Role of color Doppler ultrasonography in predicting the viability of bowel loops in children with intussusception

Abstract

Abstract Background: Intussusception mainly affects infants and toddlers, though it can affect any age of the pediatric population. Intussusception has been successfully diagnosed using B-mode ultrasonography. Once, hydrostatic or pneumatic intussusception reduction under image guidance was used to treat these children. But this needs a critical assessment of the preserved bowel viability before the procedure. There are several criteria based on ultrasonography for predicting bowel reducibility during hydrostatic or pneumatic reduction. Our study aimed to demonstrate the role of color Doppler ultrasound in predicting the viability of the intestine in children with intussusception. Materials and Methods: Thirty children under 14 years of age with clinical symptoms suggestive of intussusception were evaluated on color Doppler and power Doppler ultrasonography to predict the viability of bowel loops in children with intussusception. The compression technique was used for graded compression, and the patients were followed for clinical/surgical outcomes. Sensitivity, specificity, positive predictive value, negative predictive value, the strength of agreement of trapped fluid, vascularity at apex, and power Doppler for predicting viability of bowel loops were statistically analyzed. Results: In 17 (56.67%) children, vascularity at the apex of the intussusceptum loop was absent. Vascularity at the apex was present in only 13 of 30 patients (43.33%). On the final clinical/surgical outcome, 17 (56.67%) of patients had necrosis of the bowel loop. Bowel loops were viable in only 13 of 30 patients (43.33%). Of patients who had viability of bowel loops, 76.92% of patients did not have trapped fluid. If the trapped fluid was absent, there was a 100.00% probability of viability of bowel loops; if trapped fluid was present, there was an 85.00% chance of necrosis. Among patients who had necrosis, 100.00% of patients had trapped fluid. In predicting bowel loops’ viability, vascularity’s sensitivity and specificity at the apex on color Doppler were maximum: sensitivity 100% (75.29%–100.00%) and specificity 100% (80.49%–100.00%). In predicting the viability of bowel loops, the sensitivity and specificity of power Doppler at the apex of the intussusceptum loop were maximum: sensitivity 100% (75.29%–100.00%) and specificity 100% (80.49%–100.00%) each. Excellent agreement was seen between final diagnosis and vascularity at the apex with kappa 1 and P value <0.0001. Among 17 patients diagnosed with bowel necrosis, 17 had similar findings in vascularity at the apex. Among 13 patients diagnosed with viable bowel loops, 13 had similar vascularity findings at the apex. The concordance rate was 100.00%, and the discordance rate was 0.00% between the final diagnosis and vascularity at the apex. Conclusion: The presence or absence of blood flow in the intussusceptum loop on color Doppler sonography and power Doppler is a promising predictor of bowel viability. Trapped fluid within the intussusceptum loop emphasizes the possibility of no spontaneous resolution of intussusception. Color Doppler ultrasonography, which detects blood flow in the invaginated bowel, seems to be the most valuable diagnostic modality for predicting the likelihood of bowel reduction.