Does intussusception require a CT scan?

Written by Hu Qi Feng
Pediatrics
Updated on September 11, 2024
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Intussusception is commonly diagnosed through routine abdominal ultrasound examinations, which have a positive rate of over 90%. In the ultrasound, the transverse section of the intussusception can show concentric circles or target ring-shaped mass images, and the longitudinal section may reveal the sleeve sign. Additionally, a barium enema can be employed, along with X-ray imaging. Under X-ray, the lead point of intussusception appears as a mass shadow, and air enema reduction treatment can be performed concurrently. Generally, CT is not used as a routine diagnostic tool.

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Written by Hu Qi Feng
Pediatrics
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Intestinal intussusception described by ultrasound.

The appearance of intussusception under ultrasound shows concentric or target ring-shaped mass images on a transverse section scan, and a sleeve sign on a longitudinal section scan. For an ultrasound-guided hydrostatic reduction, a balloon is inserted through the anus and inflated, connecting a T-tube to a Foley catheter with a side tube connected to a sphygmomanometer to monitor water pressure. Isotonic saline at a temperature of thirty to forty degrees is injected, and the target ring-shaped mass image can be seen retracting to the ileocecal region. The disappearance of the concentric circles or sleeve sign under ultrasound indicates the completion of this therapeutic diagnosis.

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Can infants with intussusception sleep?

Intussusception presents as abdominal pain, which occurs in sudden, severe, and periodic episodes. The child cries restlessly with a pale face, and the pain lasts several minutes or longer. The pain then subsides, and during this relief, the child falls asleep. The pain reoccurs every ten to twenty minutes. Continuous episodes occur until the intussusception is successfully reduced, after which the child calms down and falls asleep without further crying or vomiting.

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Infant intussusception symptoms

Intussusception clinically presents with abdominal pain, which occurs in fits and starts and has a regular pattern. This manifests as sudden spasmodic colic; the child cries and is restless, drawing the knees up to the belly and turning pale. The pain lasts for several minutes or longer, then eases off, allowing the child to fall asleep quietly. These episodes recur every 10 to 20 minutes as intestinal movements provoke further attacks. Vomiting occurs, initially consisting of curdled milk or food residues and later containing bile-stained, feculent fluid. Moreover, blood in stools is an important symptom. Symptomatically, stools may appear normal for a few hours, but within six to twelve hours, 85% of affected children might pass jelly-like mucus blood stools. A palpable lump can be detected in the upper right abdomen, indicative of the point of intussusception. As for general symptoms, the child may appear well early on, but as the condition worsens, intestinal necrosis or peritonitis may occur, leading to severe dehydration, high fever, lethargy, coma, shock, and other signs of systemic toxicity.

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Causes of intussusception in children

The etiology of intussusception is divided into primary and secondary types, with 95% being primary, which is common in infants and young children. In infants, the mesentery of the ileocecal region is not yet fully fixed and has a larger degree of mobility, which is a structural factor conducive to the occurrence of intussusception. Secondary cases account for about 5%, often secondary to Meckel's diverticulum, intestinal polyps, intestinal tumors, intestinal duplications, and abdominal purpura causing swelling and thickening of the intestinal wall, which can lead to intussusception. Certain factors may cause a change in the rhythmic movement of the intestines leading to disorder, thereby inducing intussusception, such as changes in diet, viral infections, and diarrhea.

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Pediatric intussusception should see which department?

Intussusception often occurs in infants and young children, so the main symptoms are vomiting, bloody stools, and abdominal pain. Therefore, the initial consultation is usually in pediatric emergency. When intussusception is suspected as a cause of acute abdomen, the doctor will conduct intestinal tube and abdominal ultrasound examinations. If the ultrasound confirms intussusception, a transfer to pediatric surgery or emergency surgery may be considered for appropriate surgical treatment. Thus, the initial choice for consultation is usually pediatrics, but after a diagnosis is confirmed, treatment should be transferred to pediatric surgery.