Pediatric small bowel intussusception disease: feasibility of screening for surgery with early computed tomographic evaluation.
BACKGROUND
This study investigated the feasibility of early computed tomographic (CT) evaluation and the operative results of pediatric small bowel intussusception with deteriorating ischemic or obstructive symptoms, so-called small bowel intussusception disease (SBID).


METHODS
Between 1988 and 1999, among 18 patients surgically proven SBID (conventional group), 12 mimicked ileocolic intussusception and were conventionally managed with abdominal radiography, ultrasonography, reduction enema, and eventually operation. Between 2000 and 2008, we applied a modified approach with inclusion of early CT evaluation if ultrasonography showed a target lesion suspicious for SBID (diameter </=3.0 cm and/or atypically located in the paraumbilical or left abdomen). Among 15 surgically proven SBID patients (early CT group), 13 underwent early operation after CT confirmation. The clinical, imaging, and operative findings were compared between the 2 groups.


RESULTS
There were no significant differences between the 2 groups in age, gender, clinical presentations, leukocyte count, ultrasonographic features, locations of SBID, or the presence of lead points. Most patients presented with vomiting, abdominal pain, or irritable crying. In comparison with the conventional group, early CT group patients had a significantly shorter duration between admission and surgery (31.44 +/- 30.39 vs 7.47 +/- 5.95 hours; P < .01) and a lower rate of bowel complications (44.4% vs 6.7%; P = .02).


CONCLUSIONS
Pediatric SBID may present with nonspecific symptoms and may mimic ileocolic intussusception leading to delayed operative intervention. Early CT evaluation of patients with suspicious SBID ultrasonographic features is effective in avoiding futile reduction enema and significantly reducing the waiting time for operative management and the resultant incidence of bowel complications.
Ko
Sheung-Fat
SF
Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan. sfatko@adm.cgmh.org.tw
Tiao
Mao-Meng
MM
Hsieh
Chie-Song
CS
Huang
Fu-Chen
FC
Huang
Chung-Cheng
CC
Ng
Shu-Hang
SH
Lee
Shin-Yee
SY
Chen
Min-Chi
MC
D015746:Abdominal Pain / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D007410:Intestinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000601:surgery*; D007443:Intussusception / Q000000981:diagnostic imaging / Q000601:surgery*; D008403:Mass Screening; D010580:Peutz-Jeghers Syndrome / Q000000981:diagnostic imaging / Q000601:surgery; D012640:Seizures / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014839:Vomiting / Q000209:etiology