Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

US Features of Transient Small Bowel Intussusception in Pediatric Patients

Kim, Ji-Hye

  • Published : 20040700
⟨ Previous Next ⟩

Abstract

Objective: To describe the sonographic (US) and clinical features of spontaneously reduced small bowel intussusception, and to discuss the management options for small bowel intussusception based on US findings with clinical correlation. Materials and Methods: During a five years of period, 34 small bowel intussusceptions were diagnosed on US in 32 infants and children. The clinical presentations and imaging findings of the patients were reviewed. Results: The clinical presentations included abdominal pain or irritability (n = 25), vomiting (n = 5), diarrhea (n = 3), bloody stool (n = 1), and abdominal distension (n = 1), in combination or alone. US showed multi-layered round masses of small (mean, 1.5$\pm$0.3 cm) diameters and with thin (mean, 3.5$\pm$1 mm) outer rims along the course of the small bowel. The mean length was 1.8$\pm$0.5 cm and peristalsis was seen on the video records. There were no visible lead points. The vascular flow signal appeared on color Doppler images in all 21 patients examined. Spontaneous reduction was confirmed by combinations of US (n = 28), small bowel series (n = 6), CT scan (n = 3), and surgical exploration (n = 2). All patients discharged with improved condition. Conclusion: Typical US findings of the transient small bowel intussusception included 1) small size without wall swelling, 2) short segment, 3) preserved wall motion, and 4) absence of the lead point. Conservative management with US monitoring rather than an immediate operation is recommended for those patient with typical transient small bowel intussusceptions. Atypical US findings or clinical deterioration of the patient with persistent intussusception warrant surgical exploration.

Keywords

References

  1. del-Pozo G,Albillos JC,Tejedor D,et al. Intussusception in children: current concepts in diagnosis and enema reduction. RadioGraphics 1999;19:299–319.
  2. Stone DN,Kangarloo H,Graviss ER,Danis RK,Silberstein MJ. Jejunal intussusception in children. Pediatr Radiol 1980;9:65–68.
  3. Hughes UM,Connolly BL,Chait PG,Muraca S. Further report of small-bowel intussusceptions related to gastrojejunostomy tubes. Pediatr Radiol 2000;30:614–617.
  4. Jequier S,Argyropoulou M,Bugmann P. Ultrasonography of jejunal intussusception in children. Can Assoc Radiol J 1995;46:285–290.
  5. Carnevale E,Graziani M,Fasanelli S. Post-operative ileo-ileal intussusception: sonographic approach. Pediatr Radiol 1994;24:161–163.
  6. Shanbhogue RL,Hussain SM,Meradji M,Robben SG,Vernooij JE,Molenaar JC. Ultrasonography is accurate enough for the diagnosis of intussusception. J Pediatr Surg 1994;29:324–327.
  7. Ko SF,Lee TY,Ng SH,et al. Small bowel intussusception in symptomatic pediatric patients: experiences with 19 surgically proven cases. World J Surg 2002;26:438–443. Epub 2002 Jan 21
  8. Tiao MM,Wan YL,Ng SH,et al. Sonographic features of small-bowel intussusception in pediatric patients. Acad Emerg Med 2001;8:368–373.
  9. Kornecki A,Daneman A,Navarro O,Connolly B,Manson D,Alton DJ. Spontaneous reduction of intussusception: clinical spectrum, management and outcome. Pediatr Radiol 2000;30:58–63.
  10. Strouse PJ,DiPietro MA,Saez F. Transient small-bowel intussusception in children on CT. Pediatr Radiol 2003;33:316–320. Epub 2003 Feb 26
  11. Doi O,Aoyama K,Hutson JM. Twenty-one cases of small bowel intussusception: the pathophysiology of idiopathic intussusception and the concept of benign small bowel intussusception. Pediatr Surg Int. 2004 Feb 10; (Epub ahead of print)
  12. Lvoff N,Breiman RS,Coakley FV,Lu Y,Warren RS. Distinguishing features of self-limiting adult small-bowel intussusception identified at CT. Radiology 2003;227:68–72.
  13. Britton I,Wilkinson AG. Ultrasound features of intussusception predicting outcome of air enema. Pediatr Radiol 1999;29:705–710.
  14. Lim HK,Bae SH,Lee KH,Seo GS,Yoon GS. Assessment of reducibility of ileocolic intussusception in children: usefulness of color Doppler sonography. Radiology 1994;191:781–785.
  15. Lagalla R,Caruso G,Novara V,Derchi LE,Cardinale AE. Color Doppler ultrasonography in pediatric intussusception. J Ultrasound Med 1994;13:171–174.
  16. Luckey P,Kemper J,Engelbrecht V,Modder U. Idiopathic ileoileal intussusception in an adult with spontaneous reduction during enteroclysis: a case report. Abdom Imaging 2000;25:48–50.
  17. Hanquinet S,Anooshiravani M,Vunda A,Le Coultre C,Bugmann P. Reliability of color Doppler and power Doppler sonography in the evaluation of intussuscepted bowel viability. Pediatr Surg Int 1998;13:360–362.
  18. Swischuk LE,John SD,Swischuk PN. Spontaneous reduction of intussusception: verification with US. Radiology 1994;192:269–271.
  19. Mapagu C,Lam A,Martin HC,Fitzgerald DA. Intermittent intussusception. J Paediatr Child Health 2003;39:147–148.
  20. Sonmez K,Turkyilmaz Z,Demirogullari B,et al. Conservative treatment for small intestinal intussusception associated with Henoch-Schonlein's purpura. Surg Today 2002;32:1031–1034.

