Materiały źródłowe

• #1 Intussusception – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/679

  Intussusception most commonly occurs in infants between the ages of 3 and 12 months, with a peak between ages 5 and 9 months. […] When there is clinical suspicion, imaging has a valuable role. Plain abdominal x-ray may reveal an intestinal obstruction and paucity of wind in the right lower quadrant. The presence or absence of free gas will influence subsequent management; abdominal ultrasound undertaken by an experienced radiologist will usually establish the diagnosis; contrast enema (most often air but may be liquid contrast) is the most specific and sensitive test for diagnosis. […] Intussusception results in venous obstruction and bowel-wall edema that can progress to bowel necrosis, perforation, and, rarely, death. […] Key diagnostic factors include presence of risk factors, male gender, age 2 to 12 months, colicky abdominal pain, vomiting, lethargy/irritability in between waves of pain, blood per rectum/red currant jelly stool, and hypovolemic shock. […] 1st tests to order include ultrasound, abdominal plain-film x-ray, and diagnostic enema. […] Tests to consider include CT abdomen.

• #2 Pediatric Intussusception Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/409870-overview

  Intussusception is the most common cause of bowel obstruction in children 3 months to 6 years of age. Invagination of a bowel segment (usually, the small bowel) into the lumen of the more distal bowel (usually, the colon) occurs. The invaginated segment (intussusceptum) is carried distally by peristalsis. Mesentery and vessels become involved with the intraluminal loop and are squeezed within the engulfing segment (intussuscipiens). Almost all occurrences are acute, and bowel obstruction is often the presenting sign of intussusception. […] When this condition occurs in neonates and in children older than 2 years, there is a high incidence of associated bowel abnormality that serves as an initiating lead point for intussusception (about 5% of patients are found to have a lead point). […] A number of studies have shown that rotavirus vaccine is associated with an increased risk of intussusception, particularly after administration of the first dose.

• #3 Clinical case presentation: Diagnosis and treatment of idiopathic intussusception in adults

  http://www.scielo.org.co/scielo.php?pid=S0120-99572015000400012&script=sci_arttext&tlng=en

  Clinical case presentation: Diagnosis and treatment of idiopathic intussusception in adults […] Intestinal intussusception is an uncommon condition in adults which causes 1% to 5% of intestinal obstructions. […] In most cases the diagnosis is made after surgery, but with the development of imaging techniques, a diagnosis is possible prior to intervention. […] Given the findings from tests and the patient’s clinical picture which was highly suggestive of intestinal intussusception, we decided to perform an exploratory laparotomy. […] Preoperative diagnosis is difficult, but advances in the field of radiology have optimized timely diagnosis of this disorder. […] Today abdominal computed tomography (CT) is the most useful technique for preoperative diagnosis of intestinal intussusception in adults.

• #4 Intussusception

  https://www.rch.org.au/clinicalguide/guideline_index/intussusception_guideline/

  The diagnosis of intussusception requires a high index of suspicion. Consider intussusception in infants and children with intermittent distress, vomiting or isolated unexplained lethargy […] Delayed presentation of intussusception can manifest as small bowel obstruction, bowel perforation, peritonitis and/or shock […] Ultrasound is the initial study of choice […] High sensitivity (98%) and specificity (98%) when performed by an experienced paediatric ultrasonographer […] Point of Care Ultrasound can be used to confirm the diagnosis of intussusception by appropriately trained clinicians. It should not be used to exclude the diagnosis […] Perform AXR only if there are signs of obstruction or perforation […] A normal AXR does not exclude intussusception (sensitivity 50%) […] The enema may be used diagnostically and therapeutically in consultation with a surgical team […] There is a small risk of bowel perforation and bacteraemia during the gas enema. Therefore, the enema is performed where paediatric surgery is available in case of the need for laparotomy.

• #5 Case Based Pediatrics Chapter

  https://www.hawaii.edu/medicine/pediatrics/pedtext/s10c04.html

  An abdominal series reveals a soft tissue density in the right lower quadrant. Intussusception is suspected. A water-soluble contrast enema is performed. An intussusception is identified at the hepatic flexure. The ileocolic intussusception is successfully reduced. […] Intussusception is a common abdominal emergency in children. Intussusception is best described as a portion of the intestine which telescopes into a more distal intestinal segment. It is one of the most common causes of abdominal obstruction in infants. Intussusception occurs most often in patients between 3 to 12 months of age. […] The most common type of intussusception is ileocolic (also known as ileocecal) (90%). A portion of terminal ileum intussuscepts through the ileocecal valve into the colon. […] The classic triad of intussusception include crampy (intermittent, also known as colicky) abdominal pain, vomiting, and bloody stools. The classic triad was found in only 21% of cases and two symptoms were found in 70% of cases in one series of patients with intussusception.

• #6 Causes, symptoms and details of Intussusception – Pulse Reference

  https://pulsereference.com/diagnoses/intussusception/

  Intussusception is the telescoping of one segment of the intestine into an adjacent segment, most commonly the ileum into the colon. This leads to obstruction, ischaemia, and potentially bowel necrosis if untreated. […] The classic triad of symptoms in intussusception includes intermittent abdominal pain, vomiting, and red currant jelly stools, although this triad is only seen in about 15% of cases. […] Ultrasound is the imaging modality of choice, showing the characteristic target or doughnut sign in cross-section and the pseudo-kidney sign on longitudinal views, which confirm the diagnosis. Sensitivity and specificity of ultrasound for intussusception approach 98-100%. […] In children presenting atypically or in adults, CT or MRI may be required to assess for underlying pathology such as tumours or polyps causing the intussusception.

• #7 Intussusception Symptoms: Bloody Stool, Pain, Fever

  https://www.verywellhealth.com/intussusception-symptoms-7503425

  Intussusception is a condition in which part of the intestine moves inside itself in a telescoping effect. […] Making a diagnosis might be more challenging in babies and small children because they cant tell adults and healthcare providers about their symptoms. […] In adults, the signs and symptoms of intussusception may be nonspecific, meaning they are similar to those from several other digestive problems. The most common symptom is abdominal pain. It can take time to rule out various other disorders and get the correct diagnosis. […] For both children and adults, diagnosing intussusception can be difficult. This is because the symptoms aren’t the same from person to person and can be similar to many other conditions. […] In adults, intussusception is rare. For people who seek care from a healthcare provider for a bowel obstruction, only about 1% are diagnosed with intussusception.

• #8 Intussusception – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intussusception/diagnosis-treatment/drc-20351457

  Your or your child’s health care provider will start by getting a history of the symptoms of the problem. The provider may be able to feel a sausage-shaped lump in the belly. To confirm the diagnosis, your provider may order: […] An ultrasound, X-ray or computerized tomography (CT) scan may reveal intestinal obstruction caused by intussusception. Imaging will typically show a „bull’s-eye,” representing the intestine coiled within the intestine. Abdominal imaging also can show if the intestine has been torn (perforated).

• #9 Child Intussusception – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431078/

  Intussusception is often suspected based on an examination, including observation of the Dance sign (Dance sign consists of evaluating the right lower quadrant of the abdomen for retraction, which can be an indication of intussusception). […] A definite diagnosis requires confirmation by imaging modalities. […] Ultrasound is the test of choice for the diagnosis of intussusception. The appearance of the target or doughnut sign, usually around 3 cm in diameter, confirms the diagnosis. […] An abdominal x-ray may be indicated to check for intestinal obstruction. An air enema may be used for diagnosis, and the same procedure can be used for treatment. […] CT scan is sometimes used to make a diagnosis, especially when the Ultrasound imaging remains doubtful. However, in young children, obtaining a CT scan often requires the use of anesthesia and there is also the risk of intravenous contrast and radiation exposure.

• #10 Adult intussusception: still a challenging diagnosis for the surgeon | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-adult-intussusception-still-challenging-diagnosis-avance-S2255534X22000731

  Intussusception is rare in adults and can occur in the small bowel and colon. Its atypical presentation makes the diagnosis difficult. […] Diagnosis is a challenge because of the nonspecific signs and symptoms. Surgical resection should be considered in the definitive treatment and management should be individualized according to the patients comorbidities, clinical presentation, and risk of malignancy. […] Preoperative diagnosis remains challenging due to the nonspecific clinical presentation and duration. Optimal treatment is controversial and also depends on the underlying disease and the need for surgical management. […] Clinical presentation is nonspecific, with variable symptom duration. […] Abdominal CT has been reported as the most useful imaging technique for diagnosing intussusception, with 58 to 73% diagnostic accuracy.

• #11 Intussusception | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/intussusception

  Ultrasound: This radiologic test of choice uses sound waves to create pictures of the inside of the body. On ultrasound, a target-like sign can be seen that is indicative of intussusception. […] Air or contrast enema: This procedure can be diagnostic, and in some cases serve as the treatment for intussusception. Air or a contrast fluid is given into the rectum as an enema. An X-ray of the abdomen shows narrow areas, blockages and other issues. On some occasions, the pressure exerted on the intestine while inserting air or contrast will help the intestine to unfold, correcting the intussusception.

• #12 How to Diagnose Intussusception in Children | Applied Radiology

  https://appliedradiology.com/articles/how-to-diagnose-intussusception-in-children

  Abdominal pain is a frequent complaint in the pediatric emergency department. One of the top diagnostic considerations is intussusception, particularly in patients between 3 months and 3 years of age. An ileocolic intussusception is the most common type of intussusception in children and requires urgent treatment. Delay in diagnosis increases morbidity, including bowel ischemia and perforation, as well as mortality. […] In this article, we review the typical findings of intussusception in various imaging modalities used to diagnose ileocolic and small bowel intussusceptions and briefly discuss intussusception reduction. […] Overall, radiography has poor diagnostic performance in intussusception and should not be considered first-line imaging. The recommended imaging algorithm is always to perform ultrasound first in a child with suspected intussusception.

