The value of ultrasound in children with suspected intussusception

Abstract

The purpose of this study was to verify the reliability of ultrasound for the diagnosis and exclusion of intussusception and to assess the usefulness of various clinical and imaging findings for determining when ultrasound should be used as a diagnostic screen. We reviewed the medical records and radiologic examinations of 151 pediatric patients referred for possible intussusception. Clinical, radiographic, and ultrasound findings were compared in children with and without intussusception and correlated with diagnosis and reducibility of intussusception. The patients were placed in risk groups on the basis of certain combinations of clinical or radiographic findings. These groups were used to test alterations of the types of radiologic studies performed if high-risk patients were to undergo enema procedure only, without preliminary ultrasound.

Intussusception was present in 49 patients (32.5%) and absent in 102 patients (67.5%). Symptoms and physical findings such as abdominal pain, vomiting, and bloody stools were common in both groups. Empty right lower quadrant and palpable mass were strongly associated with intussusception Omitting a screening ultrasound in high-risk patients decreased the number of patients who underwent both ultrasound and enema examinations, but the number of unnecessary enemas increased with all risk factors used. Palpable mass as a risk factor allowed reduction of double studies with the least increase in unnecessary enemas. Ultrasound provided supportive evidence findings in intussusception such as intussusceptum thickness greater than 10 mm or a large amount of trapped fluid indicate poor reducibility, and thinner, more echogenic outer rings with no trapped lymph nodes suggest the possibility of spontaneous resolution. Our findings support the use of ultrasound as a screening examination for children with possible intussusception in all cases, except those with high-risk factors such as a palpable abdominal mass.