Validity of plain films in intussusception

Gastrointestinal Emergency in Neonates and Infants: A Pictorial Essay

Gastrointestinal (GI) emergencies in neonates and infants encompass from the beginning to the end of the GI tract. Both congenital and acquired conditions can cause various GI emergencies in neonates and infants. Given the overlapping or nonspecific clinical findings of many different neonatal and infantile GI emergencies and the unique characteristics of this age group, appropriate imaging is key to accurate and timely diagnosis while avoiding unnecessary radiation hazard and medical costs. In this paper, we discuss the radiological findings of essential neonatal and infantile GI emergencies, including esophageal atresia and tracheoesophageal fistula, hypertrophic pyloric stenosis, duodenal atresia, malrotation, midgut volvulus for upper GI emergencies, and jejunoileal atresia, meconium ileus, meconium plug syndrome, meconium peritonitis, Hirschsprung disease, anorectal malformation, necrotizing enterocolitis, and intussusception for lower GI emergencies.

Suspecting Intussusception and Recurrence Risk Stratification Using Clinical Data and Plain Abdominal Radiographs

PURPOSE

Although ultrasonography is the gold standard of diagnosing intussusception, plain abdomen radiograph (AXR) is often used to make differential diagnosis for pediatric patients with abdominal pain. In intussusception patients, we aimed to analyze the AXR and clinical data to determine the characteristics of early AXR findings associated with diagnosis of intussusception and recurrence after reduction.

METHODS

Between January 2011 and June 2018, 446 patients diagnosed with intussusception based on International Classification of Diseases-10 code of K56.1 were admitted. We retrospectively reviewed medical records of 398 patients who received air reduction; 51 of them have recurred after initial reduction. We evaluated six AXR features including absent ascending colon gas, absent transverse colon gas, target sign, meniscus sign, mass, and ileus. Clinical data and AXR features were compared between single episode and recurrence groups.

RESULTS

Two groups did not show significant differences regarding clinical data. Mean time to recurrence from air reduction was 3.4±3.2 days. Absent ascending colon gas (63.9%) was the most common feature in intussusception, followed by mass (29.1%). All of six AXR features were observed more frequently in the recurrence group. Absent transverse colon gas was the most closely associated AXR finding for recurrence (odds ratio, 2.964; 95% confidence interval, 1.327-6.618; p=0.008).

CONCLUSION

In our study, absence of ascending colon gas was the most frequently seen AXR factor in intussusception patients. Extended and careful observation after reduction may be beneficial if such finding on AXR is found in intussusception patients.

The role of plain radiography in assessing intussusception with vascular compromise in children

INTRODUCTION

The diagnostic value of colour Doppler sonography for the detection of blood flow in intussusception is questionable. The purpose of this study was to evaluate plain radiography in the assessment of vascular compromise in children with intussusception.

MATERIAL AND METHODS

The hospital notes of 1,119 paediatric cases of intussusception who presented between January 2007 and February 2008 were retrospectively analysed. Informed consent was given by the parents before the air enema and this study was approved by the hospital ethics committee. Overall, the plain abdominal X-rays of 190 cases were assessed independently by two experienced radiologists, and disagreements were settled by discussion. Symptom profiles, operative notes and pathological records were compared to plain radiography. SAS V8.1 was used for the analysis.

RESULTS

Of the 190 patients, 30 cases had vascular compromise on plain films, as shown by the "coffee-bean" sign or "banana" sign. There was a paucity of gas in 36 cases, a quadrant-specific gas pattern in 51 cases, and the film showed a mass in 73 cases. Statistical analysis that compared signs on plain radiography signs and symptom onset showed a significant difference. Ninety-five cases were irreducible by air enema and required surgical intervention. The location of these intussusceptions were ileo-ileal-colic (n = 44), ileo-colic (n = 25), ileo-ileal (n = 14), ileo-caecal (n = 10), and ileo-colic-colic (n = 2). Eleven cases had intestinal necrosis and underwent resection of the necrotic bowel.

CONCLUSIONS

The signs of intussusception on plain radiography were significant during the clinical assessment of children with secondary ischaemic bowel. The radiological findings were shown to have a high concordance with pathology in the assessment of intussusception.The diagnostic value of colour Doppler sonography for the detection of blood flow in intussusception is questionable. The purpose of this study was to evaluate plain radiography in the assessment of vascular compromise in children with intussusception.

Radiographic evaluation of intussusception: utility of left-side-down decubitus view

PURPOSE

To assess the incremental value of the left-side-down decubitus view in radiographic evaluation of ileocolic intussusception.

MATERIALS AND METHODS

The institutional review board approved this retrospective investigation with waiver of informed consent. Between February 24, 2002, and January 25, 2007, 304 studies (300 patients; mean age, 1.3 years; range, 0.1-3.9 years) met the following inclusion criteria: kidney ureter bladder (KUB) and decubitus views obtained, with subsequent proof of diagnosis. Using a consensus approach, two pediatric radiologists evaluated KUB and decubitus views for four variables: (a) discrete mass and (b) small-bowel obstruction (positive criteria); (c) air or stool in ascending colon and (d) cecal air or stool (negative criteria). On the basis of these criteria, each study was graded as negative, positive, or indeterminate for intussusception. Diagnostically determinate studies and the ability to visualize or exclude intussusception were calculated to determine sensitivity and specificity. The difference between proportions was calculated, along with 95% confidence intervals. Agreement between the supine KUB view and supine KUB plus left-side-down decubitus views was tested with the McNemar test.

RESULTS

Intussusception was present in 58 of 304 studies (19%). Adding the decubitus view to the KUB view increased the number of determinate studies from 110 of 304 (36.2%) to 205 of 304 (67.4%) (difference, 31.2 percentage points; P < .001). Intussusception was correctly identified with KUB view alone in 35 of 58 studies (60.3%); this value increased to 43 of 58 (74.1%) with KUB plus decubitus views (P = .0215). Intussusception was correctly excluded with the KUB view alone in 63 of 246 studies (25.6%); this increased to 143 of 246 studies (58.1%) with addition of the decubitus view (P < .0001).

CONCLUSION

The addition of decubitus views increased the number of diagnostically determinate studies and increased the ability to diagnose or exclude intussusception. The authors believe that a left-side-down decubitus view should be included in the initial evaluation of patients suspected of having intussusception, particularly when the supine view is diagnostically indeterminate.