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DOI:10.2214/AJR.05.2049
AJR 2007; 188:275-279
© American Roentgen Ray Society

Original Research

Sonography of Pediatric Small-Bowel Intussusception: Differentiating Surgical from Nonsurgical Cases

Martha M. Munden1, John F. Bruzzi2, Brian D. Coley3 and Reginald F. Munden2

1 Edward B. Singleton Diagnostic Imaging Services, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030-2399.
2 Department of Diagnostic Imaging, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 57, Houston, TX 77030.
3 Department of Radiology, Columbus Children's Hospital, Columbus, OH 43205.

OBJECTIVE. The purpose of this study was to determine whether there are clinical or sonographic findings that can be used to differentiate benign self-limited small-bowel intussusception from pathologic small-bowel intussusception that necessitates surgical intervention.

MATERIALS AND METHODS. A retrospective search was performed of abdominal sonograms obtained at two institutions between January 1996 and June 2005. Sonographic findings were correlated with medical and surgical records.

RESULTS. A total of 35 cases of isolated small-bowel intussusception were found. Thirteen (37%) of these cases necessitated surgical intervention, and 22 (63%) of the cases were benign and self-limiting. Patients with self-limiting intussusception were younger than patients with intussusception necessitating surgical intervention (mean, 4.2 vs 7.5 years; p = 0.0327). Abdominal sonograms depicted ascites and small-bowel obstruction significantly more frequently in patients with small-bowel intussusception necessitating surgery (n = 7 [54%] for each finding) than in patients with self-limiting intussusception (n =2 [9%], n =0) (p = 0.006 and p = 0.0003, respectively). At sonography, patients who later underwent surgical intervention had small-bowel intussusception of significantly greater length (mean, 7.3 cm) than those treated conservatively (mean length, 1.9 cm) (p < 0.0001). Intussusception length greater than 3.5 cm was considered a sensitive and specific independent predictor of the need for surgery (sensitivity, 93%; specificity, 100%).

CONCLUSION. When small-bowel intussusception is detected in infants and children undergoing abdominal sonography, intussusception length greater than 3.5 cm is a strong independent predictor of the need for surgical intervention.

Keywords: abdomen • pediatric imaging • small-bowel intussusception • sonography


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