Transient versus surgically managed small bowel intussusception in children: Role of ultrasound

Abstract

Background:To evaluate and compare the ultrasound (US) features of transient small bowel intussusception (SBI) with those which required surgical management.Materials and Methods:US features of 26 children with 32 intussusceptions from January 2014 to August 2014 were recorded and compared with follow-up imaging or surgical findings.Results:Transient SBI when compared to surgically managed intussusception has shorter length of intussusception (mean 2.25 cm, range 1.8-4.5 cm vs. mean 5.6 cm, range, 2.3-7.8 cm), smaller transverse diameter (mean, 1.2 cm, range 0.8-2.3 cm vs. mean, 3.3 cm, range 2.9-5.4 cm) and thin wall (mean, 3.3 mm, 2.3-4.9 mm vs. mean, 6.8 mm, range, 4.3-11.2 mm). Four out of five surgically managed intussusceptions were associated with the lead point while none of the transient SBI had any lead point. Peristalsis was absent in all surgically managed intussusceptions.Conclusion:Transient SBI is associated with a shorter length of intussusception, smaller transverse diameter, thin walls, absence of the lead point and visible peristalsis. All these findings may help in distinguishing it from those requiring surgical management.

Preoperative sonographic diagnosis of McSwain type V appendiceal intussusception

“…Firstly, ultrasonography is a simple, convenient, repeatable and the most commonly used examination method for intussusception investigation with high sensitivity, and specificity. [ 19 ] Secondly, there is no risk of exposure to ionizing radiation and allergy to contrast material compared with computed tomography. Moreover, it is a noninvasive method and needs no special preparation compared with colonoscopy.…”

Transient intussusception – What the sonographer needs to know

“…These include normal appearance of the bowel wall, normal wall thickness (<4 mm), short intussusception length (<3.5 cm), small intussusception diameter (<2.5 cm), normal blood flow characteristics on colour Doppler, lack of pain (in asymptomatic transient intussusception only), absence of a PLP, non-dilated proximal bowel, normal peristalsis, absence of ascites, progressive resolution of intussusception under real-time visualisation or on follow-up imaging, and benign clinical course with complete resolution of symptoms. 14,[21][22][23] However, like all intussusceptions, transient intussusceptions can also be caused by PLPs (Figure 7), the presence of adhesions or even the presence of intraluminal devices (Figure 8). To assist clinicians in managing patients with intussusception, sonographers should provide a detailed clinical ultrasound report containing as much detail as possible, including the location of intussusception, bowel segment involved, total diameter and length of intussusception, bowel wall thickness, associated oedema, signs of ischaemia, the presence of a lead point, the presence of free fluid, symptomatology under direct sonopalpation and the degree of diagnostic confidence based on the expertise of the sonographer and the radiologist.…”

“…24 It is important to note that only complete resolution of the intussusception and associated clinical signs can ultimately distinguish transient from persistent intussusception. 8,14 Transient symptomatic intussusception (TSI) Numerous authors have reported the spontaneous resolution of intussusception in children 5,9,14,[21][22][23] and adults. 8,10,12,13,[25][26][27][28][29][30] In some patients, resolution of symptoms may occur before any management decisions are made.…”

“…5,11,12,14 In particular, uncomplicated, enteroenteric TAIs in otherwise healthy children are thought to represent a benign physiologic entity. 9,22 In adults, the presence of TAI should prompt a careful review of patient's history and a search for a PLP. In the absence of a PLP, the event can be considered idiopathic and physiologic (Figure 2).…”

“…The combination of several features may assist in distinguishing transient from persistent intussusception. These include normal appearance of the bowel wall, normal wall thickness (<4 mm), short intussusception length (<3.5 cm), small intussusception diameter (<2.5 cm), normal blood flow characteristics on colour Doppler, lack of pain (in asymptomatic transient intussusception only), absence of a PLP, non‐dilated proximal bowel, normal peristalsis, absence of ascites, progressive resolution of intussusception under real‐time visualisation or on follow‐up imaging, and benign clinical course with complete resolution of symptoms 14,21–23 . However, like all intussusceptions, transient intussusceptions can also be caused by PLPs (Figure 7), the presence of adhesions or even the presence of intraluminal devices (Figure 8).…”