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[Ultrasound in suspected intussusception]
1Ultrasound Unit, Carmel Medical Center, Haifa.
Insights
Ultrasound is a highly accurate tool for diagnosing intussusception in children, a common abdominal emergency. This imaging method offers 100% sensitivity and negative predictive value, reducing unnecessary procedures.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Abdominal Emergencies
Background:
- Intussusception is a critical pediatric abdominal emergency with low diagnostic accuracy.
- Clinical misdiagnosis leads to unnecessary barium enemas.
- Ultrasound offers a radiation-free, accessible alternative for diagnosis.
Purpose of the Study:
- To evaluate the diagnostic accuracy of ultrasound for intussusception in children.
- To assess ultrasound's ability to identify leading points and alternative diagnoses.
Main Methods:
- Prospective study of 14 children with clinically suspected intussusception from 1991-1993.
- Ultrasound examination as the primary diagnostic tool.
- Comparison with barium enema and surgical findings where applicable.
Main Results:
- Ultrasound demonstrated 100% sensitivity and 100% negative predictive value for intussusception.
- Ultrasound correctly identified a duplication cyst and misdiagnosed impacted stool.
- Ultrasound identified intussusception in 6 of 14 suspected cases, with 4 confirmed by barium enema.
Conclusions:
- Ultrasound is a reliable imaging modality for diagnosing pediatric intussusception.
- It effectively identifies leading points and can differentiate from other conditions like ovarian torsion or appendicitis.
- Ultrasound can reduce misdiagnosis and unnecessary invasive procedures.
Abstract:
Intussusception is one of the main abdominal emergencies in children. Accuracy of clinical diagnosis is poor and in only 30-40% of cases is the clinical diagnosis of intussusception confirmed. Many unnecessary barium enemas are performed due to clinical misdiagnosis. Sonography can demonstrate intussusception, is widely available, easily performed, does not produce radiation and can be used to screen suspected cases. From 1991-1993, in 6 of 14 consecutive cases of clinically suspected intussusception the ultrasound examination was positive. In 4 of them barium enema revealed intussusception, which was reduced by the barium enema procedure. A child was sent for surgery because ultrasonography showed a duplication cyst which was considered the leading point for the bowel invagination. In the last case surgery for bowel obstruction revealed impacted stool misdiagnosed by ultrasound as an intussusception mass. In all the 8 cases in which ultrasound was negative, follow-up confirmed the absence of intussusception. The sensitivity of the ultrasound examination was 100% and the negative predictive value 100%. These results are not in accord with those of other authors. We find ultrasound a reliable imaging modality for the diagnosis of intussusception. It can identify leading points as well as other causes for the clinical presentation, including ovarian torsion or appendicitis.