods of apparent recovery: Pain may temporarily settle between episodes. A calmer interval does not mean the obstruction has resolved.

B. The classic triad and its limitations

The classic triad consists of intermittent abdominal pain, a palpable abdominal mass and bloody mucus stool. Fewer than 15% of children have all three features together. Relying on the triad can delay diagnosis. A high index of suspicion is needed when a young child has episodic distress, pallor, vomiting or unexplained lethargy.

C. Late or severe features

• Persistent pain rather than brief episodes, marked tenderness or guarding.
• Increasing abdominal distension, bilious vomiting or inability to pass stool or flatus.
• Bloody stool, signs of dehydration or reduced urine output.
• Fever, toxic appearance, altered consciousness, weak pulses, prolonged capillary refill, tachycardia or hypotension.
• Rigidity, rebound tenderness or other signs of peritonitis, which may indicate perforation or bowel necrosis.

Do not be reassured by the absence of fever, a normal blood pressure, a soft abdomen between episodes or a normal-looking stool. Early intussusception may have few examination findings, and children can deteriorate quickly.

D. Adults

Adult symptoms may be less dramatic and can develop over hours, days or longer. Abdominal pain, nausea, vomiting, bowel-habit change, gastrointestinal bleeding or features of obstruction may occur. The clinical picture depends on bowel location, duration, degree of obstruction and underlying cause. Peritonitis, severe continuous pain, fever or shock suggests complication and requires emergency escalation.

7. Assessment of suspected intussusception

A. Rapid triage and primary survey: ABCDE

Prioritise the patient’s stability while arranging urgent medical and surgical review. Begin local paediatric or adult emergency protocols. Assessment and resuscitation occur in parallel with diagnostic planning; imaging must not delay stabilisation of a shocked or peritonitic patient.

B. Focused history

• Onset and pattern: When did symptoms start? Are pain or distress episodes sudden, recurring and separated by calmer periods?
• Pain behaviour: Does the child draw up the legs, become pale, cry inconsolably or become unusually quiet during or after episodes?
• Vomiting: Ask how often, whether it is bilious, and whether the patient can keep fluids down.
• Stool and flatus: Ask about blood, mucus, diarrhoea, constipation and last stool or flatus. Do not wait for bloody stool to suspect the diagnosis.
• Hydration and urine: Ask about oral intake, wet nappies or urine frequency, tears and recent weight change if relevant.
• Associated history: Recent infection, previous episodes, known bowel disease, prior abdominal surgery, possible lead-point disorder, medicines and allergies.
• For adults: Ask about previous abdominal operations, inflammatory bowel disease, known polyps or tumours, weight loss, gastrointestinal bleeding and changes in bowel habit.

C. Focused examination and red flags

• Observe the child during an episode when possible; note pallor, leg-drawing, cry, alertness and recovery between episodes.
• Inspect the abdomen for distension, scars and movement; auscultation findings alone cannot confirm or exclude intussusception.
• Palpate gently for tenderness, guarding or a mass if trained and within local practice. Avoid repeated vigorous palpation.
• Check for dehydration and poor perfusion. Record age-appropriate observations and trends rather than relying on one reading.
• Rectal examination is not a routine screening test for every child; any examination must have a clear clinical indication and follow local policy.

• Shock, poor perfusion, reduced consciousness or rapid clinical deterioration.
• Bilious vomiting, marked distension or persistent severe abdominal pain.
• Peritonism, rigidity, suspected perforation or free intraperitoneal air.
• Bloody stool with a sick or deteriorating child.
• Inability to access imaging or paediatric surgery locally when the diagnosis is suspected.

8. Investigations

A. Ultrasound in children

Abdominal ultrasound is the initial imaging study of choice for suspected childhood intussusception in centres where it is available. It can identify the telescoped bowel and assess its location, surrounding fluid and possible lead points.

• Transverse view: The bowel-within-bowel appearance may produce a “target” or “doughnut” sign.
• Longitudinal view: The layered bowel may produce a “sandwich” or “pseudokidney” appearance.
• Important limitation: Ultrasound performance depends on the operator and patient factors. Point-of-care ultrasound can support recognition, but a negative bedside scan should not be used alone to exclude intussusception when clinical suspicion remains high.
• Additional information: Imaging may show free fluid, bowel-wall oedema, reduced perfusion or a possible lead point; the treating team interprets these findings with the clinical picture.

B. Abdominal X-ray

Plain abdominal X-ray is not the preferred test to rule out intussusception. It may be requested when obstruction or perforation is suspected, when ultrasound is not readily available, or to help assess an acutely unwell patient. It can show dilated bowel loops, reduced gas in part of the colon or free air, but a normal film does not exclude intussusception.

