Sonography of pediatric small-bowel intussusception: differentiating surgical from nonsurgical cases.
OBJECTIVE
The purpose of this study was to determine whether there are clinical or sonographic findings that can be used to differentiate benign self-limited small-bowel intussusception from pathologic small-bowel intussusception that necessitates surgical intervention.


METHODS
A retrospective search was performed of abdominal sonograms obtained at two institutions between January 1996 and June 2005. Sonographic findings were correlated with medical and surgical records.


RESULTS
A total of 35 cases of isolated small-bowel intussusception were found. Thirteen (37%) of these cases necessitated surgical intervention, and 22 (63%) of the cases were benign and self-limiting. Patients with self-limiting intussusception were younger than patients with intussusception necessitating surgical intervention (mean, 4.2 vs 7.5 years; p = 0.0327). Abdominal sonograms depicted ascites and small-bowel obstruction significantly more frequently in patients with small-bowel intussusception necessitating surgery (n = 7 [54%] for each finding) than in patients with self-limiting intussusception (n = 2 [9%], n = 0) (p = 0.006 and p = 0.0003, respectively). At sonography, patients who later underwent surgical intervention had small-bowel intussusception of significantly greater length (mean, 7.3 cm) than those treated conservatively (mean length, 1.9 cm) (p < 0.0001). Intussusception length greater than 3.5 cm was considered a sensitive and specific independent predictor of the need for surgery (sensitivity, 93%; specificity, 100%).


CONCLUSIONS
When small-bowel intussusception is detected in infants and children undergoing abdominal sonography, intussusception length greater than 3.5 cm is a strong independent predictor of the need for surgical intervention.
Munden
Martha M
MM
Edward B. Singleton Diagnostic Imaging Services, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030-2399, USA.
Bruzzi
John F
JF
Coley
Brian D
BD
Munden
Reginald F
RF
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D007443:Intussusception / Q000000981:diagnostic imaging*; D008297:Male; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*