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Ileoileocolic intussusception in children: diagnosis and significance
1Department of Diagnostic Radiology, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Insights
Pediatric ileoileocolic intussusception is challenging to diagnose but ultrasonography can identify it. Unlike ileocolic intussusception, ileoileocolic cases often require surgery due to low hydrostatic reduction success rates.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gastroenterology
Background:
- Ileoileocolic intussusception in children presents diagnostic challenges and is linked to higher morbidity.
- Pre-operative diagnosis is often difficult, necessitating improved imaging techniques.
Purpose of the Study:
- To describe the clinical and imaging features of ileoileocolic intussusception diagnosed via ultrasonography.
- To compare these features with ileocolic intussusception and evaluate the success of ultrasound-guided hydrostatic reduction.
Main Methods:
- Retrospective analysis of 10 ileoileocolic intussusception cases diagnosed by ultrasound over 36 months.
- Ultrasound-guided hydrostatic reduction was attempted in all cases.
- Comparison with 28 ileocolic intussusception cases treated similarly.
Main Results:
- Clinical and plain radiographic features were similar between ileoileocolic and ileocolic types.
- Ultrasound revealed classical signs (doughnut/pseudokidney) in both types.
- A unique complex appearance of frond-like loops was observed in all ileoileocolic cases during reduction.
- Hydrostatic reduction success rate was significantly lower for ileoileocolic (10%) compared to ileocolic (92.9%) intussusception.
- Surgery was required for all failed reductions; a Meckel's diverticulum was the only lead point identified.
Conclusions:
- Pre-operative diagnosis of ileoileocolic intussusception is feasible using ultrasonography.
- Ileoileocolic intussusception typically requires surgical intervention due to low success rates with non-operative management.
- Early identification of specific ultrasound features can guide surgical planning.
Abstract:
The ileoileocolic type of childhood intussusception is difficult to diagnose pre-operatively and is associated with increased morbidity. This study describes the clinical and imaging features of 10 consecutive ileoileocolic intussusceptions diagnosed ultrasonically in 10 patients over a 36 month period. Ultrasound-guided hydrostatic reduction using Hartmann's solution was attempted in all 10 patients. Clinical and imaging features were compared with those of 28 ileocolic intussusceptions in 25 patients diagnosed and treated using the same methods during the same period. Most of the clinical and plain radiographic features of the patients with the ileoileocolic and ileocolic types of intussusception were similar. The two types of intussusception had the classical doughnut or pseudokidney, or both, signs on pre-reduction ultrasound scans. During the reduction process, when surrounded by fluid within the caecal lumen, the ileoileocolic type of intussusception had a typical complex appearance due to frond-like loops of intussuscepted small bowel. This finding was present in all cases. The hydrostatic reduction rate was only 10% (1/10) for ileoileocolic intussusception, compared with 92.9% (26/28) for the ileocolic type. All unsuccessfully-reduced cases underwent surgery, with surgical confirmation of the intussusception type in all cases. Only one patient was found to have a lead point, caused by a Meckel's diverticulum. In conclusion, the diagnosis of ileoileocolic intussusception can be made pre-operatively and these patients require surgical management.