C. CT and adult assessment

In adults, CT of the abdomen and pelvis is commonly used to define the intussusception, assess obstruction and look for a lead point or complication. CT is also considered in selected older children or atypical cases when ultrasound is inconclusive or an alternative diagnosis is being evaluated. Imaging choices should be made by the clinical team, taking urgency, age, radiation exposure, availability and the patient’s condition into account.

D. Laboratory tests

No blood test confirms intussusception. Tests support assessment of severity, hydration, operative readiness and possible complications. They may include full blood count, electrolytes, urea and creatinine, glucose, blood group and cross-match, blood gas or lactate in a severely ill patient, and other tests guided by the differential diagnosis. Early normal results do not rule out bowel ischaemia.

9. Differential diagnosis

Intermittent abdominal pain, vomiting, lethargy and bloody stool have several possible causes. Consider the patient’s age, onset, examination and investigations. A child may have more than one condition, and a likely diagnosis should not prevent reassessment if the patient deteriorates.

10. Emergency and definitive management

Management depends on age, bowel location, haemodynamic stability, evidence of peritonitis or perforation, likelihood of a lead point and local capability. Early involvement of a paediatric or general surgeon is essential. The first-contact team should stabilise the patient and arrange timely transfer when the required imaging, enema reduction, anaesthesia or surgery is not available.

A. Immediate priorities for all patients

1. Recognise and escalate early. Activate the local emergency pathway and request urgent surgical review. In a child, involve paediatric and anaesthesia teams as appropriate.
2. Stabilise using ABCDE. Support airway and breathing, assess perfusion repeatedly and treat shock with age- and condition-appropriate resuscitation according to local protocol.
3. Keep nil by mouth. Explain the reason to the patient or caregiver. Avoid oral food, fluids, laxatives and non-prescribed enemas while obstruction or urgent intervention is being assessed.
4. Establish IV access and obtain investigations as ordered. Blood tests, group and cross-match, glucose and fluid-balance assessment may be needed, especially in a dehydrated or unstable patient.
5. Provide prescribed analgesia and comfort. Appropriate pain relief should not be withheld solely because an abdominal diagnosis is being evaluated. Reassess pain and the response to treatment.
6. Correct dehydration and electrolyte problems. Use the clinical protocol and monitor response. Avoid delays to definitive care while correcting abnormalities.
7. Consider nasogastric decompression when indicated. The clinical team may request a nasogastric tube for persistent vomiting, significant distension or obstruction, especially before surgery or transfer.
8. Prepare for imaging, reduction or surgery. Maintain warmth, monitor continuously or at a frequency appropriate to acuity, explain each step and arrange safe transfer with handover.

B. Image-guided enema reduction in a suitable child

For many children with ileocolic intussusception who are stable and have no signs of perforation or peritonitis, an air or liquid-contrast enema can be both diagnostic and therapeutic. The paediatric radiology or surgical team performs reduction using imaging guidance and local protocol.

• Before the procedure: Confirm assessment by the treating team, establish IV access, assess and treat dehydration, provide prescribed analgesia, maintain nil by mouth and prepare resuscitation equipment.
• Team and setting: Enema reduction should take place where the patient can be monitored and where paediatric surgical support and urgent rescue surgery are available because perforation or clinical deterioration can occur.
• How reduction works: Air or liquid contrast is introduced into the colon under controlled pressure and imaging. The pressure may push the telescoped bowel back into its normal position.
• Success and failure: Success is confirmed by the procedural team using imaging and the patient’s clinical course. If reduction is incomplete, a carefully selected repeat attempt may be considered under specialist guidance.
• Contraindications to enema reduction: Haemodynamic instability or shock, peritonitis, known or suspected perforation/free intraperitoneal air, or clinical deterioration are reasons not to proceed with routine enema reduction; urgent surgical management is required.
• After the procedure: Observe for recurrent pain, vomiting, pallor, lethargy, distension, fever or blood in stool. Recurrence is most likely during the first 24–48 hours, although it can occur later.

Enema reduction avoids an operation for many appropriately selected children, but it is not risk-free and is not suitable for every patient. A trained team should choose the technique and decide whether a child needs admission or observation according to the findings and local protocol.

C. Surgical management in children

Urgent operation is considered when the child is unstable, has peritonitis or perforation, cannot undergo enema reduction, has failed reduction, deteriorates during treatment or is suspected to have non-viable bowel or a significant lead point. The surgeon may reduce the bowel manually if safe, inspect the bowel for viability and remove a non-viable segment or lead point when necessary. The exact operation depends on the site and condition of the bowel.

D. Adult management

Adult management is individualised. A symptomatic adult with persistent intussusception, obstruction, bowel compromise or a suspected structural lead point needs prompt surgical assessment. CT findings, bowel viability, location, symptoms and malignancy risk help determine whether surgery and bowel resection are appropriate. Some short, transient small-bowel findings without obstruction or a lead point may be observed by specialists; they should not be managed by applying a child’s enema pathway without assessment.

