Computed tomography findings of unanticipated prolonged ileocolic intussusception in children

Abstract

Background: Attempted nonsurgical reduction of ileocolic intussusceptions after 48 hours is controversial because of the low probability of reduction and an increased risk of perforation. We sought to retrospectively identify computed tomography (CT) criteria that may help to predict bowel viability and successful enema reduction in children with ileocolic intussusception.

Methods: Unanticipated intussusception was diagnosed using CT in six children with mild, atypical symptoms of four to seven days' duration at a single institution during a one-year period. All patients underwent laparotomy without prior contrast enema. Surgical findings were compared with preoperative CT scan findings to identify any criteria that may predict successful nonsurgical management.

Results: Contrast CT scan findings were diagnostic of ileocolic intussusception. At the time of laparotomy, three children had easily reducible ileocolic intussusception with nonischemic bowel. Two children had irreducible intussusception with ischemic bowel requiring resection, and one child had a difficult reduction of nonischemic but edematous bowel. Preoperative CT scan findings correlated well with intraoperative findings for all patients. Findings of bowel-wall edema of the intussuscipiens and partial small-bowel obstruction shown on CT were associated with intussusception that was nonreducible or difficult to reduce.

Conclusion: Patients with prolonged intussusception diagnosed using CT scan may safely undergo contrast enema reduction if no bowel-wall edema of the intussuscipiens or obstruction is demonstrated.

Figure 1

Computed tomography scan of patient 2 demonstrates the classic target sign in the ascending colon (arrow). There is no evidence of bowel-wall edema of the intussuscipiens or of small-bowel obstruction. Cautious attempt at nonsurgical enema reduction would be advised.

Figure 2

Computed tomography scan of patient 4 demonstrates target sign (large arrow), bowel-wall edema of the intussuscipiens (small arrow), and dilated small bowel consistent with obstruction. Surgical management would be recommended in this situation.