Pain and irritability in Pediatric ileocolic and small bowel intussusception: A comparative study

Background: Ileocolic intussusception (ILIC) represents a medical emergency in pediatric emergency medicine. Some patients suspected of ILIC actually have small bowel intussusception (SMBI), which may appear clinically similar and can only be differentiated from the ileocolic type by ultrasound. The study aimed to compare pain and irritability among children presenting with ILIC versus SMBI. Methods: This retrospective cohort study included children aged 4 months to 4 years diagnosed with ILIC or SMBI at two tertiary pediatric EDs between January 2021 and May 2025. Pain was assessed at triage using the FLACC scale, and irritability was recorded based on reports from caregivers or medical staff. The primary outcome was pain at triage (score > 0); the secondary outcome was irritability. Multivariable regression examined associations between intussusception type and outcomes, adjusting for age, sex, symptom duration, vomiting, and lethargy. Results: The study included 141 patients with a median (IQR) age of 12 (9–22) months: 84 (59.6%) ILIC and 57 (40.4%) SMBI. Pain at ED triage occurred in 37.0% with ILIC and 35.1% with SMBI, with no significant association between intussusception type and pain presence. Irritability was more common in patients with SMBI (adjusted OR 7.9, 95% CI 2.2–28.9, p < 0.02) and in those with symptom duration <24 h (adjusted OR 4.8, 95% CI 1.6–14.8, p < 0.01). Lethargy was observed more frequently in ILIC cases. Vomiting rates were similar. Conclusion: Triage pain was mild and comparable between ILIC and SMBI. Although irritability was more frequent in SMBI, neither symptom reliably distinguished the two conditions.