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

Abstract

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.

Expression of p38 mitogen‐activated protein kinase (p38MAPK) and pathological change in intussusception

“…Such cases were more likely to require surgery. 9,18,19 There is no animal model, however, that can provide sufficient evidence of the pathological progress of intussusception. In the present study, the model was established by setting the terminal ileum into the colon.…”

“…Over time, venous congestion and arterial blood supply may be compromised. 8,9 There may be intestinal ischemia, sepsis, acidosis, or peritonitis/perforation. 10 Some reports have focused on the etiology of intussusception and established an animal model by injection of lipopolysaccharide (LPS) into the peritoneum.…”

Limited Utility of Plain Abdominal Radiographs in Evaluating Intussusceptions Secondary to Long Indwelling Feeding Tubes

“…This is in contrast to reports in pediatrics that claim plain radiography as a viable modality for evaluation of intussusceptions, especially in the setting of ischemia. [910]…”

Unicystic Ameloblastoma Masquerading as Huge Periapical Lesion, both Clinically and Histopathologically: Two Case Reports with Review of Literature

“…This is in contrast to reports in pediatrics that claim plain radiography as a viable modality for evaluation of intussusceptions, especially in the setting of ischemia. [910]…”