Sonographic features indicative of hydrostatic reducibility of intestinal intussusception in infancy and early childhood

Abstract

The aim of the study was to investigate the various sonographic patterns of intussusception, which may be indicative of its reducibility by hydrostatic reduction. Seventy-one infants and children clinically suspected of having intussusception were studied sonographically and given barium enemas. Sonographic patterns of intussusception were correlated with its reducibility. When the head of intussusception appeared as a target-like mass the hydrostatic reduction rate was 100%. When demonstrated as a doughnut-like mass, the intussusception reducibility depended on the thickness of the hypoechoic external ring of the "doughnut". With a thickness equal to, or less than, 7.2 mm the reduction rate was 100%, with a thickness ranged between 7.5 and 11.2 mm the reduction rate was 68.9% and with a thickness measured 14 to 14.2 mm a surgical resection of bowel was required. When a small amount of fluid appeared within the head of intussusception, like a crescent hypoechoic area, the hydrostatic reduction was unsuccessful, regardless of the sonographic pattern of intussusception (target- or doughnut-like mass). The presence of a small amount of free peritoneal fluid did not affect the reducibility of intussusception. In conclusion, sonographic patterns of intussusception identify good and poor prognostic features for the success of hydrostatic reduction.

A 7-Year-Old Hispanic Boy with Acute Onset of Abdominal Pain

“…1,17,18 Characteristic US findings of the transient small bowel "ileal-ileal" intussusception include small size of the doughnut ring (2-3 cm), no recognizable lead point, short segment length of less than 3.5 cm, normal vascularity on color Doppler US, and preserved wall motion. 1,4,13,16,17,[19][20][21] Due to the availability of US imaging in most emergency departments, small bowel intussusceptions may be readily identified and characterized by these recommended criteria.…”

Ultrasound-guided reduction of ileocolic intussusception in children

“…The absence of color flow within the intussusception, as the result of progressive constriction of mesenteric vessels by edematous loops, correlates with bowel necrosis and irreducibility (3,20). Some other factors have been reported to decrease the chances of successful reduction: long duration of symptoms (>48 hours), significant dehydration, radiographic evidence of small bowel obstruction, and patient age less than 3 months or more than 5 years (2,5).…”

“…Some other factors have been reported to decrease the chances of successful reduction: long duration of symptoms (>48 hours), significant dehydration, radiographic evidence of small bowel obstruction, and patient age less than 3 months or more than 5 years (2,5). A small amount of free fluid within the peritoneal cavity is a relatively common finding and does not affect reduction rates (3,20).…”

“…In the presence of predictors of irreducibility, enema therapy can be tried, before resorting to surgery, if the clinical condition is favorable (3,8,13,20). The attempt should be very gentle and careful.…”

“…Another advantage is that in the case of perforation there is no possibility for chemical peritonitis as with Barium enema, no tension pneumoperitoneum as with air enema, no chance for fluid shifts as with hypertonic contrast medium solutions or tap water, and no mortality. If reinvagination occurs, the same method can be repeated (20,24,25).…”