The impact of imaging in the management of intussusception owing to pathologic lead points in children

Abstract

Objective. To review the imaging appearances, management and outcome of a large number of children with intussusception owing to pathologic lead points (PLP) in an attempt to define the role of various imaging modalities in this clinical setting.¶Materials and methods. Review of the records and imaging studies of 43 children with intussusception due to PLP diagnosed between 1986 and 1999.¶Results. The commonest PLP found were Meckel diverticulum, polyps, Henoch-Schönlein 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 enema in 3 (11 %) of 28, and on barium enema in 6 (40 %) of 15. Air enema successfully reduced 60 % of the intussusceptions. Nine children had recurrent intussusceptions.¶Conclusion. Sonography depicted two-thirds of PLP and provided a specific diagnosis in nearly one-third of our series. Our review does not provide sufficient 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 suspicion for its presence. It remains a diagnostic challenge as to how to search for PLP in these patients, and other imaging modalities have to be requested according to each particular case.