Cited by

  1. Transient small bowel intussusceptions: ultrasound findings and clinical significance vol.31, pp.4, 2006, https://doi.org/10.1007/s00261-006-9078-z
  2. Ileoileal intussusception in children: ultrasonographic differentiation from ileocolic intussusception vol.36, pp.11, 2004, https://doi.org/10.1007/s00247-006-0311-2
  3. Ultrasonographic findings of small bowel intussusception, focusing on differentiation from ileocolic intussusception vol.80, pp.958, 2007, https://doi.org/10.1259/bjr/61246651
  4. 소아에서의 일과성 소장형 장중첩증의 임상적 고찰 vol.51, pp.5, 2004, https://doi.org/10.3345/kjp.2008.51.5.500
  5. Adult intestinal intussusception: can abdominal MDCT distinguish an intussusception caused by a lead point? vol.33, pp.5, 2004, https://doi.org/10.1007/s00261-007-9328-8
  6. Pediatric small bowel intussusception disease: Feasibility of screening for surgery with early computed tomographic evaluation vol.147, pp.4, 2004, https://doi.org/10.1016/j.surg.2009.10.031
  7. 소아에서 소장형 장중첩증; 자연 정복과 수술적 치료의 비교 vol.13, pp.2, 2004, https://doi.org/10.5223/kjpgn.2010.13.2.128
  8. Sonographic findings predictive of the need for surgical management in pediatric patients with small bowel intussusceptions vol.396, pp.7, 2004, https://doi.org/10.1007/s00423-011-0742-6
  9. Conservative management of small intestinal intussusception and cholelithiasis in a child with celiac disease vol.8, pp.4, 2011, https://doi.org/10.1016/s0976-0016(11)60016-1
  10. A 7-Year-Old Hispanic Boy with Acute Onset of Abdominal Pain vol.42, pp.12, 2013, https://doi.org/10.3928/00904481-20131122-06
  11. Case report: transient small bowel intussusception presenting as right lower quadrant pain in a 6-year-old male vol.6, pp.1, 2014, https://doi.org/10.1186/2036-7902-6-7
  12. Intussusception in childhood: role of sonography on diagnosis and treatment vol.18, pp.3, 2004, https://doi.org/10.1007/s40477-014-0110-9
  13. Circular Right Upper Quadrant Mass, Not Intussusception vol.31, pp.5, 2015, https://doi.org/10.1097/pec.0000000000000430
  14. Diagnostic Dilemma in the Treatment of a Fatal Case of Bloody Diarrhea vol.4, pp.1, 2016, https://doi.org/10.1177/2324709616638698
  15. Can intussusceptions of small bowel and colon be transient? A prospective study vol.178, pp.10, 2004, https://doi.org/10.1007/s00431-019-03455-z
  16. Intussusception in Neonates: Clinical Characteristics of Eight Cases in a Single Center vol.28, pp.1, 2004, https://doi.org/10.5385/nm.2021.28.1.29
  17. The radiological characteristics of childhood intussusception including unusual features and rare pathological lead points vol.7, pp.6, 2004, https://doi.org/10.1016/j.heliyon.2021.e07231
  18. Evaluation of spontaneous reduction among the invagination cases admitted to the paediatric emergency department; retrospective study vol.75, pp.8, 2004, https://doi.org/10.1111/ijcp.14322
  19. Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception: A Multicenter, Noninferiority Study of Paired Diagnostic Tests vol.78, pp.5, 2021, https://doi.org/10.1016/j.annemergmed.2021.04.033