• #13 How to Diagnose Intussusception in Children | Applied Radiology

  https://appliedradiology.com/articles/how-to-diagnose-intussusception-in-children

  With a sensitivity of 97.9%, specificity of 97.8%, positive predictive value of 86.6%, and negative predictive value of 99.7%, ultrasound (US) is the gold standard for evaluating a suspected intussusception. […] Specific findings on US can also assess the reducibility and potential complications related to reduction. […] One diagnostic limitation of US is the presence of extensive bowel gas, which can obscure evaluation. […] Magnetic resonance imaging (MRI) and computed tomography (CT) are not the conventional first-line imaging modalities for diagnosing intussusception. […] Small bowel-small bowel intussusceptions are often incidentally seen on US, CT, and MRI, and are typically self-limiting; therefore, they do not typically require follow-up imaging to document resolution. […] While most ileocolic intussusceptions are idiopathic owing to lymphoid hypertrophy, 1.5-12% have a pathologic lead point.

• #14 Current diagnosis and image-guided reduction for intussusception in children

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2021.01816

  Ultrasonography is the modality of choice for diagnosing intussusception. Previous studies have verified the high sensitivity (97.9%-98.5%) and specificity (97.8%-100%) of ultrasonography, along with high negative predictive value (99.7%) for ruling out intussusception. The advantages of ultrasonography include a lack of radiation, easy accessibility, cost-effectiveness, and the ability to find a pathologic lead point mass or establish alternative diagnoses. […] Nonoperative enema reduction is the treatment of choice for childhood intussusception unless there are signs of perforation or peritonitis. Nonoperative enema reduction can be performed according to the methods of image guidance (fluoroscopy or ultrasonography) and reduction medium type (liquid or air). […] Nonoperative enema reduction is effective for children without contraindications, and a recent meta-analysis of more than 40,000 cases reported a pooled success rate of 82%.

• #15 Brief Review of Intussusception Diagnosis and Management – JETem

  https://jetem.org/intussusception2/

  The patients abdominal ultrasound revealed intussusception in the right upper abdominal quadrant. […] Ultrasonography should be the initial imaging modality in cases with clinical suspicion for intussusception. […] In the pediatric population, ultrasound has a sensitivity of 97.9% and specificity of 97.8% for diagnosis of ileocolic intussusception. […] A study reported that with limited training, ED physicians could accurately perform ultrasound to diagnose intussusception, with a sensitivity of 85% and a specificity of 97%. […] Therefore, it is crucial to maintain a high index of suspicion for intussusception in children presenting with any of the above symptoms.

• #16 Intussusception (medical disorder) – Wikipedia

  https://en.wikipedia.org/wiki/Intussusception_(medical_disorder)

  Intussusception is a medical condition in which a part of the intestine folds into the section immediately ahead of it. Symptoms include abdominal pain which may come and go, vomiting, abdominal bloating, and bloody stool. It often results in a small bowel obstruction. Other complications may include peritonitis or bowel perforation. […] Diagnosis is often supported by medical imaging. In children, ultrasound is preferred while in adults a CT scan is preferred. […] A definite diagnosis often requires confirmation by diagnostic imaging modalities. Ultrasound is the imaging modality of choice for diagnosis and exclusion of intussusception, due to its high accuracy and lack of radiation. The appearance of target sign (also called „doughnut sign” on a sonograph, usually around 3 cm in diameter, confirms the diagnosis. The image seen on transverse sonography or computed tomography is that of a doughnut shape, created by the hyperechoic central core of bowel and mesentery surrounded by the hypoechoic outer edematous bowel.

• #17

  https://www.vin.com/doc/?id=3866527&pid=11268

  Ultrasonography is widely recognized for diagnosis of intussusception. The ultrasonographic pattern of intussusceptions may vary with the quality of the image, the length of bowel involved, the duration of disease process and the orientation of the imaging plane in relation to the axis of the intussusception. In transverse ultrasonographic images, the juxtaposition of the wall layers of the intussuscipiens and inner and outer intussusceptum creates multiple hyperechoic and hypoechoic concentric rings that surround a hyperechoic center. This is often referred to as a target-like mass with 'multiple concentric rings sign’. In longitudinal images, multiple hyperechoic and hypoechoic parallel lines are usually observed. A multiplane imaging technique of the suspected intussusceptions is extremely critical to avoid misdiagnosis with other conditions that may mimic intussusception. Incompleteness of the periphery of the rings is used as a differentiating feature of the intestinal intussusception from other pathogenic conditions of the bowel.

• #18

  https://www.vin.com/doc/?id=3866527&pid=11268

  Doppler ultrasonography has been used to predict the reducibility of an intestinal intussusception. Manual reduction was performed in 75% of intussusception (9/12) with blood flow in the mesenteric vessels. All dogs in the study that did not have color flow Doppler ultrasonographic signal had an irreducible intussusception at coeliotomy.

