title: Pediatric small bowel intussusception disease: feasibility of screening for surgery with early computed tomographic evaluation.
abstract: 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.
authors.affiliation: Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan. sfatko@adm.cgmh.org.tw
authors.forename: Sheung-Fat
authors.initials: SF
authors.lastname: Ko
authors.forename: Mao-Meng
authors.initials: MM
authors.lastname: Tiao
authors.forename: Chie-Song
authors.initials: CS
authors.lastname: Hsieh
authors.forename: Fu-Chen
authors.initials: FC
authors.lastname: Huang
authors.forename: Chung-Cheng
authors.initials: CC
authors.lastname: Huang
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.forename: Shin-Yee
authors.initials: SY
authors.lastname: Lee
authors.forename: Min-Chi
authors.initials: MC
authors.lastname: Chen
mesh_terms: 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