When occurring in the adult population, intussusception is usually caused by a focal lesion acting as a lead point. With early diagnosis, appropriate fluid resuscitation, and therapy, the mortality rate from intussusception in children is less than 1%. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Intussusception is the main source of bowel obstruction in the pediatric population and. Dec 20, 2018 intussusception see the image below is a process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction. When this condition occurs in neonates and in children older than 2 years, there is a high incidence of associated bowel abnormality that serves as an initiating.
An awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, handout notes, interactive material, most commons lists and pictorial differential diagnoses. This book elucidates on the examination technique, the sonographic changes in musculoskeletal rheumatic involvement and the ultrasound assessment of joint rheumatic diseases. General pediatric ultrasound protocols and ultrasound of the. Demonstration of the sonographic coiled spring sign in the right lower quadrant should raise the possibility of appendiceal intussusception. The commonest site is a segment of ileum moving into the colon through the ileocaecal valve. Discussion this case illustrates the classical ultrasound signs of intussusception.
Realtime ultrasound diagnosis of intussusception in children. The absence of blood flow within the intussusception may be indicative of bowel wall necrosis. This leads to obstruction of venous and lymphatic flow. Radiology performed ultrasound for intussusception has excellent test performance. Intussusception on ultrasound podcast part 1 and part 2. Bedside ultrasound diagnosis of pediatric intussusception on. This module teaches you how to prepare for and perform an ultrasound examination of the pediatric abdomen, and to assess the common pediatric pathologies. Short video describing ultrasound intussusception findings. Lets suppose that you work in a place without 24 hour ultrasound, and you get a toddler that is having intermittent episodes of belly pain.
Under guidance from a pediatric emergency medicine attending trained in pediatric ultrasound, the pediatric resident performed a bedside ultrasound for intussusception for her first time and was able to obtain images of the target sign and the hayfork sign typical of intussusception figures 1 and and2. Jun 20, 2017 although highquality evidence for the diagnosis of intussusception is lacking, the available evidence suggests that ultrasound is the treatment modality of choice for the diagnosis of intussusception. As initial imaging procedure, patients with clinical suspicion of intussusception underwent to transabdominal ultrasound examination. When a child is suspected of having an intussusception, the firstline modality for diagnosis is ultrasound imaging. Intussusception is the invagination telescoping of a proximal segment of bowel into the distal bowel lumen.
The pseudokidney of intussusception is an ultrasound finding in some cases of intestinal intussusception. Diagnosis of intussusception using bedside ultrasound by a. Color doppler sonography may be helpful in determining whether the intussusception is reducible. Ultrasound is valuable for evaluating abdominal pain in pediatric patients. Brian coley, md, pediatric radiologist at cincinnati childrens hospital medical center, describes how ultrasound has aided in the evaluation of intussusception, a fairly common intestinal. A case in which appendiceal intussusception was diagnosed preoperatively by sonography is described.
Using warm gel and a 10 mhz linear transducer, the examiner begins the ultrasound exam at the cecum in the right lower quadrant of the abdomen and gradually moves proximally toward the right upper quadrant while aligning the transducer in a transverse orientation to the colon until the area of intussusception is. Intussusception pediatrics clerkship the university of. An ultrasound read by the radiologist confirmed the diagnosis of ileocolic intussusception, which was successfully reduced with contrast enema with gastrografin. Ultrasound can be helpful in diagnosis of other bowel obstruction when the abdomen is gasless by. It is highly sensitive and specific when performed by an experienced paediatric radiologist and avoids radiation exposure to the child. Intussusception occurs when one segment of bowel is pulled into itself or a neighboring loop of the bowel by peristalsis. Appendicitis intussusception pyloric stenosis andrew phelps md assistant professor pediatric radiology ucsf benioff childrens hospital. Intussusception is one of the most common causes of acute abdomen in infancy.
Ultrasound imaging is the diagnostic imaging examination of choice due to its high sensitivity, specificity, pathologic characterization, and lack of ionizing radiation. Intussusception occurs with an incidence of at least 56 per 100,000 children per year in the united states, and it is the most common cause of small bowel obstruction in children. Intussusception, telescoping of a segment of the intestine into an adjacent segment, producing a mechanical obstruction of the alimentary canal. Intussusception has a characteristic appearance on ultrasound. Pseudokidney intussusception radiology reference article. Intussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment of the bowel. It is an important cause of an acute abdomen in children and merits timely ultrasound examination and reduction to preclude. When smallbowel intussusception was detected with abdominal sonography, intussusception length greater than 3. Here is one more video about pocus for intussusception by society of academic emergency medicine results.
Small bowel intussusception pediatric ultrasound a. The atlas is enriched with several figures, in which the us picture is compared with that of conventional radiography, ct and mri. A pocus protocol for intussusception ultrasound gel. This is well demonstrated in the transverse image in this case. In adults, ct and mri play a more important role in the detection and evaluation of intussusception, aiding surgical planning and, in some cases, demonstrating an associated underlying cause. The american institute of ultrasound in medicine is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines, and accreditation. Approximately 60 percent of children with intussusception are younger than one year old, and 80 to 90 percent are younger than two years. An approach to imaging the acute abdomen in the pediatric. This condition usually occurs in children between 6 months and 2 years of age. Welcome to part 2 of the intussusception series check out part 1 here. Primary intussusception is sometimes congenital and rarely appears later than the third year of life. Intussusception occurs when a portion of the digestive tract becomes telescoped into the adjacent bowel segment. The pediatric abdomen chapter 10 pediatric emergency.