• #19 Intussusception | Sonoguide

  https://www.acep.org/sonoguide/advanced/intussusception

  Per the above concerns, point-of-care abdominal ultrasound should be considered in the appropriate patient to expedite care and therefore prevent delayed diagnosis leading to complications and worse outcomes. […] US performed by radiology for ileocolic intussusception has a sensitivity of 97.9% and specificity of 97.8%. When performed by an experienced sonographer, US is an excellent primary imaging modality as it has a negative predictive value of 99.7%. […] Point-of-care ultrasound performed by pediatric emergency medicine providers looking for intussusception after only one hour of training has a sensitivity of 85% and specificity of 97%. The negative predictive value was 97%. […] Consider abdominal US in pediatric patients with a clinical concern for intussusception. These include children between 3 months and 6 years with persistent vomiting in the absence of diarrhea, as well as patients who have bloody stool, colicky abdominal pain, episodes of crying or lethargy.

• #20 Intussusception: Diagnosis, Treatment – EM Board Bombs Podcast

  https://www.emboardbombs.com/study-guide/2021-1-10-intussusception-zdank/

  An intussusception is a telescoping of part of the intestine into itself. It is the most common abdominal emergency in young children 2 years of age and is the most common cause of bowel obstruction in children. […] In adults, the diagnosis is rare, and should prompt concern for cancer. The typical age range is 6 to 36 months of age. 90% of patients are within this age range.1 Still, one must consider this diagnosis outside this age range. Those outside the age range are more likely to have a pathologic lead point. […] The history and physical are a wash, but one should still ask about abdominal pain episodes with crying, vomiting, rectal bleeding, and lethargy. The exam should evaluate for abdominal distention, abdominal masses, and rebound or guarding. […] Abdominal radiograph with ultrasound should be performed in all suspected cases. No, the radiograph will not diagnose intussusception (only rarely will a target sign be seen on x-ray) but will help rule out perforation and malrotation.

• #21 Intussusception – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/gastrointestinal-disorders-in-neonates-and-infants/intussusception

  Intussusception is telescoping of one portion of the intestine (intussusceptum) into an adjacent segment (intussuscipiens), causing intestinal obstruction and sometimes intestinal ischemia. Diagnosis is by ultrasonography. […] Diagnosis is best made by ultrasonography. […] Suspicion of the diagnosis must be high, particularly in children with atypical presentation, and studies and intervention must be done urgently, because survival and likelihood of nonoperative reduction decrease significantly with time. […] Barium enema was once the preferred initial study because it revealed the classic coiled-spring appearance around the intussusceptum. […] Currently, ultrasonography is the preferred means of diagnosis; it is easily done, relatively inexpensive, and safe; the characteristic finding is termed the target sign.

• #22 Pediatric Intussusception Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/409870-overview

  In a prospective cohort study conducted by Tonson la Tour et al at a tertiary care pediatric ED, POCUS identified 39 of 45 intussusception cases, with a sensitivity of 87% (95% confidence interval [CI] = 0.74 to 0.94). […] Abdominal radiography may be used to search for dilated small bowel and an absence of gas in the region of the cecum. […] Intussusception may not be apparent on plain-film abdominal radiography. Radiographs may appear indeterminate or normal; therefore, the presence of an unremarkable abdominal radiograph should not be the basis for excluding a diagnosis of intussusception. […] The differential diagnosis should include appendicitis and cecal volvulus. Other conditions that should be considered include inflammatory bowel disease, incarcerated inguinal hernia, internal hernia, Henoch-Schonlein purpura, hemolytic uremic syndrome, small bowel obstruction, sigmoid volvulus, and abdominal wall hernia.

• #23 Intussusception: What It Is, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/10793-intussusception

  Diagnosis typically happens alongside emergency medical treatment. Imaging tests that confirm a diagnosis include an ultrasound (in children) and a CT scan (in adults). An ultrasound can identify an intussusception with 100% accuracy. Its the first test providers use to check for an intussusception in children. […] Your childs provider may also order an air or contrast enema. During this test, your childs provider inserts air or a liquid solution containing a safe substance called barium into your childs rectum. The air or liquid creates pressure that helps lengthen the telescoped intestine so that one portion no longer folds inside the other. An X-ray records a video of the process. […] In addition to confirming the diagnosis, this procedure usually fixes intussusception in children.

• #24 Intussusception: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/930708-overview

  Intussusception (see the image below) is a process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction. With early diagnosis, appropriate fluid resuscitation, and therapy, the mortality rate from intussusception in children is less than 1%. If left untreated, however, this condition is uniformly fatal in 2-5 days. […] Imaging studies used in the diagnosis of intussusception include the following: Radiography: Plain abdominal radiography reveals signs that suggest intussusception in only 60% of cases. Ultrasonography: Hallmarks of ultrasonography include the target and pseudokidney signs. Contrast enema: This is the traditional and most reliable way to make the diagnosis of intussusception in children. […] The prognosis in patients with intussusception is excellent if the condition is diagnosed and treated early; otherwise, severe complications and death may occur.

• #25 How to Diagnose Intussusception in Children | Applied Radiology

  https://appliedradiology.com/articles/how-to-diagnose-intussusception-in-children

  Intussusception reduction can be performed under fluoroscopic guidance with either air or liquid contrast, or under ultrasound-guided hydrostatic reduction. […] The choice can be based on ones training, experience, and available resources. […] A tight air seal using taping, manually squeezing the buttocks, or inflating a balloon is required for fluoroscopically guided air reduction. […] Ultrasound-guided reduction is employed by few pediatric radiologists. […] Signs of unsuccessful reduction have been described on diagnostic US; however, two important signs must be recognized. […] Unsuccessful reduction does not always require surgery. […] Intussusception is common in children and can be readily diagnosed by a combination of clinical symptoms and ultrasound findings. Upon diagnosis of ileocolic intussusception, several safe and effective radiologic methods of reduction are available.

