Intussusception in childhood: role of sonography on diagnosis and treatment

Abstract

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...

The Correlation Between Pediatric Intussusceptions and Celiac Disease

“…1 HSP is an autoimmune disease that is the most common form of vasculitis in children. 1 Affecting 8 to 20 children per 100,000 annually, HSP has symptoms involving the skin, joints, intestines and kidneys. 5 The inflammation formed within vessel walls has the ability to create focal lead points for intussusceptions and further complicate HSP.…”

“…These unique small bowel obstructions often measure less than 3 cm anterior to posterior (AP) in the transverse plane, displaying the layers of bowel wall telescoped within each other. 1 The sonographic appearance of intussusception is described as a target or pseudo-kidney sign, causing the obstruction to stand out from the adjacent normal bowel. The sonolucent outer ring represents the edematous enfolded loop of the intussusceptum, with the echogenic central area representing the compressed mucosa.…”

“…Although the cause is nonspecific, most intussusceptions are associated with an antecedent upper respiratory tract infection or inflammation of lymphoid tissue near the ileocolic region. 1 While 90% of intussusception cases involve the ileum folding into the cecum at the ileocecal valve, it is also possible to have an ileoileal obstruction or an intussusception located exclusively within the colon. 1 Each type often presents in a similar clinical manifestation, including failure to thrive, abdominal distention, gastrointestinal bleeding, diarrhea, or nonspecific abdominal pain.…”

Intussusception of the bowel in a child malrotation

“…Главным недостатком данного метода является лучевая нагрузка на молодой растущий организм ребенка и медицинский персонал, принимающий участие в лечении пациента. В последнее время распространение получает консервативная дезинвагинация под ультразвуковым контролем [8,9,10]. Достоинства данного метода лечения заключаются в большей безопасности расправления инвагинации с использованием жидкости, нежели воздуха.…”

Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine

“…8,9 While most US modalities in the pediatric arena are the same as in adult patients (the EFAST exam for trauma, procedural guidance), other modalities are unique to the pediatric population such as in suspected pyloric stenosis and intussusception, or in the child with hip pain or a limp). [10][11][12] Mostly recently, EUS has been formally incorporated into Pediatric EM fellowship training. [13][14] Critical Care.…”