32 Section I Pediatrics

FIGURE 7.7: Ileocolic intussusception. Barium enema shows the intussusception as the f ling defect within
the hepatic f exure sur rounded by spiral mucosal folds. Signif cant distended small bow el represents distal
small bow el obstr uction. (F rom Fleisher GR, Ludwig S, and Baskin MN. Atlas of P ediatric Emergency Medicine.
Philadelphia: Lippincott Williams & Wilkins, 2004.)

FIGURE 7.8: Barium enema demonstrating intussusception. Obstr uction of the colon at the hepatic f exure.
Note the characteristic coiled-spring appearance. (F rom Eisenberg RL. An Atlas of Differential Diagnosis, 4th ed.
Philadelphia: Lippincott Williams & Wilkins, 2003.)

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 Chapter 7 Intussusception 33

Abdominal CT Scan
■ Not a f rst-line imaging modality
■ May be used to characterize a pathologic lead point pre viously detected b y ultrasound
■ May be identif ed incidentally when CT is obtained for other reasons (e.g ., appendicitis
evaluation)
■ Sensitivity and specif city for diagnosis ha ve not been w ell studied
■ Look for a round soft tissue mass with concentric rings, “target sign” representing loops of
small bow el most lik ely in the area of the ileum

TABLE 7.5: Abdominal/pelvic CT: intussusception

IV contrast Yes
PO contrast Yes
Amount of radiation 10–14 mSv*
*Approximate dose.

Classic Images

A B

FIGURE 7.9: Two images of intussusception seen on contrast CT scan: A: There is a mass within the mid
abdomen demonstrating an inter nal swir led appearance with central low attenuation lik ely representing
mesenteric fat within an ileocolic intussusception ( arrow). B: The intussusception is also captured on
longitudinal vie w (arrow). The sur rounding loops of small bow el are dilated and f lled with gas and stool lik ely
secondar y to obstr uction and reactive ileus. ( Courtesy of Children’s Hospital Boston, Boston, MA.)

FIGURE 7.10: Colonic intussusception. Axial T2-w eighted image demonstrating la yers of sigmoid colonic
intussusception with outer colon w all (arrow), pericolonic fat ( arrowhead), and inner colon w all (thin arrow). (From
Leyendecker JR and Brown JJ. Practical Guide to Abdominal and P elvic MRI. Philadelphia: Lippincott Williams &
Wilkins, 2004.)

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 34 Section I Pediatrics

Basic Management
■ NPO
■ Intravenous h ydration
■ Pain control
■ General surger y consultation
● Surgeon present during air enema reduction in case of perforation or massive
pneumoperitoneum
■ Reduction via enema
● Barium was pre viously used, but now air is used more commonly
● Safer, cheaper, and more effective
● In the prone position, an uninf ated balloon catheter is placed into the rectum; buttocks are
taped together
● Air is introduced into the rectum with monitored pressure
● Ref ux of air from cecum into ileum conf rms complete reduction
● Patients should not be sedated for pressure reduction enemas
■ Antibiotics
● With peritoneal signs
● Prophylactically for potential perforation during pressure reduction procedure
■ Admission P ost-reduction
● There is a 10% recur rence usually within 24–48 hour s
■ Surgical treatment
● Suspected intussusception in those who are acutely ill
● Evidence of perforation
● Patients in whom nonoperative reduction is unsuccessful
● Resection of a pathologic lead point

Summary
TABLE 7.6: Advantages and disadvantages of imaging modalities in intussusception
Imaging modalities Advantages Disadvantages
KUB Quick Low sensitivity ( ⬃45%)
Universally a vailable Low specif city
Low radiation High false negative rate
Ultrasound Low cost Availability
High sensitivity (98–100%) Operator-dependent
High specif city (88–100%) Body habitus limitations
Minimal patient discomfor t
No radiation
Contrast enema Gold standard Limited a vailability
Diagnostic and therapeutic Requires skilled per sonnel
Radiation exposure
Requires on-site surgeon for reduction
CT scan Used more for adult diagnosis Radiation exposure
Identif cation of lead points Not well studied in children

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