Ultrasonographic findings of small bowel intussusception, focusing on differentiation from ileocolic intussusception

Abstract

The purpose of this study was to evaluate the typical ultrasonographic findings of transient small bowel intussusception (SBI) and to differentiate it from ileocolic intussusception (ICI) in paediatrics. 22 transient SBI (male:female = 13:9, age: 7-132 months (mean 38 months)) and 27 ICI (male:female = 19:8, age: 1-60 months (mean 13 months)) patients diagnosed on ultrasonography were retrospectively evaluated. The findings of location, diameter, thickness of outer rim, and inclusion of mesenteric lymph nodes within intussuscipiens were compared. In the transient SBI, the head of intussusception was located in the right lower quadrant (RLQ) in 11 (50%), the right upper quadrant (RUQ) in 2 (9.1%) and the periumbilical area in 9 (40.9%) cases. The anteroposterior (AP) diameter ranged from 0.84-2.4 cm (mean 1.38 cm), and thickness of outer rim ranged from 0.10-0.34 cm (mean 0.26 cm). No mesenteric lymph nodes were contained within the intussuscipiens. In the ICI, the head was located in the RUQ in 17 (63%), the epigastrium in 7 (25.9%) and the left upper quadrant in 3 (11.1%) cases. The AP diameter ranged from 1.89-3.32 cm (mean 2.53 cm), and the thickness of the outer rim ranged from 0.30-0.86 cm (mean 0.53 cm). Mesenteric lymph nodes were contained within the intussuscipiens in 26 (96.3%) cases. In conclusion, when compared with ICI, the transient SBI occurs predominantly in the RLQ or periumbilical region, has a smaller AP diameter, a thinner outer rim, and dose not contain mesenteric lymph nodes.

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.…”

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

“…Diagnosis of most SBIs relies on ultrasound scanning, and types of intussusceptions can be readily distinguished [5,6,10]. In addition, with the development and wide application of ultrasound technology, the presence of temporary or transient small bowel intussusceptions has become clinically apparent [1,4,5,8,11].…”

“…In addition, with the development and wide application of ultrasound technology, the presence of temporary or transient small bowel intussusceptions has become clinically apparent [1,4,5,8,11]. Doi et al [8] have suggested the term benign small bowel intussusception to describe those that are found incidentally and/or resolve spontaneously.…”

“…Diagnosis of an intussusception is made by the appearance of characteristic findings on ultrasound [5,6]. Because some SBIs reduce spontaneously, it is controversial whether or not surgical treatment is necessary for all cases in pediatric patients [7,8].…”

Abdominal ultrasonography of the pediatric gastrointestinal tract

“…A recent review noted that larger intussusception diameter and the presence of lymph nodes within the intussusception favored ileocolic intussusception [28] . In one review, mean AP diameter of ileocolic intussusception was 2.53 cm compared to 1.38 cm of small bowel intussusception [29] . 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.…”