Sonographic features of small-bowel intussusception in pediatric patients.
OBJECTIVE
Small-bowel intussusception (SBI) for pediatric patients is unusual and difficult to diagnose preoperatively. This study sought to determine the sonographic findings of pediatric SBI.


METHODS
The sonographic features and surgical findings of 13 pediatric patients (7 boys, 6 girls; age range 4 months-15 years; average age 4 years and 2 months) with SBI encountered in the authors' hospital over a 12-year period were retrospectively reviewed.


RESULTS
Most of the patients presented with nonspecific symptoms, including vomiting, abdominal pain, and/or irritable crying. Sonographic screening in the emergency department revealed a doughnut or crescent-in-doughnut sign, or a multiple-concentric-rings sign for 11 of the 13 patients, and the lesions appeared short. Eight lesions were found in the paraumbilical or left abdominal regions. Sonographic measurement of the size of the lesions from these 11 patients ranged from 2 cm to 3.7 cm (average 2.77 cm). Subsequent barium enemas were performed for these 11 patients, none of which revealed colon lesions. Surgery revealed ileoileal intussusceptions for eight cases, jejunoileal for three, and jejunojejunal for the remaining two. Bowel ischemia or necrosis and pathologic lead points were demonstrated for seven and six patients, respectively, although none were recognized preoperatively.


CONCLUSIONS
Small-bowel intussusception is often over-looked due to nonspecific clinical presentations. Sonographic demonstration of a 2-3-cm sized, short, doughnut-like lesion, especially in the left abdomen or paraumbilical regions, should lead to strong suspicion of SBI.
Department of Pediatrics, Chang Gung University, Chang Gung Memorial Hospitals at Kaohsiung and Linkou, Kaohsiung, Taiwan.
M M
MM
Tiao
Y L
YL
Wan
S H
SH
Ng
S F
SF
Ko
T Y
TY
Lee
M C
MC
Chen
C S
CS
Shieh
J H
JH
Chuang
D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D007223:Infant; D007443:Intussusception / Q000000981:diagnostic imaging* / Q000601:surgery; D007579:Jejunal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods*