Abstract
Purpose
Intussusception is one of the most common causes of an acute abdomen in infancy. The majority of pediatric cases of intussusception are of the ileocolic type and usually idiopathic. Small bowel intussusception is rarely diagnosed in children, and few cases have been reported. The purpose of this study was to determine the clinical features and causes of small bowel intussusception in children.
Methods
We retrospectively reviewed the clinical and radiologic findings of 21 children with small bowel intussusception who were admitted to Seoul National University Children's Hospital between March 2005 and January 2010.
Results
The clinical presentation of small bowel intussusception included abdominal pain or irritability (85%), vomiting (23%), fever (14%), bloody stools (14%), and abdominal masses (4%). Six patients required surgical management. Ultrasonography showed that the mean diameter of the lesions and mean thickness of the outer rims were 1.6±0.7 and 1.7±1.8 mm, respectively. Eleven lesions were located in the left abdominal or paraumbilical regions. Children who underwent surgical management were older than children with transient small bowel intussusception (mean age, 51 vs. 109 months). The mean diameter of the lesions and mean thickness of the outer rims were greater in the surgically-managed group. The location of intussusception was not significantly different between the two groups.
REFERENCES
2. Lehnert T, Sorge I, Till H, Rolle U. Intussusception in children-clinical presentation, diagnosis and management. Int J Colorectal Dis. 2009; 24:1187–1192.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
3. Ko SF, Tiao MM, Hsieh CS, Huang FC, Huang CC, Ng SH, et al. Pediatric small bowel intussusception disease: feasibility of screening for surgery with early computed tomographic evaluation. Surgery. 2010; 147:521–528.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
4. Saxena AK, Seebacher U, Bernhardt C, Hollwarth ME. Small bowel intussusceptions: issues and controversies related to pneumatic reduction and surgical approach. Acta Paediatr. 2007; 96:1651–1654.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
5. Hur NJ, Ryu MH, Lee DJ, Kwon JH. A clinical observation on children with transient small bowel intussusception. Korean J Pediatr Gastroenterol Nutr. 2000; 3:160–168.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
6. Kornecki A, Daneman A, Navarro O, Connolly B, Manson D, Alton DJ. Spontaneous reduction of intussusception: clinical spectrum, management and outcome. Pediatr Radiol. 2000; 30:58–63.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
7. Parikh M, Samujh R, Kanojia R, Sodhi KS. Does all small bowel intussuseption need exploration? Afr J Paediatr Surg. 2010; 7:30–32.
8. Ko SF, Lee TY, Ng SH, Wan YL, Chen MC, Tiao MM, et al. Small bowel intussusception in symptomatic pediatric patients: experiences with 19 surgically proven cases. World J Surg. 2002; 26:438–443.
9. Strouse PJ, DiPietro MA, Saez F. Transient small-bowel intussusception in children on CT. Pediatr Radiol. 2003; 33:316–320.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
10. Tiao MM, Wan YL, Ng SH, Ko SF, Lee TY, Chen MC, et al. Sonographic features of small-bowel intussusception in pediatric patients. Acad Emerg Med. 2001; 8:368–373.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
11. del-Pozo G, Albillos JC, Tejedor D, Calero R, Rasero M, de-la-Calle U, et al. Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics. 1999; 19:299–319.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
12. Bisset GS 3rd, Kirks DR. Intussusception in infants and children: diagnosis and therapy. Radiology. 1988; 168:141–145.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
13. Lim HK, Bae SH, Lee KH, Seo GS, Yoon GS. Assessment of reducibility of ileocolic intussusception in children: usefulness of color Doppler sonography. Radiology. 1994; 191:781–785.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
14. Lee HC, Yeh HJ, Leu YJ. Intussusception: the sonographic diagnosis and its clinical value. J Pediatr Gastroenterol Nutr. 1989; 8:343–347.
15. Verschelden P, Filiatrault D, Garel L, Grignon A, Perreault G, Boisvert J, et al. Intussusception in children: reliability of US in diagnosis--a prospective study. Radiology. 1992; 184:741–744.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
16. Pracros JP, Tran-Minh VA, Morin de Finfe CH, Deffrenne-Pracros P, Louis D, Basset T. Acute intestinal intussusception in children. Contribution of ultrasonography (145 cases). Ann Radiol (Paris). 1987; 30:525–530.
17. Doi O, Aoyama K, Hutson JM. Twenty-one cases of small bowel intussusception: the pathophysiology of idiopathic intussusception and the concept of benign small bowel intussusception. Pediatr Surg Int. 2004; 20:140–143.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
18. Kim JH. US features of transient small bowel intussusception in pediatric patients. Korean J Radiol. 2004; 5:178–184.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
19. Lee HS, Chung JY, Koo JW, Kim SW, Kim SH. Clinical characteristics of intussusception in children: comparison between small bowel and large bowel type. Korean J Gastroenterol. 2006; 47:37–43.
