Intussusception in Children: Current Concepts in Diagnosis and Enema Reduction

Abstract

Intussusception cannot be reliably ruled out with clinical examination and plain radiography. However, a contrast material enema study and ultrasonography (US) allow definitive diagnosis of intussusception. The components of an intussusception produce characteristic appearances on US scans. These appearances include the multiple concentric ring sign and crescent-in-doughnut sign on axial scans and the sandwich sign and hayfork sign on longitudinal scans. Indicators of ischemia and irreducibility are trapped fluid at US and absence of blood flow at Doppler imaging. The aim of enema therapy is to reduce the greatest number of intussusceptions without producing perforation. Barium, water-soluble contrast media, water, electrolyte solutions, or air may be used with radiographic or US guidance. The differences in reduction and perforation rates between the various types of enemas are probably due more to perforations that occurred before enema therapy and the pressure exerted within the colon than to the contrast material used. The pressure within the colon is more constant with hydrostatic reduction than with air reduction; this fact may explain the lower risk of perforation with hydrostatic reduction. Radiation exposure is lower with air enema therapy than with barium enema therapy and is absent in US-guided enema therapy.

Ileoileal intussusception in children: ultrasonographic differentiation from ileocolic intussusception

“…Only one lead point (Burkitt lymphoma) was depicted during ultrasonographic examination of the ileoileal intussusceptions in our study. Lymphoma is uncommon in children, but is well known as a predisposing factor for intussusception [1]. One of our patients had cystic fibrosis and five had gastrointestinal infections.…”

“…The mean age of children with small bowel intussusception ranged from 4 to 11 years in several studies [3,4,7,8]. Idiopathic intussusception is more common in children between 6 months and 2 years of age [1]. The percentage of intussusceptions due to a lead point, other than normal small mesenteric lymph nodes, increases with age, from 5% in children aged 0-11 months to 60% in those aged 5-14 years.…”

“…Intussusception is diagnosed by ultrasonography (US) in a quick, simple and non-invasive way with a high sensitivity (98%-100%) and specificity (88%-100%) [1,2]. The components of an intussusception produce characteristic appearances on US images.…”

“…According to the literature, in the majority of pediatric cases the intussusception is located in the ileocolic part of the bowel. However, a small percentage of the intussusceptions are located in the small bowel [1][2][3][4]. The treatment of ileocolic and ileoileal intussusceptions is different.…”

“…It is therefore necessary to differentiate between ileocolic and ileoileal intussusceptions. There are several reports concerning the typical ultrasonographic appearances of intussusceptions, for example the doughnut or sandwich signs [1,5]. However, less is known about the ultrasonographic differentiation between ileoileal and ileocolic intussusception using criteria such as mean diameter, length and blood flow of the intussusception.…”