• #26

  https://step2.medbullets.com/pediatrics/120611/intussusception

  Most common form of bowel obstruction in children. Luminal lesion usually serves as focus point for looping bowels. Involves the terminal ileum telescoping into the proximal large bowel in most cases. Symptoms include abrupt onset of classic triad (only observed in 1/3 of patients): colicky abdominal pain, emesis, currant jelly stool. Child may flex knees to chest to relieve pain. Physical exam may reveal abdominal distention and tenderness, positive stool guaiac indicative of intestinal bleed, sausage-shaped abdominal mass may be palpated in RUQ, and signs of shock may be evident. Abdominal radiography may show small bowel obstruction (air fluid levels) and rule out free air under the diaphragm (perforated viscus, surgical emergency). Ultrasound may show small bowel obstruction and donut sign. Pneumatic decompression enema via fluoroscopy is now preferred over contrast-based enemas as risk of perforation is lower, and lower radiation exposure is needed. Hydrostatic decompression enema via fluoroscopy is both diagnostic and therapeutic in many cases. After successful reduction, child should be admitted for 24 hrs to monitor for recurrence or complications. Surgical reduction is only indicated when barium enema does not relieve obstruction. Very good to excellent prognosis if identified and treated early.

• #27 Child Intussusception – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431078/

  Intussusception is a condition in which part of the intestine folds into the section next to it. Intussusception usually involves the small bowel and rarely the large bowel. Symptoms include abdominal pain, which may wax and wane, vomiting, bloating, and bloody stool. It may result in small bowel obstruction. Other complications may consist of peritonitis or bowel perforation. This activity reviews the cause, pathophysiology, and presentation of intussusception and highlights the role of the interprofessional team in its management. […] Medical imaging often supports a diagnosis. In children, ultrasound is a preferred method to diagnose, while in adults, a CT scan is preferred. […] Intussusception requires rapid treatment. Treatment in children is typically by an enema with surgery if not successful. In adults, removal of part of the bowel is more often required.

• #28

  https://journals.lww.com/jcge/fulltext/2003/01000/the_diagnosis_and_treatment_of_adult.7.aspx

  Intussusception in adults is often diagnosed on computed tomography (CT), and the optimal treatment of this entity is not universally agreed upon. […] Preoperative diagnosis was made in four patients by CT scan and/or ultrasonography. […] The CT scan is most useful in making the diagnosis of intussusception. […] Computed tomography (CT) scan is now widely used in the evaluation of abdominal masses and nonspecific abdominal pain and may be the first examination performed in a patient in whom an intussusception is present. […] The CT findings are sufficiently characteristic to warrant a confident diagnosis based on this radiologic appearance alone. […] Although the correct diagnosis is often based on intraoperative findings, modern noninvasive and invasive imaging techniques can be very helpful in precisely identifying these lesions preoperatively.

• #29 Intestinal Intussusception: Etiology, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5179276/

  In adults, given the nonspecific nature of the clinical presentation and the wide differential, choice of imaging modality is important to arrive at a timely diagnosis. […] Diagnostic accuracy of CT has been found to be as high as 58 to 100% in other reports. […] Despite the benefits of CT, Martn-Lorenzo et al found that while CT is extraordinarily sensitive for detecting intussusception, it is limited by less accessibility, a static and single plane exploration, radiation, and finally oral and IV contrast which could further delay the study and thus the proper diagnosis. […] In the pediatric population, treatment depends on the type of intussusception. […] Surgery is required if there are signs of bowel necrosis. […] More recently, however, widespread use of CT/MRI imaging has resulted in increased frequency of the radiographic diagnosis of intussusception—this may be associated with equivocal gastrointestinal symptoms or none at all.

• #30 Intestinal Intussusception: Etiology, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5179276/

  Intussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment of the bowel. […] The diagnosis is typically made intraoperatively or by cross-sectional imaging. […] With increasingly frequent CT/MRI of the adult abdomen in the current era, transient and/or asymptomatic intussusceptions are increasingly found and may often be appropriately observed without intervention. […] In the adult population, intussusception is frequently due to a pathologic lead point, which can be intraluminal, mural, or extramural. […] The assessment of intussusception differs in pediatric and adult populations. In children, intussusception is typically idiopathic and benign, and diagnosis can be expedited by having a high index of suspicion. In adults, it typically represents obstruction from a potentially malignant etiology.

• #31 Intussusception in adults: Clinical characteristics, diagnosis and operative strategies

  https://www.wjgnet.com/1007-9327/full/v15/i16/1985.htm

  CT has become the first imaging method performed, after plain abdominal X-rays, in the evaluation of patients with non-specific abdominal complaints. […] In conclusion, intussusception in adults is a rare entity and diagnosis may be challenging because of non-specific symptoms. […] CT is the most useful imaging modality in the diagnosis of intussusception.