20. Lim HT, Park JH, Choi HJ, Kim JS, Shin HK, Gu CH. Clinical approach of ultrasonography in the diagnosis of intussusception in infant and children. J Korean Pediatr Soc. 1994; 37:649–654.
Fig. 1.
Typical benign small bowel intussusceptions (jeju-nojejunal) in a 4 year old boy with abdominal pain. Transeverse (A) and longitudinal (B) US scan showed doughnut (A) and sandwich signs (B).
![kjpgn-2010-13-2-128f1.tif](/upload/SynapseXML/0121kjpgn/thumb/kjpgn-2010-13-2-128f1.gif)
Fig. 2.
US (A) and CT scan (B) of a 5-year-old boy with recurrent abdominal pain and melena who underwent surgical reduction of small bowel intussusceptions at multiple sites (arrow). Based on biopsy, he was diagnosed with Burkitt lymphoma.
![kjpgn-2010-13-2-128f2.tif](/upload/SynapseXML/0121kjpgn/thumb/kjpgn-2010-13-2-128f2.gif)
Table 1.
Clinical Characteristics of Small Bowel Intussusception
Case | Age (months) | Sex | Irritability/Pain | Vomiting | Bloody stool | Abdominal mass | Underlying disorder | Management |
---|---|---|---|---|---|---|---|---|
1 | 6 | M | + | + | − | − | - | SR* |
2 | 17 | M | + | + | − | − | - | SR |
3 | 17 | M | + | + | − | − | - | SR |
4 | 22 | F | + | + | + | − | - | SR |
5 | 27 | M | + | − | − | − | - | SR |
6 | 38 | M | + | − | − | + | - | SR |
7 | 39 | M | + | + | − | − | - | SR |
8 | 51 | M | + | + | − | − | - | SR |
9 | 56 | M | + | + | − | − | - | SR |
10 | 57 | M | + | − | − | − | - | SR |
11 | 57 | M | + | + | − | − | Duplication cyst | SR |
12 | 149 | M | − | − | − | − | T-cell lymphoma | SR |
13 | 173 | F | + | + | − | − | Peutz-Jeghers | SR |
14 | 34 | M | + | − | − | − | Hydronephrosis | SR |
15 | 23 | M | − | − | − | − | - | SR |
16 | 179 | M | − | − | − | − | DLBL† | OP‡ (resection) |
17 | 67 | M | + | − | + | − | Burkitt lymphoma | OP (manual) |
18 | 119 | M | + | + | − | − | - | OP (manual) |
19 | 19 | M | + | + | − | − | - | OP (manual) |
20 | 164 | M | + | + | − | − | Peutz-jeghers | OP (resection) |
21 | 107 | F | + | − | + | − | Peutz-jeghers | OP (resection) |
Table 2.
Transient Small Bowel Intussusception and Surgically Managed Small Bowel Intussusception
Transient SBI (n=15) | Surgically managed SBI* (n=6) | p value | |||
---|---|---|---|---|---|
Clinical features | |||||
Male:Female† | 13:2 | 5:1 | 0.658 | ||
Mean age‡ (mo) (range) | 51±20 (6 mo∼14 yrs) | 109±17 (19 mo∼14 yrs) | 0.045 | ||
Symptoms | |||||
Pain/irritability† | 12 (85%) | 5 (83%) | 0.658 | ||
Bloody stool† | 1 (6%) | 2 (33%) | 0.184 | ||
Mass† | 1 (6%) | 0 (0%) | 0.714 | ||
Bowel ischemia/necrosis† | 0 (0%) | 2 (33%) | 0.071 | ||
Recurrence† | 3 (18%) | 1 (16%) | 0.684 | ||
Sonographic findings | |||||
Location (Right; Left; Middle)† | 7; 6; 2 | 2; 2; 1 (1: multifocal) | 0.956 | ||
Transverse diameter‡ (cm) | 1.6±0.4 (0.9∼2.0) | 3.2±0.5 (2.3∼3.5) | 0.004 | ||
Thickness of outer rim‡ (mm) | 1.6±0.8 (1.0∼2.5) | 5.8±1.4 (4.4∼7.8) | 0.004 | ||
Lead point† | 1 (6%) | 4 (67%) | 0.031 | ||
Ascites† | 1 (6%) | 4 (67%) | 0.017 | ||
Bowel distention† | 8 (53%) | 5 (83%) | 0.221 |