Sonography of Pediatric Small-Bowel Intussusception: Differentiating Surgical from Nonsurgical Cases

Munden, Martha M.; Bruzzi, John F.; Coley, Brian D.; Munden, Reginald F.

doi:10.2214/ajr.05.2049

Cited by 88 publications

(75 citation statements)

References 16 publications

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“…This information correlates with gravity and so with prognosis of intussusception, as also described by some Authors, for example by Munden et al that in their series found that length of intussusception was the most useful independent predictor of the need of surgical intervention and concluded that when small-bowel intussusception is detected in infants and children undergoing abdominal sonography, intussusception length greater than 3.5 cm is a strong independent predictor of the need of surgical intervention [19]. In the opinion of these Authors, transitory intussusception tends to have smaller both axial and longitudinal diameters compared to cases of nearly irreducible intussusception, in which diameters should be greater.…”

Section: Discussionsupporting

confidence: 55%

Intussusception in childhood: role of sonography on diagnosis and treatment

Bartocci¹,

Fabrizi²,

Valente³

et al. 2014

J Ultrasound

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Objective The aim of this study was to determine the role of ultrasound in the diagnosis and treatment of pediatric patients with acute abdominal pain caused by intussusceptions. Materials and methods We performed a retrospective study of all pediatric patients with acute abdominal pain caused by intussusceptions and that underwent ultrasound examination at the emergency service of the Radiology Department between November 2007 and June 2013. The role of ultrasonography in the diagnosis of intussusceptions has been assessed by comparing the echographic presumptive diagnosis with the final diagnosis of discharge. Its importance in the treatment has been assessed by determining the value of ultrasound findings in the choice of the best treatment. Results The ultrasound examination was positive in 16/18 patients with a final diagnosis of intussusception. Some sonographic findings seemed to be able to predict the opportunity to resort to non-surgical therapeutic options like hydrostatic or pneumatic reduction of the intestinal segments invaginated. In our casuistry, five children presented characteristics typical of this subgroup and underwent barium enema which provided the reduction of the intestinal segments involved. The future challenge will be to perform non-surgical ultrasound-guided reductions to avoid the exposure of the infants to ionizing radiations. Conclusions Ultrasonography is essential not only in the diagnosis, but also it adds important elements in the therapeutic choice and could play in the future an important role in non-surgical reduction of intestinal intussusceptions in pediatric patients.Keywords Intussusception Á Childhood Á Sonography Riassunto Obiettivo Accertare il ruolo dell'ecografia nella diagnosi e trattamento dei pazienti pediatrici con dolore addominale acuto causato da invaginazione intestinale. Materiali e metodi Abbiamo eseguito uno studio retrospettivo su tutti i pazienti pediatrici con dolore addominale acuto causato da intussuscezione e sottoposti ad esame ecografico presso il servizio di emergenza del Dipartimento di Radiologia tra il Novembre 2007 ed il Giugno 2013. Il ruolo dell'ecografia nella diagnosi di intussuscezione è stato valutato comparando la diagnosi presuntiva ecografica con la diagnosi finale di dimissione; per ciò che concerne la sua importanza nel trattamento, ci si è basati sull'influenza dei reperti ecografici sul percorso terapeutico. Risultati Su 18 pazienti con diagnosi finale di intussuscezione l'esame ecografico è risultato positivo in 16 casi; inoltre è stato possibile osservare che alcuni reperti ecografici sembrano essere in grado di predire l'opportunità di ricorrere ad opzioni terapeutiche non chirurgiche, vale a dire riduzione idrostatica o pneumatica del segmento intestinale invaginato. Nella nostra casistica, 5 bambini hanno presentato caratteristiche tali da rientrare in questo sottogruppo, e pertanto sono stati sottoposti a clisma opaco, 123J Ultrasound (2015( ) 18:205-211 DOI 10.1007 tramite cui in 3 casi si è ottenuto lo svaginam...

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Section: Discussionsupporting

confidence: 55%

Intussusception in childhood: role of sonography on diagnosis and treatment

Bartocci¹,

Fabrizi²,

Valente³

et al. 2014

J Ultrasound

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“…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. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Galloway¹,

Seguias²

2013

Pediatr Ann

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“…Small bowel intussusceptions have very little fat centrally and occur in older children with bowel disorders such as HenochSchonlein Purpura, Crohn disease, and celiac sprue; they are also seen in post-operative patients and in patients with small bowel mass acting as a lead point. Small bowel intussusception length greater than 3.5 cm is a strong predictor of need for surgical intervention [30] . However, most small bowel intussusceptions are idiopathic and transient [31] .…”

Section: Acquired Disordersmentioning

confidence: 99%

Abdominal ultrasonography of the pediatric gastrointestinal tract

Gale¹,

Gee²,

Westra³

et al. 2016

WJR

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Ultrasound is an invaluable imaging modality in the evaluation of pediatric gastrointestinal pathology; it can provide real-time evaluation of the bowel without the need for sedation or intravenous contrast. Recent improvements in ultrasound technique can be utilized to improve detection of bowel pathology in children: Higher resolution probes, color Doppler, harmonic and panoramic imaging are excellent tools in this setting. Graded compression and cine clips provide dynamic information and oral and intravenous contrast agents aid in detection of bowel wall pathology. Ultrasound of the bowel in children is typically a targeted exam; common indications include evaluation for appendicitis, pyloric stenosis and intussusception. Bowel abnormalities that are detected prenatally can be evaluated after birth with ultrasound. Likewise, acquired conditions such as bowel hematoma, bowel infections and hernias can be detected with ultrasound. Rare bowel neoplasms, vascular disorders and foreign bodies may first be detected with sonography, as well. At some centers, comprehensive exams of the gastrointestinal tract are performed on children with inflammatory bowel disease and celiac disease to evaluate for disease activity or to confirm the diagnosis. The goal of this article is to review up-to-date imaging techniques, normal sonographic anatomy, and characteristic sonographic features of common and uncommon disorders affecting the gastrointestinal tract in children.

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Sonography of Pediatric Small-Bowel Intussusception: Differentiating Surgical from Nonsurgical Cases

Abstract: When small-bowel intussusception is detected in infants and children undergoing abdominal sonography, intussusception length greater than 3.5 cm is a strong independent predictor of the need for surgical intervention.

Cited by 88 publications

References 16 publications

Intussusception in childhood: role of sonography on diagnosis and treatment

Intussusception in childhood: role of sonography on diagnosis and treatment

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

Abdominal ultrasonography of the pediatric gastrointestinal tract

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