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Yan H, Gou Z, Wang H, Zhu X, Liu J, Ling W, Huang L, Luo Y. Photoacoustic oxygenation imaging to identify ischemia/hypoxia injury and necrosis of intestine after acute intussusception: A comparative study with CDFI/CEUS. PHOTOACOUSTICS 2025; 43:100706. [PMID: 40115736 PMCID: PMC11923806 DOI: 10.1016/j.pacs.2025.100706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 02/05/2025] [Accepted: 02/23/2025] [Indexed: 03/23/2025]
Abstract
Acute intussusception is a pediatric abdominal emergency that requires immediate diagnosis and treatment. However, accurately identifying bowel necrosis non-invasively remains challenging with conventional sonography. In our study, we investigated the potential of photoacoustic imaging (PAI) as an innovative method for assessing ischemia/hypoxia injury and intestinal necrosis in cases of acute intussusception. Using PAI, we measured intestinal oxygen saturation (sO2) levels and total hemoglobin (HbT) in various models of acute intussusception at different time points. Additionally, we evaluated blood supply and ischemia/hypoxia injury using color Doppler flow imaging (CDFI) and contrast-enhanced ultrasound (CEUS). Based on histopathological results, intestinal sO₂ measured by PAI demonstrated optimal diagnostic performance for both ischemia/hypoxia injury and intestinal necrosis, with AUC values of 0.997 and 0.982, respectively, while CDFI and CEUS showed relatively high diagnostic performance for both ischemia/hypoxia injury and intestinal necrosis. In conclusion, PAI represents a promising, non-invasive imaging modality for assessing acute intussusception.
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Affiliation(s)
- Hualin Yan
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
- Tianfu Jincheng Laboratory, City of Future Medicine, Chengdu 641400, China
| | - Zehui Gou
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
- Tianfu Jincheng Laboratory, City of Future Medicine, Chengdu 641400, China
| | - Hong Wang
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
- Tianfu Jincheng Laboratory, City of Future Medicine, Chengdu 641400, China
| | - Xiaoxia Zhu
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
- Tianfu Jincheng Laboratory, City of Future Medicine, Chengdu 641400, China
| | - Juxian Liu
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wenwu Ling
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
- Tianfu Jincheng Laboratory, City of Future Medicine, Chengdu 641400, China
| | - Lin Huang
- School of Electronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Yan Luo
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, China
- Tianfu Jincheng Laboratory, City of Future Medicine, Chengdu 641400, China
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Adane L, Suleyman A, Negussie MA, Arega G. A very rare case of ileocolic and appendiceal intussusception with acute appendicitis. Radiol Case Rep 2025; 20:2923-2926. [PMID: 40224231 PMCID: PMC11987559 DOI: 10.1016/j.radcr.2025.02.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Revised: 02/22/2025] [Accepted: 02/24/2025] [Indexed: 04/15/2025] Open
Abstract
Intussusception is a common cause of bowel obstruction in children, typically occurring in those under 3 years old and often idiopathic. Secondary intussusception is less common in pediatric patients and usually involves a pathological lead point. Appendiceal intussusception is rare, occurring in only 0.01% of appendectomy specimens, and can mimic other acute abdominal conditions, making preoperative diagnosis challenging. We report a case of a 7-year-old male who presented with a 3-day history of crampy right lower quadrant pain and nonbilious vomiting. Ultrasound revealed an ileocolic intussusception with a suspected pathological lead point. Further imaging identified a distended, non-compressible appendix within the intussusceptum, leading to a diagnosis of secondary ileocolic intussusception due to acute appendicitis. Hydrostatic reduction was initially successful, but the patient developed recurrent intussusception within 24 hours. Surgical exploration confirmed McSwain type 3 appendiceal intussusception, necessitating manual reduction and appendectomy. The patient recovered well postoperatively. Clinicians should maintain a high index of suspicion for appendiceal pathology in older children with intussusception, and thorough imaging evaluation is essential. Early recognition of an inflamed appendix as the lead point is critical to prompt appropriate surgical intervention, ultimately preventing further complications. This case contributes to clinical practice by emphasizing the need for tailored diagnostic and therapeutic strategies in managing rare, complex presentations of intussusception.
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Affiliation(s)
- Leul Adane
- Department of Radiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abdulmejid Suleyman
- Department of Radiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Michael A. Negussie
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gashaw Arega
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Long B, Easter J, Koyfman A. High risk and low incidence diseases: Pediatric intussusception. Am J Emerg Med 2025; 91:37-45. [PMID: 39987626 DOI: 10.1016/j.ajem.2025.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 02/02/2025] [Accepted: 02/15/2025] [Indexed: 02/25/2025] Open
Abstract
INTRODUCTION Pediatric intussusception is a serious condition that carries with it a high risk of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of pediatric intussusception, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Intussusception is one of the most common pediatric abdominal emergencies. This is associated with one part of the intestine telescoping into another, resulting in bowel edema. If the intussusception remains untreated, obstruction, ischemia, necrosis, and perforation may result. Most cases are idiopathic, with 10-25 % associated with a pathologic mass or lead point. The most common age group affected includes those between 3 months to 5 years. The triad of intermittent abdominal pain, currant jelly stool, and sausage-shaped mass is uncommon, though most patients will present with intermittent abdominal pain. Nonbilious emesis and bloody stools (gross blood or guaiac positive) are also common. Younger patients can present atypically, including altered mental status or lethargy. Thus, intussusception should be considered in pediatric patients with abdominal pain, emesis, and a sausage-shaped mass, as well as those with atypical presentations such as altered mental status or lethargy if there is no other etiology found on testing. The diagnostic modality of choice is ultrasound. Plain radiography may assist in evaluating for obstruction and perforation. Treatment includes prompt reduction of the intussusception. In patients who are stable and have no evidence of perforation, non-operative reduction with hydrostatic or pneumatic reduction should be attempted. Operative intervention is necessary in those who are unstable, peritonitic, or have a focal lead point. Discharge may be appropriate for patients following successful non-operative reduction if the patient is able to tolerate clear fluids, is asymptomatic, and can return for any recurrence of symptoms. CONCLUSION An understanding of pediatric intussusception and its many potential mimics can assist emergency clinicians in diagnosing and managing this high risk disease.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Joshua Easter
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
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Elhadidi M, Elghazaly M, El-Saied AW, Awad M, Elayyouti M. Bypassing the Delay: Directing Pediatric Intussusception Cases to the OR Through Inflammatory Marker Assessment. World J Surg 2025. [PMID: 40252054 DOI: 10.1002/wjs.12586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2024] [Revised: 03/27/2025] [Accepted: 04/07/2025] [Indexed: 04/21/2025]
Abstract
INTRODUCTION Intestinal necrosis represents as one of the most severe complications of intussusception. Various markers of systemic inflammation, such as neutrophil counts, CRP levels, albumin concentrations, platelet counts, and lymphocyte counts as well as combined ratios, such as lymphocyte-to-CRP ratio (LCR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and CRP-to-albumin ratio (CAR), have been proposed as valuable predictors for a variety of inflammatory conditions, making them useful biomarkers for inflammation. We investigated the effectiveness of different combinations of inflammatory markers in predicting intestinal necrosis and the need for intestinal resection in cases of intussusception. PATIENTS AND METHODS This is a retrospective cohort study that included 100 patients diagnosed with intussusception and needed surgical intervention after failed nonoperative reduction of intussusception. The patients were divided into two groups based on whether they had intestinal resection. Analysis was conducted on combinations of inflammatory markers, such as NLR, PLR, LCR, and CAR, to correlate with intraoperative findings for detecting the markers with the highest correlation with intestinal necrosis in intussusception patients. RESULTS A statistically significant higher mean CAR was observed among cases with resection (15.27 ± 6.74) compared to the nonresection group (3.56 ± 4.06). Conversely, the mean LCR was significantly lower in the resection group (0.116 ± 0.12) compared to the nonresection group (0.509 ± 0.33). The ROC analysis showed that the area under the curve (AUC) for LCR in differentiating cases requiring resection was excellent, with a best-detected cutoff point of 0.1233, yielding a sensitivity of 85.7% and specificity of 90%. Similarly, the AUC for CAR in differentiating cases needing intestinal resection was excellent, with a best-detected cutoff point of 7.73, yielding a sensitivity of 92.6% and specificity of 90%. Additionally, the CAR was a statistically significant predictor of the need for resection, with each unit increase in CAR increasing the risk by 1.42 (95% CI: 1.25-1.61). CONCLUSION The mean CRP-to-albumin ratio (CAR) is significantly higher in cases requiring intestinal resection compared to those that do not require resection. LCR also provides useful information and should be used alongside the CAR in the decision-making process. If a patient's CAR exceeds 7.73 and if LCR is below 0.1233, they are more likely to need surgery due to necrosis. Given its statistical significance, CAR should be used as a key marker for predicting the need for intestinal resection. For each one-unit increase in CAR, the risk of needing intestinal resection increases by 1.42 times, which can aid in prioritizing patients for surgery, avoiding treatment delays, and enhancing patient outcome.
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Affiliation(s)
- Mahmoud Elhadidi
- Department of Pediatric Surgery, Mansoura University, Mansoura, Egypt
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Elghazaly
- Department of Pediatric Surgery, Mansoura University, Mansoura, Egypt
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adham W El-Saied
- Department of Pediatric Surgery, Mansoura University, Mansoura, Egypt
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Awad
- Department of General Surgery, Bedford Hospital, Bedford, UK
| | - Moustafa Elayyouti
- Department of Pediatric Surgery, Mansoura University, Mansoura, Egypt
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Qian YF, Guo WL. Development and validation of a deep learning algorithm for prediction of pediatric recurrent intussusception in ultrasound images and radiographs. BMC Med Imaging 2025; 25:67. [PMID: 40033220 DOI: 10.1186/s12880-025-01582-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 02/05/2025] [Indexed: 03/05/2025] Open
Abstract
PURPOSES To develop a predictive model for recurrent intussusception based on abdominal ultrasound (US) images and abdominal radiographs. METHODS A total of 3665 cases of intussusception were retrospectively collected from January 2017 to December 2022. The cohort was randomly assigned to training and validation sets at a 6:4 ratio. Two types of images were processed: abdominal grayscale US images and abdominal radiographs. These images served as inputs for the deep learning algorithm and were individually processed by five detection models for training, with each model predicting its respective categories and probabilities. The optimal models were selected individually for decision fusion to obtain the final predicted categories and their probabilities. RESULTS With US, the VGG11 model showed the best performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.669 (95% CI: 0.635-0.702). In contrast, with radiographs, the ResNet18 model excelled with an AUC of 0.809 (95% CI: 0.776-0.841). We then employed two fusion methods. In the averaging fusion method, the two models were combined to reach a diagnostic decision. Specifically, a soft voting scheme was used to average the probabilities predicted by each model, resulting in an AUC of 0.877 (95% CI: 0.846-0.908). In the stacking fusion method, a meta-model was built based on the predictions of the two optimal models. This approach notably enhanced the overall predictive performance, with LightGBM emerging as the top performer, achieving an AUC of 0.897 (95% CI: 0.869-0.925). Both fusion methods demonstrated excellent performance. CONCLUSIONS Deep learning algorithms developed using multimodal medical imaging may help predict recurrent intussusception. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Yu-Feng Qian
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, China
| | - Wan-Liang Guo
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, China.