• #32 Intussusception in children – UpToDate

  https://www.uptodate.com/contents/intussusception-in-children

  Ultrasonography is the method of choice to detect intussusception in many institutions. The sensitivity and specificity of this technique approaches 100 percent in the hands of an experienced ultrasonographer. Negative predictive value is also nearly 100 percent, so a negative study by an experienced sonographer can definitively rule out intussusception. […] The diagnosis of intussusception can be made in any of the following ways: By diagnostic ultrasound – This is the usual procedure where diagnostic ultrasound is readily available (eg, in the emergency department), or for patients with atypical presenting features. Once the diagnosis is established, the patient should proceed promptly to treatment (typically nonoperative reduction under ultrasonographic or fluoroscopic guidance). […] By ultrasound or fluoroscopy, as part of an attempt at nonoperative reduction – This is the usual procedure for patients with typical presenting features. In this case, the procedure is both diagnostic and therapeutic.

• #33 Intussusception in children – UpToDate

  https://www.uptodate.com/contents/intussusception-in-children

  Incidental finding on ultrasound or CT – In this case, next steps depend upon the patient’s symptoms since incidentally discovered intussusception can be asymptomatic and often resolves spontaneously. […] The approach to treatment of intussusception depends upon patient characteristics. Most patients with a high clinical suspicion and/or imaging evidence of ileocolic intussusception, normal vital signs, and no evidence of bowel perforation should be treated with nonoperative reduction. Nonoperative reduction is successful in approximately 70 percent of patients with intussusception, with somewhat lower success rates in young infants and children over five years. […] Surgical treatment is indicated as a primary intervention for patients with suspected intussusception who are acutely ill or have evidence of perforation. Surgery also may be appropriate when the patient is treated in a location where the radiographic facilities and expertise to perform nonoperative reduction are not readily available. Surgery is necessary for patients in whom nonoperative reduction is unsuccessful after one or more attempts, or for evaluation or resection of a focal pathologic lead point.

• #34 Intussusception in adults: Clinical characteristics, diagnosis and operative strategies

  https://www.wjgnet.com/1007-9327/full/v15/i16/1985.htm

  AIM: To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity. […] Intussusception was a preoperative diagnosis in 14 patients (70%). […] The diagnosis of intussusception was based on CT findings in the majority of our cases (10/12); two were based on colonoscopy and two on a small-bowel series. […] The clinical presentation in adult intussusception is often chronic, and most patients present with non-specific symptoms that are suggestive of intestinal obstruction. […] The symptoms in cases of adult intussusception are so non-specific that a clinical diagnosis beyond bowel obstruction is rarely made before surgery. […] Several imaging techniques may help to precisely identify the causative lesion preoperatively.

• #35

  https://journals.lww.com/jcge/fulltext/2003/01000/the_diagnosis_and_treatment_of_adult.7.aspx

  In this series, the CT scan proved to be the most useful, with US being the second most accurate. […] The CT scan has been used to evaluate patients with intestinal obstruction or an abdominal mass in whom intussusception is the final diagnosis. […] In our series, the CT scan was performed in four patients, and in all four patients, the diagnosis was confirmed. It therefore appears that the CT scan is very useful and simplifies making the diagnosis. […] Ultrasonography has been used to evaluate suspected intussusception in both children and adults. […] The major limitation of US for evaluating acute abdomens is the presence of air in the bowel, which leads to poor transmission and difficulties in image interpretation. […] In about 90% of adult intussusceptions, there is a lead point, which is a well-definable pathologic abnormality.

• #36

  https://journals.lww.com/jcge/fulltext/2003/01000/the_diagnosis_and_treatment_of_adult.7.aspx

  The optimal treatment of adult intussusception is not universally agreed upon. […] All authors agree that laparotomy is mandatory, in view of the likelihood of identifying a pathologic lesion. […] Recently, several reports have recommended a selective approach to resection. […] In most cases of ileocolic, ileocecocolic, and colocolic intussusception, primary resection without reduction should be performed, especially in patients more than 60 years of age because of the high incidence of malignancy. […] In patients with small bowel intussusception, reduction should always be initially attempted unless signs of bowel ischemia or inflammation are present or a malignancy is not suspected.

• #37 Current diagnosis and image-guided reduction for intussusception in children

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2021.01816

  The optimal time gap between enema attempts has not been established, but practitioners commonly wait for 15 minutes to a few hours. […] The reported success rate of delayed repeat enema is approximately 50% in the children with a failed initial enema reduction. […] The rare but most important complication of enema reduction, bowel perforation, is reported in approximately 0.4% of cases of air and liquid enemas. […] Successful enema reduction is less likely to be achieved in children with a longer symptom duration before presentation, younger age, unfavorable symptoms (lethargy, bloody diarrhea), radiologic findings (small bowel obstruction, trapped fluid between the intussusceptum and intussusceptor, ascites, or absence of flow in the intussusception), pathological lead points, and distant location of the intussusception. […] Many children with intussusception do not show a complete symptom triad, and a high level of clinical suspicion is necessary to not miss the diagnosis in children with nonspecific symptoms.