E. Referral and transfer where resources are limited

If ultrasound, image-guided reduction or surgery is unavailable, stabilise the patient and arrange urgent referral to the nearest facility with appropriate paediatric or surgical capability. Contact the receiving team early. During transfer, keep the patient nil by mouth, maintain monitoring and vascular access as available, continue prescribed treatment, prevent hypothermia, and give a structured handover describing symptom onset, episodes, vomiting, stool, observations, fluid treatment, investigations and response.

11. Nursing management

Nursing priorities are prompt recognition, repeated assessment, preparation for definitive treatment, prevention of aspiration and deterioration, safe transfer and clear communication with the patient or caregiver. Intussusception can change quickly, so document trends and report any change immediately.

12. Care after enema reduction or surgery

A. After successful enema reduction

• Continue observations and abdominal reassessment according to the treating team’s plan.
• Watch for recurrence, especially in the first 24–48 hours: new episodes of colicky pain, pallor, vomiting, lethargy, distension or bloody stool require urgent reassessment.
• Restart oral intake only when directed by the clinical team and when the patient’s condition supports it. Observe tolerance, vomiting and hydration.
• Confirm that the caregiver understands warning signs, the follow-up plan and where to seek urgent help after discharge.
• Admission, observation or discharge depends on the patient’s age, symptoms, procedure, risk factors, clinical stability and local protocol.

B. Pre-operative care

• Continue repeated ABCDE assessment, prescribed resuscitation and monitoring while preparing for theatre.
• Maintain nil by mouth, secure IV access and confirm that required investigations and blood preparation have been completed or are in progress.
• Check allergies, medicines, relevant history and consent status; promptly communicate missing information to the team.
• Explain the reason for urgent surgery in simple language within the nurse’s role; support the child and caregiver without delaying care.
• Follow local infection-prevention and pre-operative check procedures.

C. Post-operative care

• Airway and breathing: Monitor respiratory rate, work of breathing, oxygen saturation and recovery from anaesthesia; support prescribed oxygen and respiratory care.
• Circulation and bleeding: Monitor observations, perfusion, wound or drain output if present, fluid balance and ordered laboratory tests. Report shock or ongoing blood loss promptly.
• Pain and comfort: Assess pain using an age-appropriate scale, administer prescribed analgesia and reassess the response.
• Abdominal and bowel function: Observe distension, tenderness, nausea, vomiting, bowel sounds and passage of stool or flatus as directed by the surgical plan.
• Wound and infection: Inspect the incision and lines, use aseptic technique and report fever, increasing pain, redness, discharge or other concerning changes.
• Nutrition and hydration: Follow orders about nil by mouth and restarting feeds; monitor tolerance, hydration and electrolyte results if prescribed.
• Mobility and recovery: Encourage safe mobilisation and age-appropriate activity when authorised; support the caregiver and explain the recovery plan.

13. Nursing care plan

Nursing diagnoses and goals should be individualised to the patient’s age, assessment, treatment, family circumstances and facility protocol.

14. Complications

Early complications

• Small- or large-bowel obstruction with vomiting, distension and dehydration.
• Venous congestion, bowel-wall oedema and mucosal bleeding.
• Bowel ischaemia, necrosis or gangrene.
• Perforation, peritonitis and sepsis.
• Hypovolaemia, electrolyte disturbance, shock and acute kidney injury.
• Enema-related perforation or bacteraemia, which is why reduction requires appropriate monitoring and access to surgical care.
• Failure of enema reduction or need for bowel resection.

Later complications

• Recurrence after successful enema or operative reduction; recurrence is most common early but can occur later.
• Adhesions, wound infection, incisional hernia or bowel obstruction after surgery.
• Short bowel syndrome or nutritional problems if extensive bowel resection is required.
• Missed underlying lead point, especially in an older child or adult; recurrent symptoms need reassessment.
• Psychological distress or feeding anxiety in the child or caregiver after a frightening emergency.

15. Parent and patient education

• Explain that symptoms may come and go; temporary improvement does not always mean that the bowel problem has resolved.
• Seek urgent medical care for recurring episodes of severe abdominal pain or distress, unusual pallor or lethargy, repeated or green vomiting, abdominal swelling, blood or mucus in stool, fever or collapse.
• After enema reduction, follow the discharge and observation instructions given by the treating team. Return immediately if symptoms recur.
• Attend follow-up as arranged, particularly if the patient is older than the usual age group, has repeated episodes or a possible lead point.
• After surgery, follow instructions about wound care, medicines, activity, feeding and review. Report fever, increasing abdominal pain, persistent vomiting, wound discharge or poor intake.
• There is no reliable home treatment that can reduce an intussusception. Do not give laxatives, herbal remedies, food or drink to a vomiting child with suspected obstruction, and do not delay urgent assessment while waiting for symptoms to pass.
• Routine immunisation and general child health care should continue according to national guidance; caregivers should discuss individual vaccine questions with a qualified health worker.

