Reliability of the abdominal plain film diagnosis in pediatric patients with suspected intussusception

Eklöf, O.; Hartelius, H

doi:10.1007/bf01092945

Cited by 51 publications

(10 citation statements)

References 12 publications

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“…[5], abdominal X-rays alone correctly identified approximately 45% of intussusception. Plain radiography can also serve as the initial screening procedure [6, 7], which is principally used to identify other acute abdomen emergencies [8–10]. Certain signs can be seen in cases of intussusception, which most commonly include gas-filled bowel loops in a single quadrant and a paucity of bowel gas.…”

Section: Discussionmentioning

confidence: 99%

The role of plain radiography in assessing intussusception with vascular compromise in children

Guo¹,

Wang²,

Zhou³

et al. 2011

aoms

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IntroductionIntroduction: The diagnostic value of colour Doppler sonography for the detection of blood flow in intussusception is questionable. The purpose of this study was to evaluate plain radiography in the assessment of vascular compromise in children with intussusception.Material and methodsThe hospital notes of 1,119 paediatric cases of intussusception who presented between January 2007 and February 2008 were retrospectively analysed. Informed consent was given by the parents before the air enema and this study was approved by the hospital ethics committee. Overall, the plain abdominal X-rays of 190 cases were assessed independently by two experienced radiologists, and disagreements were settled by discussion. Symptom profiles, operative notes and pathological records were compared to plain radiography. SAS V8.1 was used for the analysis.ResultsOf the 190 patients, 30 cases had vascular compromise on plain films, as shown by the “coffee-bean” sign or “banana” sign. There was a paucity of gas in 36 cases, a quadrant-specific gas pattern in 51 cases, and the film showed a mass in 73 cases. Statistical analysis that compared signs on plain radiography signs and symptom onset showed a significant difference. Ninety-five cases were irreducible by air enema and required surgical intervention. The location of these intussusceptions were ileo-ileal-colic (n = 44), ileo-colic (n = 25), ileo-ileal (n = 14), ileo-caecal (n = 10), and ileo-colic-colic (n = 2). Eleven cases had intestinal necrosis and underwent resection of the necrotic bowel.ConclusionsThe signs of intussusception on plain radiography were significant during the clinical assessment of children with secondary ischaemic bowel. The radiological findings were shown to have a high concordance with pathology in the assessment of intussusception.The diagnostic value of colour Doppler sonography for the detection of blood flow in intussusception is questionable. The purpose of this study was to evaluate plain radiography in the assessment of vascular compromise in children with intussusception.

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Section: Discussionmentioning

confidence: 99%

The role of plain radiography in assessing intussusception with vascular compromise in children

Guo¹,

Wang²,

Zhou³

et al. 2011

aoms

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“…However, the diagnostic rate of intussusception by abdominal plain radiography is only about 50%. 1,4,9,19,20 In the present study, plain radiographic results were interpreted as reflecting essentially a normal gastrointestinal system for three of our SBI cases, and only nonspecific bowel dilatation was noted for the other ten cases. Thus, no specific radiographic sign of intussusception was found throughout our patient sample.…”

