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The role of plain radiography in assessing intussusception with vascular compromise in children
Wan-Liang Guo1, Jian Wang, Min Zhou
1Children's Hospital of Soochow University, China.
Insights
Plain radiography effectively identifies vascular compromise in pediatric intussusception, showing significant concordance with pathology. This imaging method aids in assessing bowel viability in children with intussusception.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Imaging
- Surgical Pathology
Background:
- The diagnostic accuracy of color Doppler sonography for blood flow in intussusception remains uncertain.
- Plain radiography's role in assessing vascular compromise in pediatric intussusception requires further evaluation.
Purpose of the Study:
- To evaluate the utility of plain radiography in assessing vascular compromise in pediatric intussusception cases.
- To compare radiological findings with clinical and pathological outcomes.
Main Methods:
- Retrospective analysis of 1,119 pediatric intussusception cases.
- Independent assessment of plain abdominal X-rays from 190 patients by two radiologists.
- Comparison of radiographic signs with symptom profiles, operative notes, and pathology records.
Main Results:
- Plain radiography identified vascular compromise in 30 of 190 patients using specific signs ('coffee-bean' or 'banana' sign).
- Radiographic findings showed significant differences when compared to symptom onset.
- 95 cases required surgery, with 11 cases demonstrating intestinal necrosis.
Conclusions:
- Radiographic signs of intussusception are significant for clinical assessment of ischemic bowel in children.
- Radiological findings demonstrated high concordance with pathological findings in intussusception assessment.
Introduction:
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 Methods:
The 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.
Results:
Of 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.
Conclusions:
The 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.
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