Failed Intussusception Reduction in Children: Correlation Between Radiologic, Surgical, and Pathologic Findings

Area of Science:

• Pediatric Surgery
• Radiology
• Gastroenterology

Background:

• Intussusception is a common surgical emergency in children.
• Enema reduction is the primary treatment, but irreducible cases require surgery.
• Identifying predictors of failed reduction is crucial for surgical planning.

Purpose of the Study:

• To determine causes of irreducible intussusception after contrast enema.
• To correlate imaging findings with surgical and histopathologic results.
• To evaluate the efficacy of different surgical approaches.

Main Methods:

• Retrospective analysis of 72 children with irreducible intussusception treated surgically (2005-2013).
• Review of medical records, including cause, ultrasound findings, operative management, and outcomes.
• Comparison of imaging findings with age-matched controls.

Main Results:

• Ultrasound detected most intussusceptions but missed lead points in 3/57 cases.
• Distal mass and dissecting sign were positive predictors of failed enema reduction.
• Pathologic lead points were found in 25% of cases, including lymphoid hyperplasia, Meckel diverticulum, and Burkitt lymphoma.

Conclusions:

• Distal intussusception location and the dissecting sign predict failed enema reduction.
• Screening ultrasound reduces unnecessary enemas, but some lead points are challenging to diagnose.
• Laparoscopy and laparotomy are safe, with shorter hospital stays after laparoscopy.