The impact of imaging in the management of intussusception owing to pathologic lead points in children - A review of 43 cases

Objective. To review the imaging appearances, management and outcome of a l arge number of children with intussusception owing to pathologic lead point s (PLP) in an attempt to define the role of various imaging modalities in t his clinical setting. Materials and methods. Review of the records and imaging studies of 43 chil dren with intussusception due to PLP diagnosed between 1986 and 1999. Results. The commonest PLP found were Meckel diverticulum, polyps, Henoch-S chonlein purpura and cystic fibrosis. PLP were depicted on sonography in 23 (66 %) of 35 patients, on computed tomography in 5 (71 %) of 7, on air ene ma in 3 (11 %) of 28, and on barium enema in 6 (40 %) of 15. Air enema succ essfully reduced 60 % of the intussusceptions. Nine children had recurrent intussusceptions. Conclusion. Sonography depicted two-thirds of PLP and provided a specific d iagnosis in nearly one-third of our series. Our review does not provide suf ficient data on how to continue the investigation of those patients in whom sonography does not depict a PLP but: in whom there is a high index of sus picion for its presence. It remains a diagnostic challenge as to how to sea rch for PLP in these patients, and other imaging modalities have to be requ ested according to each particular case.