Sonographic findings predictive of the need for surgical management in pediatric patients with small bowel intussusceptions

Abstract

A diameter ≥2.1 cm, length ≥4.2 cm, and thickness of the outer rim ≥0.40 cm predict the need for surgical management in pediatric patients with SBIs.

Is every intussusception treatment an emergency intervention or surgery?

“…However, reports of spontaneous reductionof SBI, which use the terms "transient" or "benign" intussusception face pediatric surgeons with the necessity to distinguish the cases who are likely to reduce spontaneously from the unlikely ones. [12,20,25] Data of the present study indicates the unlikely need for intervention when SBI segments are shorter than 2.3 cm. Following these cases with careful clinical monitoring, frequent physical examinations, and USG controls would be sufficient.…”

“…[21][22][23] Classical symptoms may be lacking in cases of SBI, which may prolong the diagnosis period and lead to severe consequences. [12] In spite of such dire consequences, possibility of spontaneous reduction of SBIs should be considered. [16,24,25] Of the 81 patients in the present study, 17 had SBI (15 IL, 2 JJ) that reduced spontaneously.…”

“…However, criteria to determine the treatment of choice (surgery or observation) has been a subject of debate. [12] ORIGINAL ARTICLE Ulus Travma Acil Cerrahi Derg, March 2016, Vol. 22, No.…”

“…[11] Intussusception is diagnosed based on characteristic findings of target (doughnut) and/or pseudokidney signs on ultrasonography (USG), which is highly accurate. [12,13] Depending on the clinical situation, treatment for ileocolic (IC) and colocolic (CC) intussusception may be non-surgical (pneumatic or hydrostatic pressure enemas under fluoroscopy or USG) or surgical (operative, manual reduction and/or resection or enterostomy intervention as needed).…”

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

“…6,14 There are conflicting reports in the literature as to the surgical predictive value of the transverse diameter and the outer thickCase Challenge ness of the external ring in SBI images. In a small study by Zhang et al, 15 outer ring thickness greater than 0.4 cm was predictive of need for surgical reduction; however no such relationship was found in similar studies. 13,16 Absence of color flow in Doppler suggests compromise of the mesenteric vasculature, indicating a potentially difficult reduction and a lower reduction success rate.…”