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Ibrahim K, Lahoud C, Lahoud R, Hachem K, Braidy C. Colo-colic intussusception secondary to a giant lipoma: A case report. Radiol Case Rep 2025; 20:1745-1748. [PMID: 39886527 PMCID: PMC11779654 DOI: 10.1016/j.radcr.2024.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 11/29/2024] [Accepted: 12/06/2024] [Indexed: 02/01/2025] Open
Abstract
Intussusception in adults is a rare condition often associated with a pathological lead point, which is frequently malignant but can occasionally be benign, such as colonic lipomas. We report the case of a 60-year-old male who presented with colicky abdominal pain, and a computed tomography (CT) revealed a colo-colic intussusception caused by a 6 cm lipoma in the transverse colon, accompanied by ischemic changes in the colonic mucosa. The patient underwent a right hemicolectomy, and histopathology confirmed the benign nature of the lesion. This case highlights the importance of early recognition and surgical intervention to prevent complications and rule out malignancy, especially in rare presentations like intussusception caused by lipomas.
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Affiliation(s)
- Karine Ibrahim
- Department of Radiology, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Christele Lahoud
- Department of Radiology, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Rachele Lahoud
- Department of Radiology, LAU Medical Center- Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Kamal Hachem
- Department of Radiology, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Chadi Braidy
- Department of Radiology, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Ibrahim L, Potdar S. Roux-en-Y Intussusception: A Case Report. Cureus 2025; 17:e78088. [PMID: 39882200 PMCID: PMC11774634 DOI: 10.7759/cureus.78088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2025] [Indexed: 01/31/2025] Open
Abstract
Roux-en-Y gastric bypass (RYGB) is a bariatric surgical procedure commonly performed in adults to treat severe obesity. While RYGB is generally safe, it occasionally leads to rare but significant complications, including intussusception, a form of bowel obstruction caused by the invagination of an intestine segment from the proximal to the adjacent distal portion. We report a case of intussusception in a 74-year-old female patient who underwent RYGB 12 years prior. A computed tomography (CT) scan revealed jejunal intussusception accompanied by internal herniation, which was subsequently confirmed through exploratory laparotomy. The segments in intussusception were successfully reduced without any complications. Postoperative follow-up demonstrated the absence of recurrence or any additional complications.
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Affiliation(s)
- Lina Ibrahim
- Chemistry, University of South Florida, Tampa, USA
| | - Santosh Potdar
- General Surgery, Tampa General Hospital Brooksville, Brooksville, USA
- General Surgery, Tampa General Hospital Spring Hill, Spring Hill, USA
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Damewood S, Finberg M, Lin-Martore M. Gastrointestinal and Biliary Point-of-Care Ultrasound. Emerg Med Clin North Am 2024; 42:773-790. [PMID: 39326987 DOI: 10.1016/j.emc.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Point-of-care ultrasound has been shown to have excellent diagnostic accuracy for a variety of gastrointestinal and biliary pathologies. This review explores the evidence and scanning techniques for hypertrophic pyloric stenosis, intussusception, appendicitis, small bowel obstruction, diverticulitis, hernias, pneumoperitoneum, and biliary pathology.
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Affiliation(s)
- Sara Damewood
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin, 800 University Bay Drive Suite 310 MC 9123, Madison, WI 53705, USA.
| | - Maytal Finberg
- Department of Emergency Medicine, University of California, 550 16th Street, Box 0649, San Francisco, CA 94143, USA; Department of Pediatrics, University of California, 550 16th Street, Box 0649, San Francisco, CA 94143, USA
| | - Margaret Lin-Martore
- Department of Emergency Medicine, University of California, 550 16th Street, Box 0649, San Francisco, CA 94143, USA; Department of Pediatrics, University of California, 550 16th Street, Box 0649, San Francisco, CA 94143, USA
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Mertiri L, Sher AC, Sammer MB, Ngan E, Seghers VJ, Madueke UM, Stafford S, Kraus SJ, Kan JH. Association of Time Since Diagnosis of Pediatric Ileocolic Intussusception With Success of Attempted Reduction: Analysis in 1065 Patients. AJR Am J Roentgenol 2024. [PMID: 39230408 DOI: 10.2214/ajr.24.31498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
BACKGROUND: Radiologists generally treat pediatric ileocolic intussusceptions emergently given potential worse outcomes from delayed reduction attempts. However, relevant literature is conflicting. OBJECTIVE: To identify factors associated with successful image-guided ileocolic intussusception reduction in children, with attention to the time interval since diagnosis. METHODS: This retrospective study included patients <6 years old who underwent attempted image-guided enema reduction of ileocolic intussusception between May 2009 and July 2023. Patients were separated into two groups: those presenting directly to the institution (nontransferred patients, who all underwent attempted reduction <8 hours after ultrasound diagnosis), and those transferred from outside facilities. EHR data were extracted. Each patient's first image-guided reduction attempt was classified as successful or unsuccessful. Univariable and multivariable analyses were performed. RESULTS: The study included 1065 patients (649 male, 416 female; mean age, 18.1 months; age range, 2.2-71.0 months; 793 nontransferred and 272 transferred patients). In nontransferred patients, the mean interval between ultrasound diagnosis and reduction attempt was 150.8 minutes; in transferred patients, the mean interval between outside facility advanced imaging and reduction attempt was 460.1 minutes (p<.001). Successful reduction occurred in 84.6% and 81.6% of nontransferred and transferred patients, respectively (p=.25). In nontransferred patients, success occurred in 85.6% of attempts <2 hours after diagnosis versus 84.0% of attempts 2-<8 hours after diagnosis (p=.54); the mean interval from diagnosis to attempted reduction was 149.7 minutes and 156.8 minutes for successful and unsuccessful attempts, respectively (p=.53). In multivariable analysis, factors showing independent associations with success were proximal intussusception location (OR=3.63, p<.001) and absence of high-risk ultrasound findings (OR=2.57, p<.001); success was not independently associated with age, sex, bloody stools, reduction method, or time since diagnosis <2 hours (p>.05). In transferred patients, the mean interval from outside advanced imaging to attempted reduction was 463.1 minutes and 440.2 minutes for successful and unsuccessful attempts, respectively (p=.74). CONCLUSION: Intussusception reduction may not require completion emergently (within 2 hours after diagnosis), but potentially may be safely performed on an urgent basis (within 8 hours). CLINICAL IMPACT: The findings have implications for determining the standard of care, including criteria for oncall activation of radiologic resources, in pediatric intussusception management.
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Affiliation(s)
- Livja Mertiri
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, Suite 470, TX 77030, USA
| | - Andrew C Sher
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, Suite 470, TX 77030, USA
| | - Marla B Sammer
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, Suite 470, TX 77030, USA
| | - Esther Ngan
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, Suite 470, TX 77030, USA
| | - Victor J Seghers
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, Suite 470, TX 77030, USA
| | - U Michael Madueke
- Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030, USA
- Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Shawn Stafford
- Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030, USA
| | - Steven J Kraus
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, Suite 470, TX 77030, USA
| | - J Herman Kan
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, Suite 470, TX 77030, USA
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Dei-Asamoa J, Owusu AA, Abdulai S, Essoun S, Bediako-Bowan A, Akinkang B, Quayson SE, Etwire V, Glover-Addy H, Hesse AAJ. Mucinous cystadenoma of the caecum: a rare cause of recurrent intussusception in a 3-year-old boy (case report). Pan Afr Med J 2024; 48:81. [PMID: 39465198 PMCID: PMC11512149 DOI: 10.11604/pamj.2024.48.81.44175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/20/2024] [Indexed: 10/29/2024] Open
Abstract
Mucinous cystadenoma of the caecum is an exceptionally rare occurrence, particularly in paediatric patients. They have been rarely reported in the appendix, ovary, pancreas, and liver. This is the first report of a mucinous cystadenoma of the caecum (to the best of the authors' knowledge) in a child. A mucinous cystadenoma of the caecum can serve as a pathological lead point in intussusception. We report a case of a 3-year-old boy with a mucinous cystadenoma of the caecum causing intussusception. The intussusception recurred after an initial successful hydrostatic reduction. He had a laparotomy which revealed a caecal mass for which a limited right hemicolectomy was done. The histological diagnosis of the caecal mass was a mucinous cystadenoma. In intussusception caused by a lead point like a mucinous cystadenoma, an enema reduction may be successful but the intussusception may recur. Physical examination may reveal pathological lead points not detected on ultrasound scans. This case report contributes to the limited literature on mucinous cystadenomas of the caecum and calls for the need for further research to better understand their aetiology, clinical manifestation, histopathological diagnosis, and management strategies.
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Affiliation(s)
| | | | - Samira Abdulai
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Samuel Essoun
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Antoinette Bediako-Bowan
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | | | - Solomon Edward Quayson
- Department of Pathology, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Pathology, University of Ghana Medical School, Accra, Ghana
| | - Victor Etwire
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | | | - Afua Adwo Jectey Hesse
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
- Accra College of Medicine, Accra, Ghana
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Gruenberg B, Crane G, Arnold DH, Harrison NJ, Levine M. Yield of abdominal radiographs in children with suspected intussusception; rate of pneumoperitoneum and other abdominal pathology. Am J Emerg Med 2024; 78:18-21. [PMID: 38181541 DOI: 10.1016/j.ajem.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVES Ultrasound is the criterion standard imaging modality for the diagnosis of intussusception. However, to our knowledge the utility of abdominal radiographs to concurrently screen for pneumoperitoneum or other abdominal pathology that could have a similar presentation has not been studied. Our institutional protocol requires the performance of AP supine and left lateral decubitus views of the abdomen prior to ultrasound evaluation for intussusception, providing an opportunity to examine the yield of abdominal radiographs in this setting. Our primary objective was to determine the rate of pneumoperitoneum on screening abdominal radiographs in children undergoing evaluation for intussusception. Our secondary objective was to determine the rate that other clinically significant pathology is found on these screening abdominal radiographs. METHODS We performed a retrospective chart review of all patients under 6 years of age who had any imaging ordered in our large urban pediatric emergency department to evaluate for suspected intussusception during the calendar years 2018-2020. RESULTS 1115 patient encounters met our inclusion criteria. Among 1090 who had screening abdominal radiographs, 82 (8%) had findings concerning for intussusception. Of those not concerning for intussusception, 635 (58%) were read as normal, 263 (24%) showed moderate to large stool burden, 107 (10%) showed generalized bowel distention, and 22 (2%) showed abnormal gastric distention. Individually the remainder of all other findings compromised <1% of encounters and included radiopaque foreign body (8), intraabdominal calcification (4), pneumonia/effusion (3), pneumatosis intestinalis, abdominal mass (2), diaphragmatic hernia (1), rib fracture (1), appendicolith (1), feeding tube malposition (1), and bowel wall thickening (1). In one encounter the patient had a bowel perforation with pneumoperitoneum present secondary to ingestion of multiple magnets. CONCLUSIONS Our study indicates that radiograph-detected pneumoperitoneum is rare in children with suspected intussusception. Constipation is the most common abnormal finding on screening radiographs. Other findings occur in approximately 15% of total cases, some of which require further workup.
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Affiliation(s)
- Blake Gruenberg
- Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Emergency Medicine, 2200 Children's Way, Nashville, TN, 37232, USA.
| | - Gabriella Crane
- Vanderbilt University Medical Center, Department of Radiology, Division of Pediatric Radiology, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Donald H Arnold
- Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Emergency Medicine, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Noah J Harrison
- Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN, 37232, USA
| | - Marla Levine
- Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Emergency Medicine, 2200 Children's Way, Nashville, TN, 37232, USA
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Hensel ME, Rodrigues-Hoffmann A, Dray BK, Wilkerson GK, Baze WB, Sulkosky S, Hodo CL. Gastrointestinal tract pathology of the owl monkey ( Aotus spp.). Vet Pathol 2024; 61:316-323. [PMID: 37830482 PMCID: PMC10804813 DOI: 10.1177/03009858231204260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Owl monkeys are small nocturnal new world primates in the genus Aotus that are most used in biomedical research for malaria. Cardiomyopathy and nephropathy are well-described common diseases contributing to their morbidity and mortality; less is known about lesions affecting the gastrointestinal tract. Records from a 14-year period (2008-2022) at the Keeling Center for Comparative Medicine and Research were queried to identify instances of spontaneous gastrointestinal disease that directly contributed to the cause of death from the 235 adult owl monkeys submitted for necropsy. Of the 235, 10.6% (25/235) had gastrointestinal disease listed as a significant factor that contributed to morbidity and mortality. Diagnoses included candidiasis (3/25), gastric bloat (4/25), and intestinal incarceration and ischemia secondary (11/25), which included intussusception (4/25), mesenteric rent (3/25), strangulating lipoma (2/25), intestinal torsion (1/25), and an inguinal hernia (1/25). Intestinal adenocarcinomas affecting the jejunum (4/25) were the most common neoplasia diagnosis. Oral squamous cell carcinoma (1/25) and intestinal lymphoma (2/25) were also diagnosed. This report provides evidence of spontaneous lesions in the species that contribute to morbidity and mortality.
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Affiliation(s)
| | | | | | | | - Wally B. Baze
- The University of Texas MD Anderson Cancer Center, Bastrop, TX
| | | | - Carolyn L. Hodo
- The University of Texas MD Anderson Cancer Center, Bastrop, TX
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Zewde Y, Bugie T, Daniel A, Wodajo A, Meskele M. Clinical presentation and management outcome of pediatric intussusception at Wolaita Sodo University Comprehensive Specialized Hospital: a retrospective cross-sectional study. J Int Med Res 2024; 52:3000605241233525. [PMID: 38518196 PMCID: PMC10960347 DOI: 10.1177/03000605241233525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/29/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE To assess the pattern of clinical presentations and factors associated with the management outcome of pediatric intussusception among children treated at Wolaita Sodo University Comprehensive Specialized Hospital, Ethiopia. METHODS This retrospective cross-sectional study included the medical records of 103 children treated for intussusception from 2018 to 2020. The data collected were analyzed using SPSS 25.0 (IBM Corp., Armonk, NY, USA). RESULTS In total, 84 (81.6%) patients were released with a favorable outcome. Ileocolic intussusception was a positive predictor, with a nine-fold higher likelihood of a favorable outcome than other types of intussusception [adjusted odds ratio (AOR), 9.16; 95% confidence interval (CI), 2.39-21.2]. Additionally, a favorable outcome was three times more likely in patients who did than did not undergo manual reduction (AOR, 3.08; 95% CI, 3.05-5.48). Patients aged <1 year were 96% less likely to have a positive outcome than those aged >4 years (AOR, 0.04; 95% CI, 0.03-0.57). CONCLUSION Most patients were discharged with favorable outcomes. Having ileocolic intussusception and undergoing manual reduction were associated with significantly more favorable outcomes of pediatric intussusception. Therefore, nonsurgical management such as hydrostatic enema and pneumatic reduction is recommended to reduce hospital discharge of patients with unfavorable outcomes.
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Affiliation(s)
- Yohannes Zewde
- Department of Surgery, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tamrat Bugie
- Department of Surgery, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Abel Daniel
- Department of Pediatrics, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Awoke Wodajo
- Department of Pediatrics, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mengistu Meskele
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Asbah M, Shrateh ON, Ashqar H, Musleh A, Abbadi K, Amro W. Waugh syndrome: A rare coexistence of intussusception and intestinal malrotation: Case report and literature review. Int J Surg Case Rep 2024; 116:109411. [PMID: 38394938 PMCID: PMC10944001 DOI: 10.1016/j.ijscr.2024.109411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Waugh's syndrome, characterized by the concurrent presence of acute intussusception and gut malrotation, is a rare clinical entity. The relationship between these conditions is not well-explored, and the true incidence may be underreported. CASE PRESENTATION A 4 month old male infant, with an uneventful medical history, presented to the pediatric emergency department due to irritability and rectal bleeding lasting one day. The infant had a history of bilious vomiting and dark bloody rectal discharge. Physical examination revealed a hypoactive, dehydrated child with a palpable mass in the left lower abdomen. Abdominal ultrasound indicated Colo-colonic intussusception, and attempts at hydrostatic reduction were unsuccessful. Subsequent CT scan revealed malrotation with ileo-Colo-rectal intussusception. The patient underwent a two-step operation, involving manual reduction and Ladd's procedure, with a successful recovery and no post-surgical complications. CLINICAL DISCUSSION Reviewing the cases, we explore the unique features of Waugh's syndrome, its diverse age presentation, and the challenges in timely diagnosis. Diagnostic modalities, including abdominal ultrasound and contrast studies, are discussed, emphasizing the importance of recognizing malrotation in conjunction with intussusception for appropriate management. CONCLUSION Our experience highlights the potential underrecognition of Waugh's syndrome and emphasizes the need for a high index of suspicion. The rarity of laparoscopic interventions in documented cases is noted, emphasizing the prevailing reliance on open surgical approaches. A call for prospective studies is made to determine the actual incidence of intussusception in intestinal malrotation cases and to enhance understanding for optimal patient management.
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Affiliation(s)
- Malvina Asbah
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Hadeel Ashqar
- Department of Radiology, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Asil Musleh
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Khaled Abbadi
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine.
| | - Wael Amro
- Department of Pediatric Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
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Alghenaim M, Awadh M, Alshafai A, Darwish A. Intestinal Intussusception Complicating an Undiagnosed Burkitt Lymphoma in a Pediatric Arab Patient. Cureus 2024; 16:e55949. [PMID: 38601415 PMCID: PMC11005805 DOI: 10.7759/cureus.55949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Burkitt's lymphoma (BL) is considered an aggressive form of a non-Hodgkin B-cell lymphoma, representing less than 5% of all pediatric malignancies and 30% of pediatric lymphomas. However, intestinal BL may present as a lead point, causing intussusception. Surgery continues to be the gold standard for the treatment and identification of localized tumors to ensure complete removal with proper margin. In this report, we describe a hidden BL presenting as intestinal intussusception in an eight-year-old Arab boy. A computed tomography (CT) scan of the abdomen revealed an ileoileal intussusception with multiple enlarged lymph nodes. The report discusses the role of histopathology, supported by immunohistochemistry studies, in establishing the diagnosis. It also covers the significance of proper laparoscopic surgery and chemotherapy in the management of this child.
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Affiliation(s)
- Marwa Alghenaim
- Department of Pathology and Laboratory Medicine, Bahrain Defense Force (BDF) Royal Medical Services, Riffa, BHR
| | - Mohamed Awadh
- Department of Pathology and Laboratory Medicine, Bahrain Defense Force (BDF) Royal Medical Services, Riffa, BHR
| | - Abdulrahman Alshafai
- Department of Pediatric Surgery, Bahrain Defense Force (BDF) Royal Medical Services, Riffa, BHR
| | - Abdulla Darwish
- Department of Pathology and Laboratory Medicine, Bahrain Defense Force (BDF) Royal Medical Services, Riffa, BHR
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Romano G, Frediani S, Aloi IP, Bertocchini A, Pardi V, Accinni A, Inserra A. Case Report: An unusual case of wide ileoileal intussusception associated with intestinal volvulus in a 8-months-old infant. Front Pediatr 2024; 12:1363731. [PMID: 38434726 PMCID: PMC10904457 DOI: 10.3389/fped.2024.1363731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Midgut volvulus and intussusception are prevalent paediatric abdominal emergencies. To the best of our knowledge, this is the first reported case of a connection between intestinal volvulus and a massive intussusception. Case report An 8-month-old male infant was brought to the emergency room with a history of abdominal pain and vomiting for <24 h. On physical examination, the child appeared restless and was found to have a circumferential hard mass of approximately 4 cm in diameter in the epigastric region. Upon admission, laboratory results showed a C-reactive protein level of 0.4 mg/dl, LDH level of 351 U/L, mild leukocytosis with a white blood cell count of 12 × 103 /µl, and 67% neutrophils. A physical exam was significant for abdominal distention, hyperresonance in percussion, and a palpable, painful epigastric mass. The findings of the operation included a dilated and ischemic intestinal loop, approximately 25 cm from the ileocecal valve, twisted upon itself for three turns. After de-rotation, an extensive occluding ileo-ileal invagination with an ischemic intestinal loop was identified, and a length of approximately 55-60 cm of the distal ileum, including the ischemic segment, was resected. Discussion This is the first reported case of a connection between intestinal volvulus and a massive intussusception. Currently, only two reported cases describe the connection between volvulus and intussusception, which are insufficient to establish a direct link between the two clinical conditions.
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Affiliation(s)
| | - Simone Frediani
- Department of General Surgery, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Kim SW, Cheon JE, Choi YH, Hwang JY, Shin SM, Cho YJ, Lee S, Lee SB. Feasibility of a deep learning artificial intelligence model for the diagnosis of pediatric ileocolic intussusception with grayscale ultrasonography. Ultrasonography 2024; 43:57-67. [PMID: 38109893 PMCID: PMC10766885 DOI: 10.14366/usg.23153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 12/20/2023] Open
Abstract
PURPOSE This study explored the feasibility of utilizing a deep learning artificial intelligence (AI) model to detect ileocolic intussusception on grayscale ultrasound images. METHODS This retrospective observational study incorporated ultrasound images of children who underwent emergency ultrasonography for suspected ileocolic intussusception. After excluding video clips, Doppler images, and annotated images, 40,765 images from two tertiary hospitals were included (positive-to-negative ratio: hospital A, 2,775:35,373; hospital B, 140:2,477). Images from hospital A were split into a training set, a tuning set, and an internal test set (ITS) at a ratio of 7:1.5:1.5. Images from hospital B comprised an external test set (ETS). For each image indicating intussusception, two radiologists provided a bounding box as the ground-truth label. If intussusception was suspected in the input image, the model generated a bounding box with a confidence score (0-1) at the estimated lesion location. Average precision (AP) was used to evaluate overall model performance. The performance of practical thresholds for the modelgenerated confidence score, as determined from the ITS, was verified using the ETS. RESULTS The AP values for the ITS and ETS were 0.952 and 0.936, respectively. Two confidence thresholds, CTopt and CTprecision, were set at 0.557 and 0.790, respectively. For the ETS, the perimage precision and recall were 95.7% and 80.0% with CTopt, and 98.4% and 44.3% with CTprecision. For per-patient diagnosis, the sensitivity and specificity were 100.0% and 97.1% with CTopt, and 100.0% and 99.0% with CTprecision. The average number of false positives per patient was 0.04 with CTopt and 0.01 for CTprecision. CONCLUSION The feasibility of using an AI model to diagnose ileocolic intussusception on ultrasonography was demonstrated. However, further study involving bias-free data is warranted for robust clinical validation.
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Affiliation(s)
- Se Woo Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su-Mi Shin
- Department of Radiology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Seul Bi Lee
- Department of Radiology, Seoul National University Children’s Hospital, Seoul, Korea
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Zhang R, Zhang M, Deng R, Li Y, Guo C. Lymphoma-related intussusception in children: diagnostic challenges and clinical characteristics. Eur J Pediatr 2024; 183:219-227. [PMID: 37861794 DOI: 10.1007/s00431-023-05289-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023]
Abstract
Intussusception is a common cause of acute abdominal pain in children and the most frequent cause of intestinal obstruction in infants. Although often idiopathic, it can stem from conditions like lymphoma. This study delves into lymphoma-related intussusception in children, aiming to enhance early detection and management. A retrospective review encompassed children admitted from 2012 to 2023 with intussusception due to intestinal lymphoma. Demographic, clinical, and imaging data were meticulously extracted and analyzed. The study included 31 children in the lymphoma-related intussusception group. Contrasted with non-lymphoma-related cases, the patients of lymphoma-related intussusception were notably older (median age: 87 months vs. 18.5 months), predominantly male, and demonstrated protracted abdominal pain. Ultrasound unveiled mesenteric lymph node enlargement and distinct intra-abdominal masses; enema reduction success rates were notably diminished. Detecting lymphoma-related intussusception remains intricate. Age, prolonged symptoms, and distinctive ultrasound findings can arouse suspicion. Timely surgical intervention, based on preoperative imaging, proves pivotal for accurate diagnosis. CONCLUSION Swift identification of lymphoma-related intussusception, distinguished by unique clinical and ultrasound features, is imperative for timely intervention and treatment. Further research is warranted to refine diagnostic approaches. WHAT IS KNOWN • Intussusception in pediatric patients can be caused by a wide spectrum of underlying diseases including lymphoma. • Early Identifying the exact underlying cause of intussusception is crucial for tailored therapy, however often challenging and time-consuming. WHAT IS NEW • Lymphoma-related intussusception may present with increased abdominal fluid accumulation, intestinal obstruction, and a higher likelihood of failed reduction during enema procedures. • For high-risk children, repeated ultrasound examinations or further investigations may be necessary to confirm the diagnosis.
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Affiliation(s)
- Rensen Zhang
- Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Chongqing health center for Women and Children, Chongqing Medical University, 120 Longshan Road, Yubei District, Chongqing, 401147, People's Republic of China
| | - Minjie Zhang
- Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Ruyu Deng
- Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yao Li
- Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Chongqing health center for Women and Children, Chongqing Medical University, 120 Longshan Road, Yubei District, Chongqing, 401147, People's Republic of China
| | - Chunbao Guo
- Department of Pediatrics, Chongqing health center for Women and Children, Chongqing Medical University, 120 Longshan Road, Yubei District, Chongqing, 401147, People's Republic of China.
- Department of Pediatrics, Women and Children's Hospital, Chongqing medical University, Chongqing, China.
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Yatabe R, Kishibe S, Akahoshi S, Shimojima N, Sakakibara H. Success rate and predictors of failure of enema reduction of intussusception in children with a water-soluble contrast medium at a height of 120 cm or less. Pediatr Int 2024; 66:e15824. [PMID: 39417579 DOI: 10.1111/ped.15824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/31/2024] [Accepted: 07/07/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND This study investigates the reduction rate and failure predictors of hydrostatic enema reduction for intussusception. The procedure typically begins with a water-soluble contrast medium at 90 cm above the patient, subsequently elevated to 120 cm. Our focus is on the reduction rate during initial attempts when the contrast medium is positioned at or below 120 cm from the patient. METHODS Hydrostatic enema reductions for intussusception, performed between March 2010 and May 2022 at Tokyo Metropolitan Children's Medical Center, were investigated retrospectively. The initial attempts involved one or more trials. The clinical characteristics, treatment modalities, and outcomes were analyzed. Logistic regression was used to identify the predictors of failure when the reduction was performed with the water-soluble contrast medium at a height of 120 cm or less. RESULTS Reduction was achieved successfully with the water-soluble contrast medium at a height at or below 120 cm in 77.5% of 351 patients. When reductions performed at heights greater than 120 cm were included, 333 (94.9%) were successful during the initial attempts and were unaccompanied by complications. Predictors of failure of reductions performed at or below 120 cm were age less than 12 months and the presence of trapped fluid. CONCLUSION The present study found a successful reduction rate of 77.5% during the initial attempts, suggesting that a height greater than 120 cm may yield an even greater success rate. Children aged below 12 months and those with trapped fluid may have a greater failure risk during the initial attempts.
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Affiliation(s)
- Reiko Yatabe
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Shun Kishibe
- Department of Emergency and Critical Care, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Shogo Akahoshi
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Naoki Shimojima
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroshi Sakakibara
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Pei Y, Wang G, Cao H, Jiang S, Wang D, Wang H, Wang H, Yu H. A deep-learning pipeline to diagnose pediatric intussusception and assess severity during ultrasound scanning: a multicenter retrospective-prospective study. NPJ Digit Med 2023; 6:182. [PMID: 37775624 PMCID: PMC10541898 DOI: 10.1038/s41746-023-00930-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
Ileocolic intussusception is one of the common acute abdomens in children and is first diagnosed urgently using ultrasound. Manual diagnosis requires extensive experience and skill, and identifying surgical indications in assessing the disease severity is more challenging. We aimed to develop a real-time lesion visualization deep-learning pipeline to solve this problem. This multicenter retrospective-prospective study used 14,085 images in 8736 consecutive patients (median age, eight months) with ileocolic intussusception who underwent ultrasound at six hospitals to train, validate, and test the deep-learning pipeline. Subsequently, the algorithm was validated in an internal image test set and an external video dataset. Furthermore, the performances of junior, intermediate, senior, and junior sonographers with AI-assistance were prospectively compared in 242 volunteers using the DeLong test. This tool recognized 1,086 images with three ileocolic intussusception signs with an average of the area under the receiver operating characteristic curve (average-AUC) of 0.972. It diagnosed 184 patients with no intussusception, nonsurgical intussusception, and surgical intussusception in 184 ultrasound videos with an average-AUC of 0.956. In the prospective pilot study using 242 volunteers, junior sonographers' performances were significantly improved with AI-assistance (average-AUC: 0.966 vs. 0.857, P < 0.001; median scanning-time: 9.46 min vs. 3.66 min, P < 0.001), which were comparable to those of senior sonographers (average-AUC: 0.966 vs. 0.973, P = 0.600). Thus, here, we report that the deep-learning pipeline that guides lesions in real-time and is interpretable during ultrasound scanning could assist sonographers in improving the accuracy and efficiency of diagnosing intussusception and identifying surgical indications.
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Affiliation(s)
- Yuanyuan Pei
- Provincial Key Laboratory of Research in Structure Birth Defect Disease and Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Guijuan Wang
- School of Computer Science, South China Normal University, Guangzhou, China
| | - Haiwei Cao
- Ultrasonic Department, Kaifeng Children's Hospital, Kaifeng, China
| | - Shuanglan Jiang
- Ultrasonic Department, Dongguan Children's Hospital, Dongguan, China
| | - Dan Wang
- Ultrasonic Department, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Haiyu Wang
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongying Wang
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Hongkui Yu
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
- Department of Ultrasonography, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China.
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Rukwong P, Wangviwat N, Phewplung T, Sintusek P. Cohort analysis of pediatric intussusception score to diagnose intussusception. World J Clin Cases 2023; 11:5014-5022. [PMID: 37583866 PMCID: PMC10424024 DOI: 10.12998/wjcc.v11.i21.5014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Intussusception is a primary cause of intestinal obstruction in young children. Delayed diagnosis is associated with increased morbidity. Ultrasonography (USG) is the gold standard for diagnosis, but it is operator dependent and often unavailable in limited resource areas. AIM To study the clinical characteristics of intussusception including management and evaluation of the diagnostic accuracy of abdominal radiography (AR) and the promising parameters found in the pediatric intussusception score (PIS). METHODS Children with suspected intussusception in our center from 2006 to 2018 were recruited. Clinical manifestations, investigations, and treatment outcomes were recorded. AR images were interpreted by a pediatric radiologist. Diagnosis of intussusception was composed of compatible USG and response with reduction. The diagnostic value of the proposed PIS was evaluated. RESULTS Ninety-seven children were diagnosed with intussusception (2.06 ± 2.67 years, 62.9% male), of whom 74% were < 2 years old and 37.1% were referrals. The common manifestations of intussusception were irritability or abdominal pain (86.7%) and vomiting (59.2%). Children aged 6 mo to 2 years, pallor, palpable abdominal mass, and positive AR were the parameters that could discriminate intussusception from other mimics (P < 0.05). Referral case was the only significant parameter for failure to reduce intussusception (P < 0.05). AR to diagnose intussusception had a sensitivity of 59.2%. The proposed PIS, a combination of clinical irritability or abdominal pain, children aged 6 mo to 2 years, and compatible AR, had a sensitivity of 85.7%. CONCLUSION AR alone provides poor screening for intussusception. The proposed PIS in combination with common manifestations and AR data was shown to increase the diagnostic sensitivity, leading to timely clinical management.
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Affiliation(s)
- Punwadee Rukwong
- Department of Pediatrics, Phrapokklao Hospital, Chantaburi 22000, Meuang, Thailand
| | - Nathawit Wangviwat
- Division of Laboratory Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Teerasak Phewplung
- Department of Radiology, Chulalongkorn University, Bangkok 10330, Thailand
| | - Palittiya Sintusek
- Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
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22
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Li Y, Zhou Q, Liu C, Sun C, Sun H, Li X, Zhang L. Epidemiology, clinical characteristics, and treatment of children with acute intussusception: a case series. BMC Pediatr 2023; 23:143. [PMID: 36997992 PMCID: PMC10061978 DOI: 10.1186/s12887-023-03961-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND To summarize the clinical and epidemiological characteristics of acute intussusception. METHODS This retrospective study included pediatric patients with acute intussusception admitted to the Department of Pediatric Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, from January 2014 to December 2019. RESULTS A total of 402 infants/children were included (301 males and 101 females) with a mean age of 2.4 ± 1.5 years (2 months to 9 years). Thirty patients (7.5%) had a history of cold food intake, diarrhea, and upper respiratory infection before disease onset. Paroxysmal abdominal pain and crying occurred in 338 patients (84.1%). Eight patients (2.0%) had the typical triad, 167 (41.5%) had vomiting, 24 (6.0%) had bloody stools, and 273 (67.9%) had palpable abdominal mass. The average intussusception depth was 4.0 ± 1.4 cm. Air enema reduction was performed in 344 cases: 335 (97.3%) were successful. Fifty-eight patients were treated with intravenous phloroglucinol (2 mg/kg), and 53 (91.4%) were successful. Sixty-five patients suffered relapses, with a relapse rate of 16.8%. CONCLUSIONS Pediatric acute intussusception is common. There was no obvious etiology. The clinical manifestations are mostly atypical. Abdominal pain is the most common complaint. Air enema reduction is an effective treatment. The recurrence rate is high.
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Affiliation(s)
- Yan Li
- Department of Scientific Research, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Qi Zhou
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Chao Liu
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Chao Sun
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Hao Sun
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Xiang Li
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Lei Zhang
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China.
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Hwang J, Yoon HM, Kim PH, Jung AY, Lee JS, Cho YA. Current diagnosis and image-guided reduction for intussusception in children. Clin Exp Pediatr 2023; 66:12-21. [PMID: 35798026 PMCID: PMC9815940 DOI: 10.3345/cep.2021.01816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/02/2022] [Indexed: 02/04/2023] Open
Abstract
Intussusception involves an invagination of the proximal bowel into the distal bowel, with ileocolic intussusception being the most common type. However, a diagnostic delay can lead to intestinal ischemia, bowel infarction, or even death; therefore, its early diagnosis and management are important. The primary role of abdominal radiography is to detect pneumoperitoneum or high-grade bowel obstruction in cases of suspected intussusception, and ultrasonography is the modality of choice for its diagnosis. Nonoperative enema reduction, the treatment of choice for childhood intussusception in cases without signs of perforation or peritonitis, can be safely performed with a success rate of 82%. Enema reduction can be performed in various ways according to image guidance method (fluoroscopy or ultrasonography) and reduction medium (liquid or air). Successful enema reduction is less likely to be achieved in children with a longer symptom duration, younger age, lethargy, fever, bloody diarrhea, unfavorable radiologic findings (small bowel obstruction, trapped fluid, ascites, absence of flow in the intussusception, intussusception in the left-sided colon), and pathological lead points. This review highlights the current concepts of intussusception diagnosis, nonsurgical enema reduction, success rates, predictors of failed enema reduction, complications, and recurrence to guide general pediatricians in the management of childhood intussusception.
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Affiliation(s)
- Jisun Hwang
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Risk Factors of Nonsurgical Management Failure in Pediatric Intussusception Patients With Delayed Presentation. Pediatr Emerg Care 2022; 38:650-653. [PMID: 36449735 DOI: 10.1097/pec.0000000000002873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVES The present study aimed to investigate the time-related predicting factors of the ultrasound-guided hydrostatic reduction (USGHR) failure in pediatric patients with ileocolic intussusception and delayed presentation. METHODS The present retrospective study included pediatric patients diagnosed with ileocolic intussusception who presented to our hospital with the related symptoms started 48 hours ago or greater duration during 2018-2020. The patients with spontaneous reduction were excluded from the study. Afterward, the participants with failed and successful USGHR were compared in terms of age, sex, symptom duration, and ultrasound findings using the χ 2 and logistic regression tests. RESULTS A total of 103 children were included in the present study. The mean symptom duration was 4.13 ± 2.39 days, with a range of 2-14 days. Moreover, 47.6% of the patients had a successful reduction. In addition, there was a significant relationship between failed USGHR and the factors of symptom duration, free peritoneal fluid, entrapped fluid between intussuscepted loops, the size of the invaginated segment, and malperfusion of the intussuscepted bowel loops detected using the Doppler ultrasound ( P < 0.05). However, there was no significant relationship between failed USGHR and the factors of the primary location of intussusception and the presence of intussuscepted lymph nodes ( P > 0.05). CONCLUSIONS The presence of entrapped fluid between the intussuscepted loops, free peritoneal fluid, and the length of the intussuscepted segments were all associated with USGHR failure in our study. Therefore, determining these predictors may help anticipate failure of reduction.
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Lee JY. ED point-of-care-ultrasound intussusception diagnosis is accurate. J Pediatr 2022; 251:220-224. [PMID: 36464404 DOI: 10.1016/j.jpeds.2022.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Jeong-Yong Lee
- University of Ulsan College of Medicine, Seoul, Republic of Korea
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Outcomes in pediatric patients with documented delays between ileocolic intussusception diagnosis and therapeutic enema attempt: evaluation of reduction efficacy and complication rate. Emerg Radiol 2022; 29:953-959. [PMID: 35907145 DOI: 10.1007/s10140-022-02079-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Ileocolic intussusception is considered a pediatric emergency, with concerns for risk of significant morbidity in children with a prolonged intussusception state. Emergent therapy is standard of care, as prior studies have shown poor outcomes in patients with long delays (> 24 h) before intervention. Various factors can result in shorter delays, and there are limited studies evaluating outcomes in these patients. This study aimed to determine if there were differences in reduction success rates associated with short in-hospital time delays. OBJECTIVE This study is to determine enema success rate and morbidity in patients with documented time delays between intussusception diagnosis and therapeutic enema. MATERIALS AND METHODS A retrospective evaluation of pediatric patients with intussusception at a single children's hospital between 2007 and 2019 was performed. Patient's records were reviewed for time of symptom onset, radiologic diagnosis, and attempted enema. Ultrasounds and radiographs were reviewed for bowel obstruction, free peritoneal fluid, trapped fluid around the intussusceptum, and absent bowel wall perfusion. Patients were evaluated for efficacy of reduction attempt, requirement for surgical reduction, and complications including bowel resection and bowel perforation. RESULTS There were 175 cases of ileocolic intussusception requiring enema reduction. Successful reduction occurred in 72.2% (13/18) of cases performed within 1 h of diagnosis; 74.3% (78/105) between 1 and3 h; 73.2% (30/41) between 3 and 6 h; and 81.2% (9/11) with greater than 6 h. Need for bowel resection was not associated with short delays between diagnosis and reduction attempts (p = .07). CONCLUSIONS There was no difference in intussusception reduction efficacy or complication rate in patients with increasing time between imaging diagnosis of ileocolic intussusception and reduction attempt, including delay intervals up to 8 h.
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Lin-Martore M, Firnberg MT, Kohn MA, Kornblith AE, Gottlieb M. Diagnostic accuracy of point-of-care ultrasonography for intussusception in children: A systematic review and meta-analysis. Am J Emerg Med 2022; 58:255-264. [PMID: 35749802 DOI: 10.1016/j.ajem.2022.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/10/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Ileocolic intussusception can be challenging to diagnose due to vague complaints, but rapid diagnosis and treatment can help prevent morbidity and mortality. Prior research has focused on radiologic ultrasound, with more recent studies focusing on point-of-care ultrasonography (POCUS). This systematic review and meta-analysis assesses the diagnostic accuracy of POCUS for children with suspected ileocolic intussusception. METHODS PubMed, Embase, CINAHL, LILACS, the Cochrane databases, Google Scholar, conference abstracts, and bibliographies of selected articles were searched for studies evaluating the accuracy of POCUS for the diagnosis of intussusception in children. Data were dual extracted into a predefined worksheet, and quality analysis was performed with the QUADAS-2 tool. Data were summarized, and a meta-analysis was performed. RESULTS Eleven studies (n = 2400 children) met our inclusion criteria. Overall, 14.4% of children had intussusception. POCUS was 95.1% (95% CI: 90.3% to 97.2%) sensitive and 98.1% (95% CI: 95.8% to 99.2%) specific with a positive likelihood ratio of 50 (95% CI: 23 to 113) and a negative likelihood ratio of 0.05 (95% CI: 0.03 to 0.09). CONCLUSIONS POCUS has excellent diagnostic accuracy for intussusception in children presenting to the emergency department.
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Affiliation(s)
- Margaret Lin-Martore
- Department of Emergency Medicine and Department of Pediatrics, University of California, San Francisco, CA, United States of America
| | - Maytal T Firnberg
- Department of Emergency Medicine and Department of Pediatrics, University of California, San Francisco, CA, United States of America
| | - Michael A Kohn
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, United States of America
| | - Aaron E Kornblith
- Department of Emergency Medicine and Department of Pediatrics, University of California, San Francisco, CA, United States of America
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
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Samy L, Snelling PJ. You are what you eat: The diagnosis of recurrent intussusception in the emergency department. J Paediatr Child Health 2022; 58:1079-1080. [PMID: 34528322 DOI: 10.1111/jpc.15750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Lydia Samy
- Children's Emergency, Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Peter J Snelling
- Children's Emergency, Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.,Emergency Department, Sonography Innovation and Research (Sonar) Group, Gold Coast, Queensland, Australia.,Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
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An unusual cluster of Waugh syndrome as a cause of intestinal obstruction in children - A case series. Int J Surg Case Rep 2022; 96:107269. [PMID: 35700619 PMCID: PMC9194577 DOI: 10.1016/j.ijscr.2022.107269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/28/2022] [Accepted: 05/29/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The association of intussusception with intestinal malrotation is a rare phenomenon named Waugh syndrome by Brereton et. It is a rare disease entity with less than 100 cases described so far. A cluster presentation is something unusual for rare diseases. CASE PRESENTATION All four patients have presented with features suggestive of bowel obstruction as all of them have had colicky abdominal pain. Three patients have vomiting as an additional complaint, so as the diarrhea. Fever has also been reported in one patient. Patients have presented in 6 months period, non-consecutively. Abdominal pain, diarrhea and vomiting are alarming in the pediatric population. When each case presented, an immediate resuscitation was performed including IV lines, nasogastric suctioning, electrolytes correction, and blood and FFP transfusion as necessary. Abdominal ultrasonography was performed revealing target sign. After optimization for surgery, manual reduction of the intussusception was done followed by a Ladd's procedure for the malrotation was performed for all 4 patients with excellent outcomes. CLINICAL DISCUSSION With the surgery, after case optimization, remains the standard of care; the presence of cluster presentation for Waugh syndrome could suggest that some environmental factors might be implicated and further observations can be carried out to look more into such phenomenon. CONCLUSION Waugh syndrome, a combined presentation of intestinal malrotation and intussusception, is a rare syndrome that can present in children. Optimization for surgery followed by a 2-step surgical approach is the usual treatment with excellent outcomes described.
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Wessling J, Schreyer A, Grenacher L, Juchems M, Ringe K. [Incidental and "leave me alone" findings of the GI tract-part 2 : Intestinal wall and mesentery]. Radiologe 2022; 62:167-178. [PMID: 35088094 DOI: 10.1007/s00117-021-00964-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
Due to the widespread use of computed tomography (CT) and magnetic resonance imaging (MRI) asymptomatic incidental findings of the gastrointestinal (GI) tract are increasingly being recognized. Incidental findings are frequently not part of the primary inquiry from referring physicians but it is obligatory to make a diagnosis and to stipulate the need for further clarification. A multitude of incidental findings in the intestinal lumen, in the intestinal wall and in the adjacent mesentery or subperitoneal space are shown in CT and MRI of the GI tract. The last part of the two-part review addresses the gastrointestinal incidental findings in the intestinal wall and the adjacent sections. Extramural incidental findings occur as mesenteric inflammation, tumors and cysts. Many of the findings can be classified as benign and as "leave me alone lesions" do not necessitate any further clarification but in contrast others need a definitive clarification. The most important incidental findings in the GI tract are systematically classified, illustrated and evaluated with respect to the clinical relevance, depending on the localization (e.g. stomach, small and large intestines).
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Affiliation(s)
- J Wessling
- Zentrum für Radiologie und Neuroradiologie, Clemenshospital, Raphaelsklinik, EVK Münster, Düesbergweg 24, 48153, Münster, Deutschland.
| | - A Schreyer
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum der Medizinischen Hochschule Brandenburg, Hochstr. 29, 14770, Brandenburg, Deutschland
| | - L Grenacher
- Conradia Radiologie München, Augustenstr. 115, 80798, München, Deutschland
| | - M Juchems
- Diagnostische und Interventionelle Radiologie, Klinikum Konstanz, Mainaustr. 35, 78464, Konstanz, Deutschland
| | - K Ringe
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Li SM, Wu XY, Luo CF, Yu LJ. Laparoscopic approach for managing intussusception in children: Analysis of 65 cases. World J Clin Cases 2022; 10:830-839. [PMID: 35127899 PMCID: PMC8790435 DOI: 10.12998/wjcc.v10.i3.830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/19/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intussusception can be managed by pneumatic reduction, ultrasound-guided hydrostatic reduction, open or laparoscopic surgery, but laparoscopy in such cases remains controversial.
