Intramural and subserosal echogenic foci on US in large-bowel intussusceptions: prognostic indicator for reducibility?

Abstract

Background-In large bowel intussusceptions, several reports described US signs which are associated with a lower likelihood of reducibility by hydrostatic or pneumatic enema. US may demonstrate echogenic dots or lines (foci) in the bowel wall, which may indicate ischemic bowel.

Point-of-care ultrasound identification of pneumatosis intestinalis in pediatric abdominal pain: a case report

“…The presence of pneumatosis intestinalis in intussusception indicates bowel ischemia [5]. The concurrent presence of sub-serosal air significantly decreased the chances of successful reduction of intussusception [5]. In our patient, the plain film done to detect pneumatosis intestinalis was negative for intramural air but the POCUS had detected the presence of intramural air.…”

“…Ultrasound depiction of pneumatosis intestinalis in bowel wall in the form of echogenic foci or lines is a predictor of non-reducibility during air enema with a sensitivity of 47% and specificity of 96% [5]. The presence of pneumatosis intestinalis in intussusception indicates bowel ischemia [5]. The concurrent presence of sub-serosal air significantly decreased the chances of successful reduction of intussusception [5].…”

“…In our patient, the plain film done to detect pneumatosis intestinalis was negative for intramural air but the POCUS had detected the presence of intramural air. Pneumatosis intestinalis appears as echogenic dots and lines in the bowel wall and can be easily detected in the edematous, thickened bowel [5]. The detection of sub-serosal air is relatively difficult because of the presence of concurrent intraluminal air.…”

“…Abdominal conditions include necrotizing enterocolitis, ileo-colic intussusception with bowel ischemia, venous occlusion of the bowel vasculature and inflammatory bowel disease [1–4]. Non-abdominal conditions that can result in pneumatosis intestinalis include asthma, bronchopulmonary dysplasia, post-bone marrow transplantation, congenital heart disease, juvenile rheumatoid arthritis, hemolytic anemia and generalized vascular hypo-perfusion [5, 6]. …”

Air encircling the intussusceptum on air enema for intussusception reduction: an indication for surgery?

“…The small amount of air is seen as tiny echogenic dots encircling the intussusceptum head, abutting the intussuscipiens mucosa (Figures 2b, 3b). This sonographic appearance can be useful when air enema findings are unclear or equivocal and repeat sonography is performed following air enema, and can be added to the other sonographic features that have been described as associated with decreased enema reduction rates [2,23]. It has to be emphasised that this particular sonographic sign is only seen after an air enema reduction attempt.…”