Imaging modalities to rule out intussusception

What imaging modalities are commonly used in children to confirm or rule out intussusception?

• Plain radiographs lack sensitivity and many false-negative results occur, so normal plain films should not exclude the diagnosis of intussusception. Later in the disease, up to 60% may show absence of air in the right upper and lower quadrants and evidence of soft tissue density.

• Ultrasonography has the advantage of being relatively fast, noninvasive, and without exposure to ionizing radiation. Although it may be operator dependent, in experienced hands the sensitivity (98-100%) and specificity (88-100%) are high. It is important to note that if intussusception is detected on ultrasound, air or barium contrast enema under fluoroscopy is still indicated for treatment.

• Contrast enema has long been the standard for diagnosis and treatment of intussusception. Barium or air is introduced under pressure into the bowel via a tube in the rectum during fluoroscopy. Air is safer, cheaper, and more effective at reduction and poses less risk if there is bowel perforation.

Sources

Byrne AT, Goeghegan T, Govender P, et al: The imaging of intussusception. Clin Radiol 2005;60:39-46. 

Marin JR, Alpern ER: Abdominal pain in children. Emerg Med Clin North Am 2011;29:401-428.

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