Classic Triad not always present
Maintain high index of suspicion
All labs nonspecific
Guaiac-positive stool (~50%)
Maintain high index of suspicion
Ultrasound
Sensitivity and specificity approach 100%, but operator dependent
Some emergency departments have successfully implemented bedside point-of-care ultrasound
Scanning technique involves using a linear probe and applying graded compression serially over all 4 quadrants of the abdomen, looking for a "bullseye lesion" in the short axis view and a "pseudokidney sign" in the longitudinal view
Ultrasound can diagnose ileo-ileal<unk> , whereas contrast enema cannot
Negative ultrasound = may still be intermittent<unk> 
Some emergency departments have successfully implemented bedside point-of-care ultrasound
Air contrast enema
Diagnostic and frequently curative
Prior to procedure, IV hydration, NG tube decompression, surgery consult
Hydrostatic (saline or water-soluble contrast) enema also may be used
CT Abdomen
For adults (air contrast or barium enemas not sufficient)
Up to 20% of cases do not have lead point
Up to 20% of cases do not have lead point
Intussusception
Emergent
Meckel's diverticulum
Necrotizing Enterocolitis
Rectal foreign body
Volvulus
Necrotizing enterocolitis
Testicular torsion