This handout is for intussusception (ileocolic / ileoileal) — pediatric. Your care team identified this based on: child 6 mo - 3 y with paroxysmal abdominal pain in episodes lasting 5-30 min separated by quiet intervals (drawing knees up; inconsolable crying); classic intussusception entry signal (acr appropriateness criteria; aap nec-adjacent surgical-emergency guidance).
Other reasons your team may use this plan: currant-jelly stool (mucus + blood) or bloody stool in child 6 mo - 3 y — pathognomonic but late finding (~ 60% of cases); lr+ ~ 10 for intussusception in age-appropriate cohort; palpable sausage-shaped abdominal mass typically ruq or epigastrium (dance sign — empty rlq) — third element of classic triad; lr+ ~ 8; classic triad — paroxysmal pain + bloody stool + abdominal mass — only ~ 15% of patients have all three; high lr+ when present.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| normal saline / lactated Ringer's | 20 mL/kg IV bolus over 30-60 min, repeat × 1-2 PRN; max ~ 60 mL/kg total before reassessing for fluid overload | IV | bolus PRN with reassessment | ACR Appropriateness Criteria — pre-enema resuscitation REQUIRED if severe dehydration; lower bolus thresholds vs adult sepsis given pediatric fluid-overload risk; halt or slow if hepatomegaly / rales / no response (AAP pediatric resuscitation principles) |
| morphine | 0.05-0.1 mg/kg IV every 2-4 h PRN; titrate to comfort | IV | q2-4h PRN | Analgesia for paroxysmal pain; titrate to comfort without obscuring abdominal exam |
| ketamine | 1-2 mg/kg IV by pediatric sedation team for procedural sedation; supplemental 0.5 mg/kg PRN | IV | procedural | Preferred procedural-sedation agent for air-enema (preserves airway reflexes + analgesic); per institutional pediatric sedation protocol + AAP pediatric sedation guidance |
| dexmedetomidine | 1 mcg/kg IV load over 10 min then 0.2-0.7 mcg/kg/h continuous; alternative procedural sedation option | IV | load then continuous | Alternative procedural-sedation; useful when ketamine contraindicated (psychotic features, increased ICP concerns); per institutional protocol |
| midazolam | 0.05-0.1 mg/kg IV (max 2 mg single dose) for anxiolysis adjunct | IV | PRN procedural | Adjunct anxiolysis; not stand-alone procedural sedation in this context |
| ceftriaxone | 50 mg/kg IV (max 2 g) single dose at induction; expand to broad-spectrum if perforation | IV | pre-op single dose; broader if perforation | Pre-op antimicrobial prophylaxis for surgical reduction; expand to pip-tazo or carbapenem + metronidazole if perforation / peritonitis confirmed |
| piperacillin-tazobactam | 80-100 mg/kg IV q6-8h (piperacillin component) for confirmed perforation / peritonitis | IV | q6-8h | Broad Gram-positive + Gram-negative + anaerobe single-agent backbone for intra-abdominal contamination per Solomkin IDSA intra-abdominal 2010 (peds-adapted) |
| metronidazole | 10 mg/kg IV q8h (max 500 mg/dose); add to ceftriaxone for anaerobic cover when pip-tazo not available | IV | q8h | Anaerobic cover adjunct; alternative to single-agent pip-tazo |
Plan: Pre-enema resuscitation + sedation + analgesia for pediatric intussusception (ACR Appropriateness Criteria + AAP pediatric sedation guidance)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Pediatrician follow-up within 1-2 weeks; return precautions reviewed with caregivers (recurrence signs: return of paroxysmal pain episodes, vomiting, bloody stool, lethargy — present to ED). Recurrent intussusception (≥ 2 episodes) → pediatric GI consult for lead-point workup: contrast study (upper-GI / small-bowel follow-through) + Meckel's scan (Tc-99m pertechnetate) + considered colonoscopy if age-appropriate; MR enterography for polyposis syndromes (Peutz-Jeghers). HSP-associated cases → rheumatology follow-up for HSP management beyond acute event. Rotavirus vaccine surveillance: report post-vaccine cases to VAERS (CDC surveillance) per AAP recommendation; family counseling that net benefit far exceeds individual case risk.
Guideline: ACR Appropriateness Criteria — Suspected Pediatric Intussusception + AAP statement on rotavirus vaccine + intussusception (post-licensure surveillance; net benefit favors continued vaccination) + Applegate KE AJR 2005 (imaging evidence-based review) + Daneman A Pediatr Radiol 2004 (pneumatic vs hydrostatic enema) + Sadigh G AJR 2015 (meta-analysis pneumatic vs hydrostatic) + Solomkin IDSA intra-abdominal 2010 (peds-adapted for perforation management) + SSC peds 2020 (for shock physiology if perforation precipitates sepsis)