• #38 Intussusception | Sonoguide

  https://www.acep.org/sonoguide/advanced/intussusception

  Ultrasound is the first-line imaging modality for detecting intussusception in pediatric patients. It is safe and does not expose children to radiation as the abdominal x-ray and barium enema do. Ultrasound also has a higher sensitivity and specificity for detecting intussusception than a non-contrasted x-ray. Emergency clinicians are appropriately and effectively using point-of-care ultrasound to more rapidly detect intussusception, which is useful in directing utilization of healthcare resources and expediting definitive care. […] Missed diagnosis of intussusception occurs frequently; some centers have found a rate as high as 48%. Symptoms can be as non-specific as crying or lethargy. […] Enema reduction of intussusception is often less successful in the delayed diagnosis due to worsened bowel wall edema.

• #39 Intussusception: A Challenging Diagnosis in Adolescence

  https://www.contemporarypediatrics.com/view/intussusception-challenging-diagnosis-adolescence

  The diagnosis of intussusception is often a challenge to emergency physicians because most patients present with nonspecific signs and symptoms. The index of suspicion should be particularly high in older children who often have pathologic lead points and atypical presentations: delayed diagnosis can lead to ischemic complications.

• #40 The diagnosis and treatment of retrograde intussusception: a single-centre experience | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-021-01391-0

  To investigate the clinical manifestations, treatments of retrograde intussusception and summarize the experience. […] Retrograde intussusception is easily misdiagnosed before surgery. During air enema, if the intussusception mass was fixed and did not move with increasing pressure, we should be aware of the possibility of retrograde intussusception, and the enema pressure should not be too large to avoid intestinal perforation. […] If intussusception is suspected, the preferred auxiliary examination is CDU. The sensitivity of CDU is 97.5% and its specificity is 99%. […] Air enema or water enema under CDU monitoring is currently the preferred treatment method for intussusception reduction. However, for retrograde intussusception, whether it is an air enema or water enema, not only will it not reset the intussusception mass, but also will cause the mass of intussusception to become tighter as the enema pressure increases, and which may lead to intestinal perforation.

• #41 Intussusception – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intussusception/symptoms-causes/syc-20351452

  Intussusception is the most common cause of intestinal obstruction in children younger than 3 years old. […] Intussusception requires emergency medical care. If you or your child develops the symptoms listed above, seek medical help right away. […] In adults, intussusception is usually the result of a medical condition or procedure, including: A polyp or tumor. […] Intussusception can cut off the blood supply to the affected portion of the intestine. If left untreated, lack of blood causes tissue of the intestinal wall to die. […] Symptoms of peritonitis include: Belly pain. […] Intussusception is rare in adults. Also, because symptoms of the disorder often overlap with the symptoms of other disorders, it’s more challenging to identify.

• #42 Intussusception (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/intussusception.html

  Intussusception is a medical emergency that needs care right away. It’s the most common abdominal emergency in children under 2 years old. […] Doctors usually check for intussusception if a child keeps having periods of pain, drawing up the legs, vomiting, feeling drowsy, or poop with blood and mucus. […] If the doctor suspects intussusception, the child may be sent to an emergency room (ER). Usually, doctors there will ask a pediatric surgeon to see the child right away. The ER doctor might order an abdominal ultrasound or X-ray, which can sometimes show a blockage in the intestines. […] Two kinds of enemas often can diagnose and treat intussusception at the same time: In an air enema, doctors place a small soft tube in the rectum (where poop comes out) and pass air though the tube. The air travels into the intestines and outlines the bowels on the X-rays. If there’s intussusception, it shows the telescoping piece in the intestine. At the same time, the pressure of the air unfolds the inside-out section of bowel and cures the blockage. […] In a barium enema, a liquid mixture called barium is used instead of air to fix the blockage in the same way. […] Both types of enema are very safe, and children usually do very well. Most children treated with the enema do not need surgery.

• #43 Pediatric Intussusception Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/409870-overview

  Prolonged intussusception may result in bowel necrosis and/or perforation. Once the patient is stabilized, reduction procedures should be initiated immediately; radiographic examination and physical examination should be performed to ensure that neither free air nor peritonitis is present. […] Both air and radiopaque liquid contrast have been used to reduce ileocolic intussusception under fluoroscopy. […] Unless perforation, peritonitis, or Henoch-Schonlein purpura is present, radiologic reduction should be attempted. […] The success rate is 50-85%, depending on factors such as the length of time of the intussusception and degree of edema of the loop and ileocecal valve. […] In patients older than 2 years, it should be assumed that intussusception has a lead point etiology; in such cases, further investigation should be undertaken.

• #44 Intussusception in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/i/intussusception.html

  In some cases, the intussusception fixes itself during this test. The intestine may go back into place on its own. […] If your child’s intestine is damaged and the part removed is small, the 2 sections of healthy intestine will be sewn back together. […] Intussusception is a medical emergency. It’s a life-threatening illness. If not treated, it can cause serious problems such as: Intestinal infection, The death of intestinal tissue, Internal bleeding, A severe abdominal infection called peritonitis, A very serious illness called sepsis that occurs when the body has an overwhelming response to an infection, Shock, which refers to life-threatening changes in blood pressure, pulse, and breathing. […] Intussusception can happen again, especially if it’s not treated correctly or with surgery the first time.

