[Analyses of air enema and radiographic film for acute intussusception in children]

Abstract

Objective: To analyze the different success rates of air enema in intussusception cases at different ages and evaluate the value of plain film in assessing the pathogenetic condition of intussusception and intussusception with vascular compromise in children.

Methods: A retrospective analysis was performed on the success rates of air enema in 1119 pediatric cases of intussusception at different ages. The radiographic findings of 190 cases were analyzed. Air enema reduction failed in 95 cases. And 95 control cases were randomly selected for reduction by air enema. Their operative and pathological data were analyzed and compared with the findings of plain film. Intestinal obstruction with vascular compromise was analyzed by a comparison of plain film and pathology. The plain films of patients were analyzed by two experienced radiologist independently. Whenever there was dissension, they discussed and reached an agreement.

Results: In all cases of intussusception, the successful reduction rate was 91.5%. The cases within 1-year-old were 627 cases, air enema success rate was 87.1% and the success rate of air enema was 97.2% in beyond 1-year-old group. There was significant difference between two groups (χ(2) = 36.01, P < 0.01). In 95 cases of failed air enema reduction, 14 cases were ileoileal, 10 ileocaecal and 25 ileocolic. And 44 cases were ileoilealcolic and 2 ileocoliccolic. Eleven cases had intestinal necrosis. Four cases had small bowel duplication cyst and 3 with Meckel's diverticulum. Intestinal obstruction with vascular compromise in plain film had a high concordance with pathology (kappa = 0.7128). The pathology type was somewhat correlated with the finding of plain film (P < 0.01). As assessed by plain film, there were intussusceptions with vascular compromise (n = 30) with a coffee-bean sign or banana sign, a paucity of bowel gas (n = 36), quadrant gas (n = 51) and mass or crescent (n = 73). Through an analysis between plain film signs and the onset of symptom by Spearman correlation (nonzero correlation = 20.67, P < 0.01), there was statistical significance.

Conclusion: The successful rate of air enema in intussusception is lower in within 1-year-old group than beyond 1-year-old group. The sign of plain film is more significant in assessing the pathogenetic conditions of intussusception. And it has a high concordance with pathology in assessing the intestinal obstruction with vascular compromise.