Intussusception Medication

  • Author: Felix C Blanco, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Jan 13, 2012
 

Medication Summary

Drug therapy is not currently a component of the standard of care for intussusception. Medications are limited to those used for pain control after surgery. In the immediate postoperative period, weight-adjusted intravenous morphine is usually administered. As the oral diet is resumed, acetaminophen with codeine or ibuprofen is given orally.

Patients with HSP or hemophilia and intussusception require standard therapy for the individual disease. Some investigators have advocated the use of steroids in intussusception secondary to HSP and lymphoid hyperplasia, with varied results.

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Opioid Analgesics

Class Summary

Opioid analgesics are used to control acute crisis and chronic pain.

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Morphine sulfate (Duramorph, Astramorph, MS Contin, Avinza, Kadian)

 

An opioid analgesic, morphine interacts with endorphin receptors in the CNS.

Acetaminophen with codeine (Tylenol-3)

 

This is a mild narcotic analgesic. Provide the family with a small supply for use when pain severity is greater than what can be managed with acetaminophen alone. Counsel parents to use only for severe pain, not as the first medication for each symptom.

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Nonsteroidal Anti-Inflammatory Drugs

Class Summary

These agents add to the effects of opioids during painful crises and allow use of lower doses of narcotics.

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Ibuprofen (Advil, Motrin)

 

Ibuprofen is usually the drug of choice for the treatment of mild to moderate pain, if no contraindications exist. It inhibits inflammatory reactions and pain by decreasing the activity of the enzyme cyclo-oxygenase, resulting in inhibition of prostaglandin synthesis.

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Contributor Information and Disclosures
Author

Felix C Blanco, MD  Research Fellow, Department of Surgery, Children's National Medical Center

Felix C Blanco, MD is a member of the following medical societies: American College of Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

A Alfred Chahine, MD  Associate Professor of Surgery and Pediatrics, George Washington University School of Medicine and Health Sciences; Chief of Pediatric Surgery, Georgetown University Medical Center; Attending Surgeon, Children's National Medical Center

A Alfred Chahine, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Pediatric Surgical Association, and International Pediatric Endosurgery Group

Disclosure: Nothing to disclose.

Lonnie King, MD  Consulting Staff, Department of Emergency Medicine, Children's Healthcare of Atlanta at Scottish Rite

Lonnie King, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Garry Wilkes  MBBS, FACEM, Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Specialty Editor Board

Hisham Nazer, MB, BCh, FRCP, DCh, DTM&H  Professor of Pediatrics, Consultant in Pediatric Gastroenterology, Hepatology and Clinical Nutrition, Bushnaq Medical Centre, University of Jordan Faculty of Medicine, Jordan

Hisham Nazer, MB, BCh, FRCP, DCh, DTM&H is a member of the following medical societies: Royal College of Paediatrics and Child Health, Royal College of Physicians, Royal College of Surgeons in Ireland, Royal College of Surgeons of Edinburgh, and Royal Society of Tropical Medicine and Hygiene

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

B UK Li, MD  Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

References

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  3. Sanni RB, Nandiolo R, Coulibaly Diaoudia MT, Vodi L, Mobiot ML. Acute intussusception due to intestinal Kaposi's sarcoma in an infant. Afr J Paediatr Surg. Jul-Dec 2009;6(2):131. [Medline].

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  7. Zanardi LR, Haber P, Mootrey GT, et al. Intussusception among recipients of rotavirus vaccine: reports to the vaccine adverse event reporting system. Pediatrics. Jun 2001;107(6):E97. [Medline].

  8. Christie CD, Duncan ND, Thame KA, et al. Pentavalent rotavirus vaccine in developing countries: safety and health care resource utilization. Pediatrics. Dec 2010;126(6):e1499-506. [Medline].

  9. [Best Evidence] Ruiz-Palacios GM, Pérez-Schael I, Velázquez FR, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med. Jan 5 2006;354(1):11-22. [Medline].

