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Published on: July 21, 2023
Current diagnosis and image-guided reduction for intussusception in children
Jisun Hwang1, Hee Mang Yoon2, Pyeong Hwa Kim2
1Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
Insights
Early diagnosis and nonoperative enema reduction are crucial for intussusception management in children. Ultrasonography is key for diagnosis, with enema reduction achieving an 82% success rate in appropriate cases.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Interventional Procedures
Background:
- Intussusception, the telescoping of one bowel segment into another, commonly affects the ileocolic region.
- Delayed diagnosis of intussusception can result in severe complications, including intestinal ischemia, infarction, and mortality.
- Prompt diagnosis and management are essential for favorable outcomes in pediatric intussusception.
Purpose of the Study:
- To review current concepts in the diagnosis and nonsurgical management of childhood intussusception.
- To highlight success rates, predictors of failure, complications, and recurrence of enema reduction.
- To provide guidance for pediatricians in managing intussusception.
Main Methods:
- Review of diagnostic modalities, emphasizing the role of abdominal radiography and ultrasonography.
- Discussion of nonoperative enema reduction techniques, including image guidance and reduction mediums.
- Analysis of factors influencing the success of enema reduction and potential complications.
Main Results:
- Ultrasonography is the preferred diagnostic tool for intussusception.
- Nonoperative enema reduction is a safe and effective primary treatment, with an overall success rate of 82%.
- Predictors of failed enema reduction include longer symptom duration, younger age, lethargy, fever, bloody diarrhea, and specific radiologic findings.
Conclusions:
- Early diagnosis via ultrasonography and prompt nonoperative enema reduction are vital for managing childhood intussusception.
- Understanding predictors of failed reduction and potential complications aids in clinical decision-making.
- This review offers a comprehensive guide for pediatricians on intussusception management, including recurrence and complications.
Abstract:
Intussusception involves an invagination of the proximal bowel into the distal bowel, with ileocolic intussusception being the most common type. However, a diagnostic delay can lead to intestinal ischemia, bowel infarction, or even death; therefore, its early diagnosis and management are important. The primary role of abdominal radiography is to detect pneumoperitoneum or high-grade bowel obstruction in cases of suspected intussusception, and ultrasonography is the modality of choice for its diagnosis. Nonoperative enema reduction, the treatment of choice for childhood intussusception in cases without signs of perforation or peritonitis, can be safely performed with a success rate of 82%. Enema reduction can be performed in various ways according to image guidance method (fluoroscopy or ultrasonography) and reduction medium (liquid or air). Successful enema reduction is less likely to be achieved in children with a longer symptom duration, younger age, lethargy, fever, bloody diarrhea, unfavorable radiologic findings (small bowel obstruction, trapped fluid, ascites, absence of flow in the intussusception, intussusception in the left-sided colon), and pathological lead points. This review highlights the current concepts of intussusception diagnosis, nonsurgical enema reduction, success rates, predictors of failed enema reduction, complications, and recurrence to guide general pediatricians in the management of childhood intussusception.
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