Validity of plain films in intussusception

Abstract

The aim of this study was to re-evaluate the specificity of plain film findings in intussusception. The plain film findings in 80 cases of proven intussusception were reviewed. Findings documented were: (1) presence or absence of small bowel obstruction, (2) paucity of right lower quadrant gas, (3) presence of an intracolonic mass, (4) presence of a rim or target sign, and (5) presence of the classic triad of intestinal obstruction, intracolonic mass, and paucity of right lower quadrant gas. Intestinal obstruction was present in 54% of patients. In 19 patients (24%) the abdominal films were completely normal. Paucity of right lower quadrant gas was seen in 10% of patients, while specific findings of a mass or a target (rim) sign were seen in 29% of patients. The classic triad of an intracolonic mass, obstruction, and paucity of gas in the right lower quadrant occurred in only 1 patient (1%). Plain films of the abdomen were diagnostic of intussusception in only 29% of cases. A completely normal gas pattern was seen in one-quarter of our patients. This being the case, most patients with suspected intussusception will require further imaging, either by ultrasound or contrast enema. In our institution we favor the ultrasound study.

Radiographic Evaluation of Intussusception: Utility of Left-Side-Down Decubitus View

“…Although many intussusceptions are located in the transverse colon and although a mass is often visible on the supine radiograph, the movement of air into the ascending colon and cecum often outlines the intussusceptum when it is located in the proximal transverse colon or when it has not reached the transverse colon and is located within the ascending colon or cecum, thus expediting subsequent care (Fig 4). Unlike previous investigations that used KUB with upright views (3,8), our results indicate that the KUB plus leftside-down decubitus set is helpful in the diagnosis and care of patients suspected of having intussusception. Initial radiographs provide important information in patients presenting with abdominal findings and important management information in those with intussusception, such as the presence of high-grade small-bowel obstruction and the presence or absence of free air.…”

“…Hooker et al with the rate of identification reported by others (Hernandez et al [3] reported 29%; Sargent et al [8] reported 42% with the supine view and 32% with the upright view). This is also in keeping with the data in the 1975 review by Williams (11), which indicates that the abdominal series is expected to depict intussusception in one-third of the cases and to show normal or nonspecific findings in the remaining two-thirds.…”

“…In many cases, the abdominal series consists of a KUB view and an upright view, which directs air toward the upper portion of the abdomen and fluid toward the lower portion of the abdomen and the right lower quadrant. Although this view is helpful in depicting free air and air-fluid levels, it has been shown to be unhelpful as a diagnostic aid in patients with intussusception (3,8). The benefit of left lateral decubitus positioning is that air in the transverse colon is directed toward the ascending colon and cecum, thereby improving visualization of this key portion of the colon in this patient population.…”

“…Published data on the utility of radiographic diagnosis and exclusion of intussusception vary (2), with more recent literature indicating that radiographic diagnosis of intussusception is made in only 29% of cases (3). Many abdominal series include a kidney, ureter, bladder (KUB) view with an upright radiograph to assess for bowel obstruction and free intraperitoneal air (2,(4)(5)(6).…”

Large hamartomatous polyp presenting with profuse rectal bleeding in colo-colic intussuception in a child: a case report

“…Abdominal X-rays may show dilated gas-filled proximal bowel with paucity of gas distally and multiple air fluid levels but they generally have low sensitivity and specificity for the diagnosis of intussusception as a quarter of intussusception cases have a normal abdominal radiograph. [10] The well established imaging modality for the diagnosis of intussusception is an abdominal ultrasonography. It is quite sensitive, specific, reliable and inexpensive tool for diagnosing intussusception and can also help in identification of pathological lead points.…”