Ileocolic intussusception in the emergency department. Experience after the implementation of a sedoanalgesia protocol

Abstract

Objectives: To describe the clinical presentation of children with ileocolic intussusception in the emergency department, and to evaluate the clinical outcomes associated with the implementation of a multidisciplinary protocol for reduction using sedation and analgesia.

Patients and Method: Retrospective review of children diagnosed with ileocolic intussusception in a tertiary pediatric hospital over 8 years (2017–2024). Before 2021, reductions were performed in the radiology department without sedation. Afterward, a multidisciplinary protocol was implemented to perform the procedure using sedations and analgesia in the emergency department.

Results: A total of 112 episodes in 92 patients were analyzed, with a median age of 21.5 months (IQR 9–35). Males accounted for 75% of cases. The most frequent symptom was abdominal pain (84.8%), followed by vomiting (56.5%) and leg flexion (47.3%). 12 episodes (10.7%) resolved spontaneously. In 93 episodes (83%), hydrostatic reduction with saline enema was initially performed (33 with sedation and analgesia in the emergency department). 4 patients (3.6%) required hydrostatic reduction under general anesthesia in the operating room, and 3 (2.7%) required primary laparotomy. First-attempt reduction success was achieved in all cases managed with sedation and analgesia, compared to 71.7% without sedation (p = 0.0004). Complication rates were lower in the sedation group (12.1% vs. 22.8%), although not statistically significant. Sedation- and analgesia-related complications were mild and infrequent. The average length of stay in the emergency department was similar between groups.

Conclusions: The use of sedation and analgesia is a safe and useful strategy for the reduction of ileocolic intussusception in the emergency department in selected patients, with a higher success rate and no increase in complications, improving patient comfort and facilitating the procedure.