AIM To explore the clinical characteristics, effectiveness, and complications of surgical reduction for intussusception using laparoscopy in children.
METHODS This study was a retrospective case series of pediatric patients with intussusception who underwent surgical reduction by laparoscopy from May 2011 to April 2016 at Taizhou Hospital of Zhejiang Province. Clinical characteristics (operation time, intraoperative blood loss, conversion rate of laparotomy, reasons for conversion, postoperative hospital stay, and adverse events) were described.
RESULTS The 65 patients included 45 boys and 20 girls. The average age was 2.3 years (27.5 ± 24.5 mo). Of the 65 patients, 61 underwent surgical reduction by laparoscopy after a failed enema reduction of intussusception, and four underwent the procedure directly. All patients were treated successfully and 57 (87.7%) patients underwent successful laparoscopic surgery, two of which had a spontaneous reduction. Among the remaining cases, one was converted to open surgery via right upper quadrant incision, and seven required enlarged umbilical incisions. Intestinal resection was performed in 5 patients because of abnormal bowel lesions. There were no complications (intestinal perforations, wound infections, or intestinal adhesions) during the follow-up of 3 years to 8 years. Two patients experienced a recurrence of intussusception; one was resolved with pneumatic reduction, and the other underwent a second laparoscopic surgery.
CONCLUSION Laparoscopic approach for pediatric intussusception is feasible and safe. Bowel resection if required can be performed by extending umbilical incision without the conventional laparotomy.
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Affiliation(s)
- Sheng-Miao Li
- Department Pediatric Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
| | - Xiao-Ying Wu
- Department Pediatric Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
| | - Chun-Fen Luo
- Department Pediatric Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
| | - Lin-Jun Yu
- Department Pediatric Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
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Hom J, Kaplan C, Fowler S, Messina C, Chandran L, Kunkov S. Evidence-Based Diagnostic Test Accuracy of History, Physical Examination, and Imaging for Intussusception: A Systematic Review and Meta-analysis. Pediatr Emerg Care 2022; 38:e225-e230. [PMID: 32941364 DOI: 10.1097/pec.0000000000002224] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Intussusception is the most common cause of pediatric small bowel obstruction. Timely and accurate diagnosis may reduce the risk of bowel ischemia. We quantified the diagnostic test accuracy of history, physical examination, abdominal radiographs, and point-of-care ultrasound. METHOD We conducted a systematic review for diagnostic test accuracy of history, physical examination, and imaging concerning for intussusception. Our literature search was completed in June 2019. Databases included Medline via Ovid, Embase, Scopus, and Wiley Cochrane Library. We conducted a second review of the literature up to June 2019 for any additional studies. Inclusion criteria were younger than 18 years and presenting to the emergency department for abdominal complaints, consistent with intussusception. We performed data analysis using mada, version 0.5.8. We conducted univariate and bivariate analysis (random effects model) with DerSimonian-Laird and Reitsma model, respectively. QUADAS-2 was used for bias assessment. RESULTS The literature search identified 2639 articles, of which 13 primary studies met our inclusion criteria. Abdominal pain, vomiting, and bloody stools had positive likelihood ratios LR(+) between 1 and 2, whereas the negative likelihood ratio, LR(-), ranged between 0.4 and 0.8. Abnormal abdominal radiograph had LR(+) of 2.5 and LR(-) of 0.20, whereas its diagnostic odds ratio was 13. Lastly, point-of-care ultrasound had LR(+) of 19.7 and LR(-) of 0.10. The diagnostic odds ratio was 213. CONCLUSIONS History and physical examination had low diagnostic test accuracy. Abdominal radiographs had low diagnostic test accuracy, despite moderate discriminatory characteristics. Point-of-care ultrasound had the highest diagnostic test accuracy to rule in or rule out intussusception.
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Affiliation(s)
| | | | - Susan Fowler
- Washington University, Brown School Library, St. Louis, MO
| | - Catherine Messina
- Department of Family, Population and Preventive Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook, NY
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Fakhry T, Fawzy AN, Mahdy AT. The efficacy of delayed, repeated reduction enema in management of intussusception. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00072-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Management of intussusception varies according to the case, time of presentation, cause, and symptoms. In this study, we focus on describing the demographic and sonographic characteristics of children with intussusception with failed initial enema reduction who were managed by delayed repeated enema attempts and identify predictors associated with successful repeated reduction.
Results
This study was conducted in the period from December 2018 to April 2020 at university hospitals (pediatric surgery unit). This study included 40 patients with intussusceptions; 27 are males, and 13 of them are females. Their ages ranged from 5 months to 3 years old. Patients in this study had failed initial enema reduction attempts under sonographic guidance and had subsequent delayed (≥ 2 h from the initial attempt) repeated enemas made up the study population.
Of the 40 patients, 34 patients (85%) were successfully reduced, and 6 patients (15%) failed reduction and required surgical intervention. There were no deaths, perforation, or resection of gangrenous bowel. Two cases showed recurrences, but required no surgical intervention. It is also noted that early presentation (< 12 h), stable, non-complicated, and with little or no bloody diarrhea are predictors of successful DRE.
Conclusion
Delayed repeated enema in the treatment of intussusception is a viable option in patients with unsuccessful initial enema reduction provided that early presentation, stable vitals, and no signs of perforation or peritonitis are present.
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Suleiman JM, Msuya D, Tarmohamed M, Lodhia J. Prolapsed ileocolic intussusception in an infant: An uncommon presentation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Aoki Y, Iguchi A, Kitazawa K, Kobayashi H, Senda M, Honda A. Differences in Clinical Findings Based on the Duration of Symptoms and Age of Children With Ileocolic Intussusception: A Single-Institution Survey in Rural Japan. Pediatr Emerg Care 2021; 37:537-542. [PMID: 32108726 DOI: 10.1097/pec.0000000000001750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to determine whether the rates of abdominal pain or irritability, vomiting, and hematochezia differ depending on the duration of symptoms and age of the children with ileocolic intussusception. METHODS We retrospectively investigated the charts of ileocolic intussusception children between January 2008 and December 2017 at a rural general hospital in Japan. Children were separated into 2 groups: the early visiting group, including children examined within 6 hours after onset, and the late visiting group, including children examined more than 6 hours after onset. We further separated them into 2 groups based on age: the infant group (age, <18 months) and the child group (age, ≥18 months). We compared clinical features, such as abdominal pain or irritability, vomiting, and hematochezia, between each group. RESULTS Among 105 children with ileocolic intussusception, 51 were in the early visiting group and 49 were in the infant group. Hematochezia less frequently occurred in the early visiting group than in the late visiting group (29% vs 50%, P = 0.046). Furthermore, abdominal pain or irritability occurred less frequently in the infant group than in the child group (79.6% vs 98.2%, P = 0.003). Conversely, vomiting and hematochezia were more frequent in the infant group than in the child group (83.7% vs 51.8%, P < 0.001; 55.1% vs 26.8%, P = 0.005). CONCLUSIONS Clinical features of pediatric ileocolic intussusception may depend on symptom duration and age.
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Affiliation(s)
| | - Akihiro Iguchi
- From the Department of Pediatrics, Asahi General Hospital, Chiba
| | | | | | - Masayoshi Senda
- From the Department of Pediatrics, Asahi General Hospital, Chiba
| | - Akihito Honda
- From the Department of Pediatrics, Asahi General Hospital, Chiba
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Caro-Domínguez P, Hernández-Herrera C, Le Cacheux-Morales C, Sánchez-Tatay V, Merchante-García E, Vizcaíno R, Fernández-Pineda I. Ileocolic intussusception: Ultrasound-guided hydrostatic reduction with sedation and analgesia. RADIOLOGIA 2021; 63:406-414. [PMID: 34625196 DOI: 10.1016/j.rxeng.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The first-choice treatment for ileocolic intussusception is imaging-guided reduction with water, air, or barium. The objectives of the current study were to evaluate the efficacy and safety of ultrasound-guided reduction of intussusception using water in patients under sedation and analgesia. We compare this approach with our previous experience in reduction using barium under fluoroscopic guidance without sedation and analgesia and investigate what factors predispose to surgical correction. MATERIAL AND METHODS We retrospectively reviewed cases of children with ileocolic intussusception treated in a third-level pediatric hospital during a 52-month period: during the first 24 months, reduction was done using barium and fluoroscopy without sedoanalgesia, and during the following 28 months, reduction was done using water and ultrasound with sedoanalgesia. A pediatric radiologist and a pediatrician reviewed the clinical history, surgical records, and imaging studies. RESULTS In the 52-month period, 59 children (41 boys and 18 girls; mean age, 16.0 months) were diagnosed with ileocolic intussusception at our hospital. A total of 33 reductions (28 patients and 5 recurrences) were done using barium under fluoroscopic guidance, achieving a 61% success rate. A total of 38 reductions (31 patients and 7 recurrences) were done using water under ultrasound guidance with patients sedated, achieving a success rate of 76%. No significant adverse effects were observed in patients undergoing ultrasound-guided hydrostatic reduction under sedation, and the success rate in this group was higher (p = 0.20). The factors that predisposed to surgical reduction were greater length of the intussusception (p = 0.03), location in areas other than the right colon (p = 0.002), and a greater length of time between symptom onset and imaging tests (p = 0.08). CONCLUSION Ultrasound-guided hydrostatic reduction of ileocolic intussusception under sedoanalgesia is efficacious and safe.
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Affiliation(s)
- P Caro-Domínguez
- Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - C Hernández-Herrera
- Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - C Le Cacheux-Morales
- Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - V Sánchez-Tatay
- Servicio de Urgencias Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - E Merchante-García
- Unidad de Radiología Pediátrica, Departamento de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - R Vizcaíno
- Departamento de Cirugía Pediátrica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - I Fernández-Pineda
- Departamento de Cirugía Pediátrica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Abstract
PURPOSE We assessed management and outcomes for intussusception at nine academic hospitals in South Africa. METHODS Patients ≤ 3 years presenting with intussusception between September 2013 and December 2017 were prospectively enrolled at all sites. Additionally, patients presenting between July 2012 and August 2013 were retrospectively enrolled at one site. Demographics, clinical information, diagnostic modality, reduction methods, surgical intervention and outcomes were reviewed. RESULTS Four hundred seventy-six patients were enrolled, [54% males, median age 6.5 months (IQR 2.6-32.6)]. Vomiting (92%), bloody stool (91%), abdominal mass (57%), fever (32%) and a rectal mass (29%) represented advanced disease: median symptom duration was 3 days (IQR 1-4). Initial reduction attempts included pneumatic reduction (66%) and upfront surgery (32%). The overall non-surgical reduction rate was 28% and enema perforation rate was 4%. Surgery occurred in 334 (70%), 68 (20%) patients had perforated bowel, bowel resection was required in 61%. Complications included recurrence (2%) and nosocomial sepsis (4%). Length of stay (LOS) was significantly longer in patients who developed complications. Six patients died-a mortality rate of 1%. There was a significant difference in reduction rates, upfront surgery, bowel resection, LOS and mortality between centres with shorter symptom duration compared longer symptom duration. CONCLUSION Delayed presentation was common and associated with low success for enema reduction, higher operative rates, higher rates of bowel resection and increased LOS. Improved primary health-care worker education and streamlining referral pathways might facilitate timely management.