There is no established way for caregivers to prevent most idiopathic childhood intussusception. The most useful public-health message is early recognition and prompt referral when a child develops warning symptoms.

16. Key points for revision

• Intussusception is telescoping of a proximal bowel segment into an adjacent distal segment; the mesentery is drawn in with it.
• Ileocolic intussusception is the commonest childhood pattern and most cases occur in infants and young children.
• The classic triad of intermittent pain, palpable mass and currant jelly stool occurs in fewer than 15% of children.
• Episodes of colicky distress, pallor, vomiting or unexplained lethargy can be enough to warrant urgent assessment.
• Venous and lymphatic obstruction cause congestion and oedema; prolonged compression may cause ischaemia, necrosis and perforation.
• Ultrasound is the initial imaging test of choice for children. A normal plain X-ray or negative point-of-care scan does not safely exclude disease when suspicion remains high.
• Stabilise first. Keep the patient nil by mouth, obtain IV access, treat dehydration or shock according to protocol, give prescribed analgesia and involve a surgeon early.
• Image-guided enema reduction is an option for selected stable children without peritonitis or perforation and with surgical backup available.
• Shock, peritonitis, perforation, deterioration or failed enema reduction requires urgent surgical management.
• Adult intussusception more often has a structural lead point; CT and surgical assessment guide management.
• Teach caregivers about early recurrence and the need to return for recurrent pain, vomiting, pallor, lethargy or bloody stool.

17. Common examination questions

1. Define intussusception and distinguish between the intussusceptum and intussuscipiens.
2. State the commonest type of intussusception in infants and young children.
3. List the components of the classic triad and explain why its absence does not exclude the diagnosis.
4. Outline the sequence by which intussusception can cause bowel necrosis.
5. What is the first-line imaging investigation for suspected intussusception in a child?
6. State four immediate nursing or team priorities for a child with suspected intussusception.
7. Give three situations in which routine enema reduction is contraindicated or unsafe.
8. List four reasons a child may require urgent surgery.
9. Why should an adult with intussusception be assessed for a structural lead point?
10. State five symptoms that a caregiver should treat as a reason for urgent reassessment after discharge.

1. Intussusception is telescoping of one bowel segment into the adjacent segment. The entering proximal segment is the intussusceptum; the receiving distal segment is the intussuscipiens.
2. Ileocolic intussusception, in which terminal ileum passes through the ileocaecal valve into the colon.
3. Intermittent abdominal pain, palpable mass and red currant jelly stool. All three occur together in fewer than 15% of children, and blood or a mass may be absent early.
4. Telescoping draws in the mesentery; venous and lymphatic drainage become impaired; oedema worsens compression; arterial supply falls; prolonged ischaemia may cause necrosis and perforation.
5. Abdominal ultrasound.
6. Examples: rapid ABCDE assessment and escalation, nil by mouth, IV access, prescribed fluids and analgesia, repeated observations, urgent imaging and surgical review, safe transfer.
7. Haemodynamic instability or shock, peritonitis, suspected bowel perforation/free intraperitoneal air, or clinical deterioration.
8. Shock, peritonitis or perforation, failed or unsuitable enema reduction, bowel ischaemia/necrosis, clinical deterioration or a significant lead point.
9. Adult cases are more often associated with an underlying lesion; CT and surgical assessment help detect a lead point, obstruction or bowel compromise.
10. Recurrent severe pain or distress, pallor, lethargy, vomiting (especially green/bilious), abdominal distension, blood or mucus in stool, fever or collapse.

18. References and further reading

• Royal Children’s Hospital Melbourne. Clinical Practice Guideline: Intussusception. Guidance on presentation, assessment, imaging, enema reduction and escalation.
• World Health Organization. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. 2nd edition. 2013.
• American Pediatric Surgical Association. Conditions F–O: Intussusception. Patient and family information.
• Marsicovetere P, Ivatury SJ, White B, Holubar SD. Intestinal Intussusception: Etiology, Diagnosis, and Treatment. Clinics in Colon and Rectal Surgery. 2017;30(1):30–39.
• World Health Organization and International Committee of the Red Cross. Basic Emergency Care: Approach to the Acutely Ill and Injured. 2018.

These notes support learning and do not replace individual clinical assessment, the decisions of a qualified clinician, or current local emergency, paediatric and surgical protocols. Management depends on the patient’s condition and available resources.

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