Intussusception in children older than 1 year: current aspects of etiology, diagnosis and treatment

In children older than one year of life, intussusception is more often associated with a pathological leading point, which reduces the success rate of exclusively conservative interventions and increases the importance of timely surgical treatment. However, maintained heterogeneity of approaches and diagnostic errors still affect outcomes. A search and analytical summary of domestic and foreign publications was performed, with the priority given to clinical recommendations, systematic reviews/meta-analyses, multicenter studies, and large clinical series. The search was conducted in the eLibrary, PubMed, and Scopus databases for the period 01.01.2020–31.12.2025 using Russian and English keywords related to intussusception in children (diagnosis, pathological leading point, disinvagination, surgical tactics); the manual review of bibliographies on key publications was done as well. The analytical part of the review includes 27 sources, on the basis of which conclusions and tables were formed. The clinical and instrumental signs of a probable pathological leading point and the ultrasound criteria for intestinal wall viability were summarized. It was shown that pneumatic/hydrostatic disinvagination under ultrasound or X-ray control is possible at an early stage; however, if it is ineffective, there are doubts about adequate perfusion, or there is a high probability of a pathological leading point, it is advisable to switch to diagnostic and therapeutic laparoscopy with mandatory removal of the pathological leading point, if present. The authors also outline situations requiring resection with the restoration of intestinal tube continuity. Organizational conditions reducing the proportion of emergency resections and complications (early availability of ultrasound, standardized routes, interdisciplinary interaction) as well as the role of machine learning algorithms and clinical predictive models as auxiliary decision support tools are highlighted as well. An age-oriented, practice-oriented management algorithm for children older than one year is presented: from recognizing the signs of pathological leading point and justifying the refusal of further attempts at disinvagination to the structure of laparoscopic intervention. Application of the presented scheme is intended to reduce the frequency of relapses and complications as well as to improve immediate and long-term treatment outcomes.