FIGURE 116.7 Ileocolic intussusception Barium enema shows the intussusception as the filing defect within the hepatic flexure surrounded by spiral mucosal folds Significant distended small bowel represents distal small bowel obstruction Triage Consideration Blood per rectum or bilious emesis in a child with possible intussusception should be triaged to an acute treatment area with immediate assessment by the emergency department team Children with evidence of shock or bowel obstruction may need immediate operative care Initial Assessment Most children present with significant intermittent abdominal pain This symptom may have been preceded by the symptoms and signs of a viral gastroenteritis or even an upper respiratory infection Gradually, the child becomes more irritable and anorectic, and may vomit The pattern of pain in a