Sonographic features of small-bowel intussusception in pediatric patients

Objective: Small-bowel intussusception (SBI) for pediatric patients is unus ual and difficult to diagnose preoperatively. This study sought to determin e the sonographic findings of pediatric SBI. Methods: The sonographic featu res and surgical findings of 13 pediatric patients (7 boys, 6 girls; age ra nge 4 months-15 years; average age 4 years and 2 months) with SBI encounter ed in the authors' hospital over a 12-year period were retrospectively revi ewed. Results: Most of the patients presented with nonspecific symptoms, in cluding vomiting, abdominal pain, and/or irritable crying. Sonographic scre ening in the emergency department revealed a doughnut or crescent-in-doughn ut sign, or a multiple-concentric-rings sign for 11 of the 13 patients, and the lesions appeared short. Eight lesions were found in the paraumbilical or left abdominal regions. Sonographic measurement of the size of the lesio ns from these 11 patients ranged from 2 cm to 3.7 cm (average 2.77 cm). Sub sequent barium enemas were performed for these 11 patients, none of which r evealed colon lesions. Surgery revealed ileoileal intussusceptions for eigh t cases, jejunoileal for three, and jejunojejunal for the remaining two. Bo wel ischemia or necrosis and pathologic lead points were demonstrated for s even and six patients, respectively, although none were recognized preopera tively. Conclusions: Small-bowel intussusception is often overlooked due to nonspecific clinical presentations. Sonographic demonstration of a 2-3-cm sized, short, doughnut-like lesion, especially in the left abdomen or parau mbilical regions, should lead to strong suspicion of SBI.