• #45 Intussusception | Sonoguide

  https://www.acep.org/sonoguide/advanced/intussusception

  Intussusception can resolve and recur. It is possible to have a positive point-of-care ultrasound and a negative radiology ultrasound or vice versa. […] Missed diagnosis can lead to ischemic bowel, necrosis and perforation. Also, enema reduction of intussusception is often less successful in the delayed diagnosis due to worsened bowel wall edema. […] Ultrasound can predict failure in enema reduction through the following findings: trapped free fluid, intramural air, or absence of flow on Doppler imaging.

• #46

  https://ugeskriftet.dk/dmj/early-diagnosis-and-treatment-intussusception-children-mandatory

  The relationship between each of the calculated time intervals and the following end points was analysed: primary treatment modality, definitive treatment modality and the result of any primary enema treatment. A significantly higher use of enema as the primary treatment modality was observed when the intussusception diagnosis was confirmed within four hours of hospitalisation. The rate of intestinal resection was significantly lower when the intussusception diagnosis was confirmed within four hours of hospitalisation and when treatment was initiated within six hours of hospitalisation. […] This study found a relatively low utilisation rate for enema reduction and an overall low enema success rate. The success rate of enema was significantly higher and the intestinal resection rate lower when the diagnosis was confirmed within four hours of hospitalisation, which underpins the importance of a quick and timely diagnosis.

• #47 A deep-learning pipeline to diagnose pediatric intussusception and assess severity during ultrasound scanning: a multicenter retrospective-prospective study | npj Digital Medicine

  https://www.nature.com/articles/s41746-023-00930-8

  Ileocolic intussusception is one of the common acute abdomens in children and is first diagnosed urgently using ultrasound. […] Manual diagnosis requires extensive experience and skill, and identifying surgical indications in assessing the disease severity is more challenging. […] This multicenter retrospective-prospective study used 14,085 images in 8736 consecutive patients (median age, eight months) with ileocolic intussusception who underwent ultrasound at six hospitals to train, validate, and test the deep-learning pipeline. […] Thus, here, we report that the deep-learning pipeline that guides lesions in real-time and is interpretable during ultrasound scanning could assist sonographers in improving the accuracy and efficiency of diagnosing intussusception and identifying surgical indications.

• #48 A deep-learning pipeline to diagnose pediatric intussusception and assess severity during ultrasound scanning: a multicenter retrospective-prospective study | npj Digital Medicine

  https://www.nature.com/articles/s41746-023-00930-8

  The sensitivity and specificity of ultrasound for intussusception can achieve 92100% of diagnosis. […] Therefore, specialized imaging knowledge and skilled sonographers are required to diagnose whether it is intussusception, and the recognition of surgical indications to assess disease severity is more challenging. […] We aim to develop and validate a deep-learning pipeline for real-time navigation of diagnostic planes during ultrasound scanning to identify ileocolic intussusception and provide surgical indications using heterogeneous multicenter datasets of images and videos for retrospective testing and external validation. […] The performance of junior sonographers with AI-assistance is compared with those of junior, intermediate, and senior sonographers. […] This model achieved average AUCs of 0.972 and 0.956 on the internal image test set and the external video dataset, respectively.

• #49 A deep-learning pipeline to diagnose pediatric intussusception and assess severity during ultrasound scanning: a multicenter retrospective-prospective study | npj Digital Medicine

  https://www.nature.com/articles/s41746-023-00930-8

  Overall, this diagnostic tool can assist sonographers in managing children with ileocolic intussusception. […] Accurate and timely diagnosis of ileocolic intussusception and recognizing surgical indications are critical for selecting treatment plans and achieving positive treatment outcomes. […] Our algorithm achieved a higher AUC using three ultrasound datasets. […] Furthermore, our algorithm identified surgical indications, facilitating the assessment of disease severity and increasing confidence in selecting the appropriate treatment options. […] We suggest that a deep-learning pipeline trained using a dataset labeled with a priori knowledge can diagnose intussusception and provide surgical indications.

• #50 Mastering the Intussusception Ultrasound – Tips and Tricks | EM Ultrasound Section

  https://www.acep.org/emultrasound/newsroom/apr2021/mastering-the-intussusception-ultrasound—tips-and-tricks

  While small bowel intussusceptions often spontaneously reduce, if symptoms and findings persist, computed tomography (CT) may be necessary to determine management. […] POCUS is useful in differentiating variants of intussusception that range from a surgical emergency to a transient source of abdominal pain allowing clinicians to better manage these patients. […] Intussusception is the most common cause of intestinal obstruction in children under 2 years of age and should be on the differential for any fussy baby without an obvious source. […] Repeat ultrasound in patients you have a high clinical suspicion for intussusception, especially if the patient has an active episode of crying and abdominal pain.

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