Intussusception in Children: Diagnostic Imaging and Treatment

Abstract

Children with clinically suspected intussusception should undergo enema reduction after surgical consultation. The only absolute contraindications to enema are signs of peritonitis on clinical exam or free air on abdominal radiographs. Air enema has better overall reduction rates than liquid enema, but the outcome depends on the experience of the radiologist (moderate evidence). Ultrasound (US) should be the primary imaging modality in the initial diagnosis of intussusception because it is a noninvasive test with high sensitivity and specificity. US also plays a role in the evaluation of reducibility of intussusception, presence of a lead point mass, potential incomplete reduction after enema, and of intussusception limited to small bowel (limited evidence). Barium should not be used due to the poorer outcomes compared with iodinated liquid contrast in those children who perforate (moderate evidence). Abdominal radiographs have poor sensitivity for the detection of intussusception, but may serve to screen for other diagnoses in the differential diagnosis, such as constipation, and for free peritoneal air. For evaluating children with a low probability for intussusception, sonography is the preferred screening test (limited evidence). The use of delayed repeat enema for the reduction of intussusception shows promise, but there are few data on the appropriate methods or time (limited evidence). For recurrence of intussusception, including multiple recurrences, enema is the preferred method for reduction (limited evidence).