  10. Zickafoose JS, Benneyworth BD, Riebschleger MP, Espinosa CM, Davis MM. Hospitalizations for Intussusception Before and After the Reintroduction of Rotavirus Vaccine in the United States. Arch Pediatr Adolesc Med. Jan 2 2012;[Medline].

  11. Niramis R, Watanatittan S, Kruatrachue A, et al. Management of recurrent intussusception: nonoperative or operative reduction?. J Pediatr Surg. Nov 2010;45(11):2175-80. [Medline].

  12. Weihmiller SN, Buonomo C, Bachur R. Risk stratification of children being evaluated for intussusception. Pediatrics. Feb 2011;127(2):e296-303. [Medline].

  13. [Best Evidence] Morrison J, Lucas N, Gravel J. The role of abdominal radiography in the diagnosis of intussusception when interpreted by pediatric emergency physicians. J Pediatr. Oct 2009;155(4):556-9. [Medline].

  14. Hooker RL, Hernanz-Schulman M, Yu C, Kan JH. Radiographic evaluation of intussusception: utility of left-side-down decubitus view. Radiology. Sep 2008;248(3):987-94. [Medline]. [Full Text].

  15. Hryhorczuk AL, Strouse PJ. Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception. Pediatr Radiol. Oct 2009;39(10):1075-9. [Medline].

  16. Munden MM, Bruzzi JF, Coley BD, Munden RF. Sonography of pediatric small-bowel intussusception: differentiating surgical from nonsurgical cases. AJR Am J Roentgenol. Jan 2007;188(1):275-9. [Medline].

  17. Shekherdimian S, Lee SL, Sydorak RM, Applebaum H. Contrast enema for pediatric intussusception: is reflux into the terminal ileum necessary for complete reduction?. J Pediatr Surg. Jan 2009;44(1):247-9; discussion 249-50. [Medline].

  18. Jen HC, Shew SB. The impact of hospital type and experience on the operative utilization in pediatric intussusception: a nationwide study. J Pediatr Surg. Jan 2009;44(1):241-6. [Medline].

  19. Sandler AD, Ein SH, Connolly B, Daneman A, Filler RM. Unsuccessful air-enema reduction of intussusception: is a second attempt worthwhile?. Pediatr Surg Int. 1999;15(3-4):214-6. [Medline].

  20. Bonnard A, Demarche M, Dimitriu C, et al. Indications for laparoscopy in the management of intussusception: A multicenter retrospective study conducted by the French Study Group for Pediatric Laparoscopy (GECI). J Pediatr Surg. Jul 2008;43(7):1249-53. [Medline].

  21. Fraser JD, Aguayo P, Ho B, et al. Laparoscopic management of intussusception in pediatric patients. J Laparoendosc Adv Surg Tech A. Aug 2009;19(4):563-5. [Medline].

  22. Herwig K, Brenkert T, Losek JD. Enema-reduced intussusception management: is hospitalization necessary?. Pediatr Emerg Care. Feb 2009;25(2):74-7. [Medline].

  23. Gilmore AW, Reed M, Tenenbein M. Management of childhood intussusception after reduction by enema. Am J Emerg Med. Oct 25 2010;[Medline].

 
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Abdominal radiograph shows small bowel dilatation and paucity of gas in the right lower and upper quadrants.
Air contrast enema shows intussusception in the cecum.
Barium enema shows intussusception in the descending colon.
CT scan reveals the classic ying-yang sign of an intussusceptum inside an intussuscipiens.
Abdominal ultrasonography reveals the classic target sign of an intussusceptum inside an intussuscipiens.
Laparoscopic view of a jejuno-jejunal intussusception
Note intussusception in the left upper quadrant on this plain film of an infant with pain vomiting. Courtesy of Dr. Kelly Marshall, Children's Healthcare of Atlanta at Scottish Rite.
Intussusception evident during air contrast enema prior to reduction. Courtesy of Dr. Kelly Marshall, Children's Healthcare of Atlanta at Scottish Rite.
 
 
 
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