This page includes the following topics and synonyms. Sonography of pediatric smallbowel intussusception. Close this message to accept cookies or find out how to manage your cookie settings. Intussusception is the most common cause of small bowel obstruction in young infants. Intussusception and pyloric stenosis have specific age ranges. Roskind et al studied 198 children 3 months to 36 months who underwent 3view abdominal radiography for intussusception.
The clinical picture and abdominal films suggestive of bowel obstruction combined to generate a concern for intussusception. This process leads to bowel obstruction, venous congestion and bowel wall ischaemia. Ultrasound protocols please use and scan in exam work sheets. Find the top 100 most popular items in amazon books best sellers. Most children with intussusception develop the sudden onset ultrasound examination of the female pelvic floor.
Intussusception is most common from 6 to 12 months of age, and the vast majority of cases occur in the first 2 years of life. It refers to the longitudinal ultrasound appearance of the intussuscepted segment of bowel which mimics a kidney. Discussion doughnut or pseudokidney sign is the most common sign of intussusception. Novel applications of ultrasound in pediatric emergency medicine. Sep 17, 2012 brian coley, md, pediatric radiologist at cincinnati childrens hospital medical center, describes how ultrasound has aided in the evaluation of intussusception, a fairly common intestinal. Diagnosis of intussusception by physician novice sonographers in the emergency department. Diagnosis of intussusception using bedside ultrasound by a pediatric resident in the emergency department. Plain radiography, barium studies and ultrasound are still important in the imaging of intussusception, particularly in children. The sonographic finding of multiple concentric hypoechoic and hyperechoic rings was confirmed at laparotomy to be due to appendiceal intussusception. Ultrasound findings of transient small bowel intussusception are small size without a thickened bowel wall. Unlike the large bowel intussusception, small bowel intussusception generally dont require intervention, are self limiting and will usually resolve by themselves.
On transverse sections, a swirling pattern of alternating layers of hyper and hypoechogenic bowel wall layers is noted. In this age group, intussusception is idiopathic in almost all cases. Intussusception typically presents between 6 and 36 months of age, and is the most common cause of intestinal obstruction in this age group. The ultrasound of abdominal cavity and hydrocolonic sonography make it possible to find the intussusception and to identify the tumour or polyp in the structure of the intussusceptum in 100 % of. Long measure proximal mid distal trans measure if abnormal caliber. Stay informed with the latest updates on coronavirus covid19. The doughnut represents the outer walls, with the center representing the intussusceptum and the crescent representing the accompanying mesentery. Buonomo c 1999 the radiology of necrotizing enterocolitis. Intussusception is defined as the invagination of one bowel segment into another telescoping into a distal segment. Small bowel intussusception an overview sciencedirect topics. If exam is negative or there is only one finding, you may write in tech comments, otherwise please use sheet. Ultrasound recommended for intussusception diagnosis. Intussusception is the most common cause of intestinal obstruction in very young children. The ultrasound revealed a targetoid appearance figure 1 in the bowel and a pseudokidney sign figure 2 consistent with intussusception.
Clinical and ultrasonographic features of secondary. Treatment is discussed in general, and factors that affect the. The ultrasound examination was positive in 1618 patients with a final diagnosis of intussusception. Jun 18, 2016 intussusception is a common cause of childhood intestinal obstruction, occurring more frequently in white children aged 6 months to 2 years and in more males than in females 3. On the sagittal section, a sandwich like appearance of alternating loops of bowel is noted. May 08, 2019 small bowel intussusceptions like their counterparts the large bowel intussusceptions are the prolapsing of one part of the bowel into the immediately adjacent part of bowel. Ultrasound for pediatric intussusception ultrasound first. A portion of the bowel telescopes into the adjacent portion of the bowel. Variants of the us findings and the appearances of complicated intussusception are also presented. Delayed presentation of intussusception can manifest as small bowel obstruction, bowel perforation, peritonitis andor shock. It is an important cause of an acute abdomen in children and merits timely ultrasound examination and reduction to preclude significant sequelae including bowel necrosis.
Some sonographic findings seemed to be able to predict the opportunity to resort to nonsurgical therapeutic options like hydrostatic or pneumatic reduction of the intestinal segments invaginated. If the obstruction isnt reduced, there will be mesenteric artery obstruction leading to ischemia of the bowel. Ultrasound, ultrasonography, bedside ultrasound, pointofcare ultrasound, point of care ultrasound, pocus, musculoskeletal ultrasound. Radiology performed ultrasound for intussusception has excellent test. Eklof o, hugosson c 1976 post evacuation findings in barium enema treated intussusceptions. Therefore a high index of suspicion and thorough knowledge of this condition is of major importance to be able. The xray was compared with ultrasound, air enema, operative procedure, or improved clinical course.
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