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Caro-Domínguez P, Hernández-Hernández C, Le Cacheux C, Sánchez-Tatay V, Merchante E, Vizcaíno R, Fernández I. Invaginación ileocólica: reducción hidrostática ecoguiada con sedoanalgesia. RADIOLOGIA 2021. [DOI: 10.1016/j.rx.2020.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pediatric Covid-19 mesenteric lymphoid hyperplasia associated intussusception: A case report and literature review. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021; 73:101988. [PMID: 34430199 PMCID: PMC8376529 DOI: 10.1016/j.epsc.2021.101988] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/31/2021] [Indexed: 12/24/2022] Open
Abstract
A 2 month old, full term, previously healthy male, with known COVID-19 infection 3 weeks prior to arrival presented to the Emergency Department (ED) with complaints of 5–6 episodes of non-bilious and non-bloody emesis. According to the child's parents, the emesis was mostly associated with feeding. His parents endorsed that the patient had one episode of diarrhea that was maroon in color and appeared different than typical stools. Abdominal exam at that time was non distended with no tenderness and no other significant findings. The patient was observed while feeding in the ED and was noted to have some minimal spit up with arching of his back. A presumptive diagnosis of reflux was made, and the patient was discharged home with education on feeding. The infant was brought back to the ED the following day due to worsening emesis. Additionally, his parents noted more episodes of bloody stools. His abdomen appeared mildly distended with moderate tenderness on abdominal examination. During evaluation, a large “currant jelly” stool was observed (Fig. 1). An abdominal ultrasound was obtained, which demonstrated an ileocolic intussusception with a possible enlarged lymph node as lead point. The patient received an air contrast enema with successful reduction. Repeat ultrasound was obtained which confirmed resolution, and the patient was admitted for overnight observation. The patient tested positive for SARS-CoV-2 using polymerase chain reaction testing. He was discharged the following day after successful advancing of diet, normal serial abdominal exams, and observed normal bowel movements.
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Tan SK, Tan CW, Hassan J, Nallusamy MA, Boo JA, Puspanathan P. Sphacelation with auto-anastomosis of the intestine: a rare outcome of intussusception in a child—a case report. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00103-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intussusception is the telescoping of a proximal segment of the bowel into a distal segment. It can be idiopathic or pathological. Children commonly present with colicky abdominal pain, vomiting, a palpable abdominal mass, and bloody stools. Our case describes the unusual presentation of bowel sphacelation with auto-anastomosis in a child with intussusception and its clinical progression.
Case presentation
A 3-year-old boy with underlying stage IV rhabdomyosarcoma of the left orbit presented with high-grade fever and diarrhea for 1 day. He was treated for neutropenic sepsis in view of low absolute neutrophil count and recent history of chemotherapy. During his admission, he developed abdominal distension, high bilious aspirates, and diarrhea with bloody stools. Abdominal X-ray showed dilated bowel loops. Impression was septic ileus with coagulopathy. He was treated with blood transfusion and bowel rest. On the 6th day of illness, he passed out a tubular structure per rectum which was confirmed to be a segment of gangrenous bowel by histopathological examination. A diagnosis of intussusception with bowel sphacelation was made. He was treated conservatively, and his obstruction was resolved. He was discharged well with no abdominal symptoms during follow-up.
Conclusion
Intussusception is a common cause of small bowel obstruction in children. A high index of suspicion of intussusception should be maintained in children presenting with vomiting and bloody stools complemented by ultrasound to avoid missing this diagnosis. Sphacelation of the intussuscepted bowel with auto-anastomosis is a rare presentation of intussusception with a favorable outcome.
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Diagnostic Applications of Point-of-Care Ultrasound in Pediatric Emergency Medicine. Emerg Med Clin North Am 2021; 39:509-527. [PMID: 34215400 DOI: 10.1016/j.emc.2021.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Point-of-care ultrasound has become an essential part of pediatric emergency medicine training and practice. It can have significant clinical benefits, including improving diagnostic accuracy and decreasing length of stay, and does not require radiation exposure for patients. In this review, we summarize the current diagnostic point-of-care ultrasound applications in pediatric emergency medicine, their evidence, and techniques.
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Bergmann KR, Arroyo AC, Tessaro MO, Nielson J, Whitcomb V, Madhok M, Yock-Corrales A, Guerrero-Quesada G, Chaudoin L, Berant R, Shahar-Nissan K, Deanehan JK, Lam SHF, Snelling PJ, Avendano P, Cohen SG, Friedman N, Ekpenyong A, Pade KH, Park DB, Lin-Martore M, Kornblith AE, Montes-Amaya G, Thomas-Mohtat R, Jin J, Watson D, Sivitz A. Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception: A Multicenter, Noninferiority Study of Paired Diagnostic Tests. Ann Emerg Med 2021; 78:606-615. [PMID: 34226072 DOI: 10.1016/j.annemergmed.2021.04.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/13/2021] [Accepted: 04/27/2021] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVE To determine the diagnostic accuracy of point-of-care ultrasound (POCUS) performed by experienced clinician sonologists compared to radiology-performed ultrasound (RADUS) for detection of clinically important intussusception, defined as intussusception requiring radiographic or surgical reduction. METHODS We conducted a multicenter, noninferiority, observational study among a convenience sample of children aged 3 months to 6 years treated in tertiary care emergency departments across North and Central America, Europe, and Australia. The primary outcome was diagnostic accuracy of POCUS and RADUS with respect to clinically important intussusception. Sample size was determined using a 4-percentage-point noninferiority margin for the absolute difference in accuracy. Secondary outcomes included agreement between POCUS and RADUS for identification of secondary sonographic findings. RESULTS The analysis included 256 children across 17 sites (35 sonologists). Of the 256 children, 58 (22.7%) had clinically important intussusception. POCUS identified 60 (23.4%) children with clinically important intussusception. The diagnostic accuracy of POCUS was 97.7% (95% confidence interval [CI] 94.9% to 99.0%), compared to 99.3% (95% CI 96.8% to 99.9%) for RADUS. The absolute difference between the accuracy of RADUS and that of POCUS was 1.5 percentage points (95% CI -0.6 to 3.6). Sensitivity for POCUS was 96.6% (95% CI 87.2% to 99.1%), and specificity was 98.0% (95% CI 94.7% to 99.2%). Agreement was high between POCUS and RADUS for identification of trapped free fluid (83.3%, n=40/48) and decreased color Doppler signal (95.7%, n=22/23). CONCLUSION Our findings suggest that the diagnostic accuracy of POCUS performed by experienced clinician sonologists may be noninferior to that of RADUS for detection of clinically important intussusception. Given the limitations of convenience sampling and spectrum bias, a larger randomized controlled trial is warranted.
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Affiliation(s)
- Kelly R Bergmann
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN.
| | - Alexander C Arroyo
- Department of Pediatric Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Mark O Tessaro
- Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathan Nielson
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Valerie Whitcomb
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Manu Madhok
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Adriana Yock-Corrales
- Department of Emergency Medicine, Hospital Nacional de Niños: "Dr. Carlos Sáenz Herrera," CCSS, San José, Costa Rica
| | - German Guerrero-Quesada
- Department of Surgery, Hospital Nacional de Niños: "Dr. Carlos Sáenz Herrera," CCSS, San José, Costa Rica
| | - Lindsey Chaudoin
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, NC
| | - Ron Berant
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Keren Shahar-Nissan
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - J Kate Deanehan
- Department of Pediatric Emergency Medicine, Johns Hopkins Children's Center, Baltimore, MD
| | - Samuel H F Lam
- Department of Emergency Medicine, Sutter Medical Center Sacramento, Sacramento, CA
| | - Peter J Snelling
- Department of Pediatric Emergency Medicine, Gold Coast University Hospital and Griffith University, Southport, Queensland, Australia
| | - Pablo Avendano
- Division of Pediatric Emergency Medicine, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Stephanie G Cohen
- Department of Pediatrics and Emergency Medicine, Children's Healthcare Atlanta and Emory University, Atlanta, GA
| | - Nir Friedman
- Department of Pediatric Emergency Medicine, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Atim Ekpenyong
- Department of Pediatrics, University of California, San Diego, CA
| | - Kathryn H Pade
- Department of Pediatrics, University of California, San Diego, CA
| | - Daniel B Park
- Department of Pediatrics and Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Margaret Lin-Martore
- Department of Emergency Medicine and Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Aaron E Kornblith
- Department of Emergency Medicine and Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Gerardo Montes-Amaya
- Department of Pediatric Emergency Medicine, Hospital Infantil Ciudad Juárez, Chihuahua, Mexico
| | - Rosemary Thomas-Mohtat
- Department of Pediatric Emergency Medicine, Children's National Hospital, Washington, DC
| | - Jing Jin
- Department of Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
| | - Dave Watson
- Department of Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
| | - Adam Sivitz
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, NJ
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Hines JJ, Mikhitarian MA, Patel R, Choy A. Spectrum and Relevance of Incidental Bowel Findings on Computed Tomography. Radiol Clin North Am 2021; 59:647-660. [PMID: 34053611 DOI: 10.1016/j.rcl.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A wide spectrum of incidental bowel findings can be seen on CT, including but not limited to, pneumatosis intestinalis, diverticular disease, non-obstructive bowel dilatation, transient small bowel intussusception, and submucosal fat. Radiologists should be aware that such findings are almost always benign and of little clinical significance in the absence of associated symptoms. Conversely, vigilance must be maintained when evaluating the bowel, because malignant neoplasms occasionally come to clinical attention as incidental imaging findings. When suspicious incidental bowel wall thickening is detected, the radiologist can alert the clinical team to the finding prior to the patient becoming symptomatic, potentially leading to definitive management at an early, more curable stage.
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Affiliation(s)
- John J Hines
- Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Department of Radiology, Huntington Hospital, Northwell Health, 270 Park Avenue, Huntington, NY 11743, USA.
| | - Mark A Mikhitarian
- Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
| | - Ritesh Patel
- Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
| | - Andy Choy
- Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
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Karakuş OZ, Sabuncu S, Ulusoy O, Sarioglu FC, Güleryüz H, Ateş O, Hakgüder G, Olguner M, Akgür FM. Ultrasound-guided hydrostatic enema reduction of intussusception and confirmation with single abdominal radiograph in children. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:451-455. [PMID: 33782988 DOI: 10.1002/jcu.23012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To detect false-positive reduction results after ultrasound (US)-guided hydrostatic intussusception reduction, we have incorporated water-soluble contrast material to the enema fluid and confirmed the reduction with a single abdominal radiograph. We present the results of the combined imaging method for the reduction of intussusception in children. MATERIALS AND METHODS The records of the patients who were treated for intussusception were analyzed retrospectively. Patients were divided into two groups: a US-guided reduction group and a US-guided reduction plus radiographic control group. The patient characteristics, symptoms, treatment methods, outcomes, and complications and follow-up were analyzed. RESULTS A total of 164 intussusception episodes were treated in 153 patients. Hydrostatic reduction of intussusception was performed in 59 patients in the US-guided group and in 94 patients in the US-guided plus radiographic control group. Recurrence rate in the US-guided group was 15.7%, vs 3.5% in the US-guided plus radiography group (P = .029). In the US-guided plus radiographic control group, 5 (5.3%) false positive reductions under US guidance were determined by abdominal radiography. CONCLUSION In order to decrease false positive reduction rate and early recurrence, US-guided intussusception reduction can be performed with saline plus water-soluble contrast material and confirmation of reduction obtained with a single direct abdominal radiograph.
