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Using Color Doppler Sonography–Guided Reduction of Intussusception to Differentiate Edematous Ileocecal Valve and Residual Intussusception

Soroka University Medical Centre Ben Gurion University of the Negev Beer Sheva 84101, Israel

Editor's note.—The reader's attention is directed to the article titled "Intussusception: The Use of Delayed, Repeated Reduction Attempts and the Management of Intussusceptions due to Pathologic Lead Points in Pediatric Patients," which appears on page 1169 of this issue.

Intussusception is a common emergency in infants and young children. Sonography has been used to evaluate children believed to have intussusception [1]. Sonographically guided hydrostatic reduction has become a popular nonsurgical technique for treatment of intussusception and has been described comprehensively elsewhere [2]. Criteria for successful reduction include disappearance of the intussusceptum, reflux of fluid from the cecum into the terminal ileum, and visualization of the fluid-filled ileum.

The ileocecal valve may appear edematous after a successful reduction of intussusception and may look like a doughnut-shaped structure in the area of Bauhin's valve [3]. The appearance may resemble residual intussusception. It has been proposed that a continuous movement of air bubbles floating from the cecum into the ileum indicates successful reduction and vice versa—that stagnation of flow at the cecum implies incomplete reduction even if a patent ileocecal valve and fluid-filled terminal ileum are visible [3].

Color Doppler sonography has been reported to be useful for evaluating urine flow through the ureterovesical junction ("jet phenomenon") and depicting communication between the urinary bladder and a bladder diverticulum [4]. To the best of our knowledge, water flow recognition on color Doppler sonography has not been previously reported.

Air bubbles in the fluid can be seen by an experienced sonography operator [2], but we found in our practice that color Doppler sonography visualizes continuous fluid flow more easily (Fig. 3A, 3B, 3C).

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A. —10-month-old male infant who underwent hydrostatic reduction of ileocolic intussusception. Longitudinal sonogram taken during administration of hydrostatic water enema shows fluid with air bubbles surrounding intussusceptum (arrows).

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B. —10-month-old male infant who underwent hydrostatic reduction of ileocolic intussusception. Longitudinal sonogram of right lower abdomen obtained immediately after successful reduction shows opened "lips" of ileocecal valve. Recognition of flow through ileocecal valve without air bubble detection in fluid is difficult.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C. —10-month-old male infant who underwent hydrostatic reduction of ileocolic intussusception. Color Doppler sonogram clearly shows flow through ileocecal valve.

The experience of the radiologist significantly affects the results of sonographically guided hydrostatic reduction [5]. Using color Doppler sonography to determine flow through the ileocecal valve might improve the performance of an inexperienced radiologist who is learning to use this technique.

In conclusion, we report a new factor that we believe might improve the monitoring of success in the sonographically guided hydrostatic reduction of intussusception.

References

1. Daneman A, Navarro O. Intussusception 1: A review of diagnostic approaches. Pediatr Radiol2003; 33:79 –85[Medline]
2. Peh WC, Khong PL, Lam C, et al. Reduction of intussusception in children using sonographic guidance. AJR1999; 173:985 –988[Free Full Text]
3. Woo SK, Kim JS, Suh SJ, Paik TW, Choi SO. Childhood intussusception: US-guided hydrostatic reduction. Radiology1992; 182:77 –80[Abstract/Free Full Text]
4. Weingardt JP, Nemcek AA Jr, Miljkovic SC. The diverticular jet effect: color Doppler differentiation of bladder diverticula from other pelvic fluid collections. J Clin Ultrasound1994; 22:397 –400[Medline]
5. Crystal P, Hertzanu Y, Farber B, Shabshin N, Barki Y. Sonographically guided hydrostatic reduction of intussusception in children. J Clin Ultrasound2002; 30:343 –348[Medline]

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This Article Figures Only Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Crystal, P. Articles by Barki, Y. Search for Related Content PubMed PubMed Citation Articles by Crystal, P. Articles by Barki, Y. Social Bookmarking                      What's this?