The appendix sign: a radiographic marker for irreducible intussusception

Area of Science:

• Pediatric Radiology
• Gastrointestinal Imaging
• Surgical Intervention

Background:

• Radiographic reduction is the standard for pediatric intussusception, with over 80% success.
• Identifying patients likely to fail nonoperative management can optimize treatment and reduce complications.

Purpose of the Study:

• To introduce and evaluate the 'appendix sign' as a novel radiographic predictor of failed nonoperative reduction in intussusception.
• To assess the association between the appendix sign and failure of enema reduction.

Main Methods:

• Retrospective review of 91 pediatric intussusception cases over 12 years.
• Analysis of radiographic findings, specifically the visualization of the appendix before small bowel contrast reflux.

Main Results:

• The appendix sign was observed in 18% of reviewed studies (14/91).
• Of these 14 cases, 71% failed enema reduction (10/14).
• The appendix sign demonstrated 43% sensitivity and 93% specificity for predicting failure.

Conclusions:

• The appendix sign is associated with a higher likelihood of failed enema reduction in pediatric intussusception.
• This sign may serve as a valuable marker to guide decisions regarding further reduction attempts and surgical intervention.