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Affiliation(s)
- Osman Z Karakuş
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Serra Sabuncu
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Oktay Ulusoy
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Fatma Ceren Sarioglu
- Division of Pediatric Radiology, Department of Radiology, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Handan Güleryüz
- Division of Pediatric Radiology, Department of Radiology, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Oğuz Ateş
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
| | - Feza M Akgür
- Department of Pediatric Surgery, Dokuz Eylül University, Medical School, Izmir, Turkey
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Kim PH, Hwang J, Yoon HM, Lee JY, Jung AY, Lee JS, Cho YA. Predictors of failed enema reduction in children with intussusception: a systematic review and meta-analysis. Eur Radiol 2021; 31:8081-8097. [PMID: 33974147 DOI: 10.1007/s00330-021-07935-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/25/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify predictors of failed enema reduction in children with intussusception. METHODS PubMed and EMBASE were searched for all studies published over a 20-year time frame, prior to March 25, 2020. Original articles that reported predictors of failed enema reduction were included. The pooled odds ratio (OR) for successful enema reduction according to various features was calculated. The combined estimates were meta-analytically pooled by random-effects modeling. The risk of bias was assessed using the National Institute of Health Quality Assessment Tool. This review was registered to the PROSPERO (CRD42020190178). RESULTS A total of 38 studies, comprising 40,133 cases, were included. The shorter duration of symptoms (< 24 h; combined OR, 3.812; 95% CI, 2.150-6.759) and abdominal pain (combined OR, 2.098; 95% CI, 1.405-3.133) were associated with the success (all p < 0.001). Age < 1 year (combined OR, 0.385; 95% CI, 0.166-0.893; p = 0.026), fever (combined OR, 0.519; 95% CI, 0.371-0.725; p < 0.001), rectal bleeding (combined OR, 0.252; 95% CI, 0.165-0.387; p < 0.001), and vomiting (combined OR, 0.497; 95% CI, 0.372-0.664; p < 0.001) were associated with the failed reduction. The ascites (combined OR, 0.127; 95% CI, 0.044-0.368; p = 0.001), left-sided intussusception (combined OR, 0.121; 95% CI, 0.058-0.252; p < 0.001), and trapped fluid (combined OR, 0.179; 95% CI, 0.061-0.525; p = 0.017) on US were associated with the failed reduction. CONCLUSIONS Successful predictors for intussusception reduction have been summarized. This evidence can help identify patients who are more likely to fail non-operative reduction and could be potential surgical candidates. KEY POINTS • A shorter duration of symptoms and presence of abdominal pain were associated with increased probability of success. • Age (less than 1 year), presence of fever, rectal bleeding, vomiting, and presence of ascites, left-sided intussusception, or trapped fluid on ultrasonography were associated with decreased probability of success. • This study suggests that various clinical and ultrasonography predictors would help identify patients who are more likely to fail nonoperative reduction and identify potential preoperative candidates.
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Affiliation(s)
- Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jisun Hwang
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Jeong-Yong Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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Chukwubuike KE. Childhood intussusception: Correlation between ultrasound reports and intra-operative findings. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211010824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Intussusception, a common cause of intestinal obstruction in children, is usually diagnosed through ultrasound scan. The aim of this study was to evaluate the correlation between the ultrasound report and intra-operating findings in children who had laparotomy for intussusception. Materials and methods: This was a retrospective study of children aged 12 months and below who had laparotomy for intussusception between January 2017–December 2019 at the pediatric surgery unit of Enugu State University Teaching Hospital Enugu, Nigeria. Findings at ultrasound and findings at surgery were statistically compared. Results: A total of 103 cases of intussusceptions were seen during the study period. Out of this number, 69 patients were treated by laparotomy and formed the basis of this report. There was male predominance and the median age of the patients was 8 months. Abdominal pain was the most common presenting symptom. At presentation, about one-quarter of the patients were anemic while one-half of the patients had electrolyte derangement. Comparing the findings at ultrasound and findings at surgery, ultrasound was found to have an accuracy of 89.9%. Approximately, equal number of patients had manual reduction and bowel resection. Surgical site infection was the most common post-operative complication and mortality occurred in 8 (11.6%) patients. Conclusion: Ultrasound has high accuracy rate and is quite reliable for the diagnosis of intussusception.
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Oh YR, Je BK, Oh C, Cha JH, Lee JH. Suspecting Intussusception and Recurrence Risk Stratification Using Clinical Data and Plain Abdominal Radiographs. Pediatr Gastroenterol Hepatol Nutr 2021; 24:135-144. [PMID: 33833969 PMCID: PMC8007848 DOI: 10.5223/pghn.2021.24.2.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/21/2020] [Accepted: 10/17/2020] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Ye Rim Oh
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Bo Kyung Je
- Department of Radiology, Korea University Ansan Hospital, Ansan, Korea
| | - Chaeyoun Oh
- Department of Pediatric Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Jae Hyung Cha
- Medical Science Research Center, Korea University Ansan Hospital, Ansan, Korea
| | - Jee Hyun Lee
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea
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A Hospital-Based Multi-Centric Study to Determine the Clinico-Epidemiological Profile of Intussusception in Children < 2 Years in Rajasthan, India. Indian J Pediatr 2021; 88:131-137. [PMID: 33403615 DOI: 10.1007/s12098-020-03601-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/02/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the clinical and epidemiological profile of Intussusception in children aged <2 y after introduction of rotavirus vaccine in Universal Immunization Programme of Rajasthan. METHOD This was a hospital-based multi-centric surveillance study conducted at three tertiary care sentinel sites in Rajasthan over a period of 2 y. Children <2 y of age admitted with intussusception as per Brighton's criteria 1 were enrolled. Demographic details including age, sex, clinical presentation, diagnostic methods, duration of symptoms, mode of treatment, and complications were recorded and analyzed. RESULTS During the study period of 2 y, the authors identified 164 cases of intussusception based on level-1 Brighton's criteria. Median age at presentation was 7 mo [Interquartile range (IQR) 5-10 mo] with a male to female ratio of 2:1. Pain abdomen and blood stained stool were the commonest presenting complaints (88.4% and 81.7%, respectively). Commonest site of intussusception was Ileocolic (82.32%). Pathological lead point was identified in 18.9% cases. Distinct seasonality was observed as maximum cases of intussusception were detected in the months of Jan-March (34.1%). Surgical intervention was required in the 89.63% cases. The median time duration between onset of symptoms and admission at sentinel site was 2 d (IQR 1-3 d). Proportion of cases that required surgery increased as the time interval between onset of symptoms and admission increases. CONCLUSION Intussusception is a common surgical condition among children under-two years of age with majority of cases occurring during infancy. Case management is dependent primarily on time duration elapsed between symptoms onset and admission to tertiary care centre. Early case detection and timely referral may provide an opportunity to avoid surgical interventions.
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Delgado-Miguel C, García A, Delgado B, Muñoz-Serrano AJ, Miguel-Ferrero M, Barrena S, Lopez Santamaria M, Martinez L. Routine Ultrasound Control after Successful Intussusception Reduction in Children: Is It Really Necessary? Eur J Pediatr Surg 2021; 31:115-119. [PMID: 33124030 DOI: 10.1055/s-0040-1719055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Recurrence of ileocolic intussusception (ICI) has been related to residual bowel wall edema after enema reduction. Early oral tolerance has been associated with a higher risk of re-intussusception, so an imaging test (ultrasound) has traditionally been performed before restarting oral tolerance. Our aim is to analyze the cost-effectiveness of performing a routine ultrasound in patients who remain asymptomatic after successful enema reduction. MATERIALS AND METHODS A retrospective observational study was performed in patients with ICI who underwent a successful enema reduction between 2005 and 2019 and distributed in two groups according to whether or not a routine ultrasound was performed before restarting oral tolerance: group A (ultrasound) or B (no ultrasound). We analyzed demographic, clinical and laboratory variables, length of hospital stay, and recurrence rate. RESULTS We included 366 patients who presented 373 ICI episodes (165 in group A and 208 in group B), without significant differences in gender and age. Group A patients presented a higher percentage of vomiting and bloody stools than those in group B without differences in the other clinical features studied, time of evolution, or laboratory variables. Group A presented a higher length of hospital stay than group B (36 vs. 24 hours), although it was not statistically significant (p = 0.30). No statistically significant differences were observed in the recurrence rate between both groups (10.3% A vs. 10.8% B; p = 0.83). CONCLUSION Performing routine ultrasound before restarting oral tolerance in asymptomatic patients after successful ICI reduction does not decrease the risk of re-intussusception and should not be routinely encouraged.
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Affiliation(s)
| | - Antonella García
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Bonifacio Delgado
- Department of Mathematics, Complutense University of Madrid, Madrid, Comunidad de Madrid, Spain
| | | | | | - Saturnino Barrena
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
| | | | - Leopoldo Martinez
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
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Hsiao HJ, Wang CJ, Lee CC, Hsin YC, Yau SY, Chen SY, Lo WC, Wu PW, Chen CL, Chang YJ. Point-of-Care Ultrasound May Reduce Misdiagnosis of Pediatric Intussusception. Front Pediatr 2021; 9:601492. [PMID: 33614550 PMCID: PMC7889804 DOI: 10.3389/fped.2021.601492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/08/2021] [Indexed: 12/01/2022] Open
Abstract
Aim: Intussusception, the most common abdominal emergency in early childhood, is frequently misdiagnosed at initial presentation. The effect of using point-of-care ultrasonography (POCUS) by emergency medicine physicians on pediatric intussusception misdiagnosis rate remains unclear. Here, we summarize outcomes and misdiagnoses before and after training junior and senior physicians on using POCUS for diagnosing intussusception and compared their performance levels. Materials and Methods: This observational cohort analysis included patients with suspected intussusception who visited a pediatric emergency department (ED) between January 2017 and December 2019. All enrolled patients were evaluated by junior (<10-year experience) or senior attending physicians. Misdiagnosis was defined as a finding of negative air reduction or confirmation of diagnosis on ED revisit or admission. The misdiagnosis rates and outcomes before and after POCUS training for intussusception diagnosis were evaluated and performance of the junior and senior physicians was compared. Results: Of the 167 enrolled patients, 130 were confirmed to have intussusception by air reduction. Misdiagnosis rate was significantly lower in the post-training patient group after training than in the pre-training patient group (43.7 vs. 12.7%, P < 0.001). After training, fewer misdiagnoses were made by the junior (59.1 vs. 25.9%, P = 0.003) and senior (31.7 vs. 0%, P < 0.001) physicians. In the post-training patient group, the door-to-reduction time and rate of ultrasonography consultation with an expert also decreased significantly (118.2 ± 124.5 vs. 198 ± 250.2 min, P = 0.006). Abdominal pain (80.9%) was the most common symptom of intussusception, followed by vomiting (58.3%), fever (17.8%), bloody stool (15.4%), and diarrhea (14.2%). Even after training, the presenting symptoms of intussusception often leading junior physicians to misdiagnosis were diarrhea and fever. Conclusions: A brief POCUS training leads to decreased misdiagnosis rates in both the senior and junior physicians. Junior physicians should increase their awareness regarding diarrhea and fever being the presenting symptoms of intussusception, particularly in early childhood. Combining clinical judgment and POCUS results forms the core principle of the evaluation of children with intussusception.
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Affiliation(s)
- Hsiang-Ju Hsiao
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chao-Jan Wang
- Department of Radiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chien-Chung Lee
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Chen Hsin
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Sze-Yuen Yau
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Yen Chen
- Department of Pediatrics, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Wan-Chak Lo
- Department of Radiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Patricia-Wanping Wu
- Department of Radiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chyi-Liang Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Jung Chang
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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