Sonographic Features of Small‐bowel Intussusception in Pediatric Patients

Abstract

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.

Pneumatic reduction in the treatment of childhood intussusception cases

“…Negatif prediktif değeri %100 olarak bildirilmiştir. İç içe girmiş barsak segmentlerinin, lamelli ekojen yapılar şeklide yansıması ile oluşan hedef tahtası bulgusu (target sign), konsantrik halka ve sandviç bulguları tanıyı düşündüren görüntülerdir (10,11). Ayakta direkt karın grafisi de sık istenmesine rağmen ancak ayırıcı tanıda yardımcı olabilir.…”

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].…”

“…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].…”

Intussusception : Pain Abdomen in Paediatrics Revisited

“…The target sign is described to be twice as frequent as that of the crescent sign. On ultrasound, intussusception appears as a complex mass with alternating high and low reflectivity rings surrounding a highly reflective centre [4]. The layer of bowel appearing as ring on axial sections varies with oedema and in severe cases only two layers are apparent described by some authors as 'doughnut sign".…”