INTUSSUSCEPTION

Intussusception is the most common abdominal emergency in infancy and childhood. Most cases are idiopathic ileocolic intussusceptions; rarel y is a lead point present. Abdominal ultrasound is the imaging modalit y of choice for the demonstration as well as the exclusion of an intus susception. The target (transverse section) and pseudokidney (longitud inal section) signs are pathognomonic sonographic findings. Simultaneo us depiction of lead points or lymph nodes or the presence of an enter o-enteral intussusception may lead to different appearances. When an i ntussusception has been diagnosed with ultrasound, further complicatio ns such as small bowel obstruction or free intraperitoneal fluid have to be excluded at the same time. In addition, the perfusion of the int ussusceptum can be evaluated with color Doppler ultrasound. There is g eneral consensus that the only contraindications for conservative redu ction are bowel perforation, peritonitis and hypovolemic shock. The ol dest and most widespread method is hydrostatic reduction with barium u nder fluoroscopic control. Pneumatic reduction under fluoroscopic moni toring has gained more and more acceptance. An alternative technique i s sonographically guided hydrostatic reduction with normal saline solu tion. Both latter methods are reported to have success rates of 80-90 % and are clearly superior to the barium technique. In our opinion ult rasound monitoring offers the most precise control of the whole reduct ion process, with distinct demonstration of the intraluminal structure s, especially of the ileocecal valve and of a possible lead point. A c omplication can be recognized immediately. The primary advantage is th e lack of radiation exposure. Therefore, with appropriate equipment an d experience this method may be regarded as most promising in the mana gement of intussusception in infancy and childhood.