Section: Discussionmentioning

confidence: 99%

Sonographic Features of Small‐bowel Intussusception in Pediatric Patients

Tiao

Wan

et al. 2001

Academic Emergency Medicine

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Objective: Small-bowel intussusception (SBI) for pediatric patients is unusual and difficult to diagnose preoperatively. This study sought to determine the sonographic findings of pediatric SBI. Methods: The sonographic features and surgical findings of 13 pediatric patients (7 boys, 6 girls; age range 4 months-15 years; average age 4 years and 2 months) with SBI encountered in the authors' hospital over a 12-year period were retrospectively reviewed. Results: Most of the patients presented with nonspecific symptoms , including vomiting, abdominal pain, and/or irritable crying. Sonographic screening in the emergency department revealed a doughnut or crescent-in-doughnut sign, or a multiple-concentric-rings sign for 11 of the 13 patients, and the lesions appeared short. Eight lesions were found in the paraumbilical or left abdominal regions. Sonographic measurement of the size of the lesions from these 11 patients ranged from 2 cm to 3.7 cm (average 2.77 cm). Subsequent barium enemas were performed for these 11 patients, none of which revealed colon lesions. Surgery revealed ileoileal intussusceptions for eight cases, jejunoileal for three, and jejunojejunal for the remaining two. Bowel ischemia or necrosis and pathologic lead points were demonstrated for seven and six patients, respectively, although none were recognized preoperatively. Conclusions: Small-bowel intussusception is often overlooked due to nonspecific clinical presentations. Sono-graphic demonstration of a 2-3-cm sized, short, doughnut-like lesion, especially in the left abdomen or paraumbilical regions, should lead to strong suspicion of SBI.

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“…In addition, the interpretation of an abdominal radiograph may vary depending on the experience of the physician reviewing the radiograph, the level of comfort with pediatric radiology, and the quality and technique of the radiograph. 2,24,26,36,39,40 In a recent prospective study of clinical predictors of intussusception, the authors identified right upper quadrant abdominal mass, rectal bleeding and the triad of intermittent abdominal pain, vomiting, and right upper quadrant abdominal mass as significantly predictive of intussusception. 13 Negative predictors were also identified, but none with sufficient accuracy to obviate evaluation with ultrasound or air or contrast enema.…”

Section: Commentmentioning

confidence: 99%

“…The utility of plain radiographs in diagnosing intussusception has been the subject of controversy, with regard to their sensitivity and specificity 2,[24][25][26][36][37][38][39][40][41] as well as to interobserver reliability. 25,26,38,40 In the present study, a highly suggestive abdominal radiograph was found to be an important independent predictor.…”

Section: Commentmentioning

confidence: 99%

Predictors of Intussusception in Young Children

Kuppermann¹,

O'Dea²,

Pinckney³

et al. 2000

Arch Pediatr Adolesc Med

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Objective: To identify predictors of intussusception in young children.Design: A retrospective cross-sectional study. Setting and Patients:A consecutive sample of children younger than 5 years on whom contrast enemas were performed because of suspected intussusception seen at an urban children's hospital from 1990 to 1995. Methods:We evaluated historical, clinical, and radiographic variables. Variables documented in 75% or more of the medical records and associated with intussusception (PՅ.20) in the univariate analysis were evaluated in a multiple logistic regression analysis. Variables retaining significance (PՅ.05) in the multivariate analysis were considered independent predictors of intussusception. We used bootstrap resampling techniques to validate the multivariate model.Results: Sixty-eight (59%) of the 115 patients had intussusception. Univariate predictors of intussusception included male sex, age younger than 2 years, history of emesis, rectal bleeding, lethargy, abdominal mass, and a highly suggestive abdominal radiograph. In the multivariate analysis, we identified only 4 independent predictors (adjusted odds ratio; 95% confidence interval): a highly suggestive abdominal radiograph (18.3; 4.0-83.1), rectal bleeding (17.3; 2.9-104.0), male sex (6.2; 1.2-32.3), and a history of emesis (13.4; 1.4-126.0). We identified 3 of these 4 variables (all but emesis) as independent predictors in more than 50% of 1000 bootstrap data samples.Conclusions: Rectal bleeding, a highly suggestive abdominal radiograph, and male sex are variables independently associated with intussusception in a cohort of children suspected of having this diagnosis. Knowledge of these variables may assist in clinical decision making regarding diagnostic and therapeutic interventions.Arch Pediatr Adolesc Med. 2000;154:250-255

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Reliability of the abdominal plain film diagnosis in pediatric patients with suspected intussusception

Cited by 51 publications

References 12 publications

The role of plain radiography in assessing intussusception with vascular compromise in children

The role of plain radiography in assessing intussusception with vascular compromise in children

Sonographic Features of Small‐bowel Intussusception in Pediatric Patients

Predictors of Intussusception in Young Children

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