Predictors and Ultrasonographic Diagnosis of Intussusception in Children

INTUSSUSCEPTION IS THE invagination of a portion of the intestine, called intussusceptum, into the lumen of an adjacent segment of intestine, called intussuscipiens, in the direction of the normal peristalsis or occasionally in a retrograde direction. The intussusceptum is composed of an inner or entering wall and an outer or returning wall. The first description of intussusception appears in 1793 by Hunter. The first successful operative reduction was reported by Hutchinson in 1873. In 1876, Hirschsprung published the first of several reports on the reduction of intussusception by hydrostatic pressure. Later in 1926, Hipsley described a series of patients managed with this method of treatment. In human medicine, intussusception is a disease primarily of infants and toddlers, although intussusception can occur at any age; only 10% to 25% of cases occur after 2 years of age.2 The peak incidence occurs between 5 and 9 months,9 and then decline. It rarely occurs younger than 2 months but may occur even in neonatal period. Although rare, intussusception has been reported in preterm infants. Males are affected approximately twice as often as females. The small intestine is the most difficult part to examine of the gastrointestinal (GI) tract because of its length and tortuous course. The traditional investigations with small bowel enteroclysis and small bowel follow-through reveal information sparingly, and unfortunately involve radiation exposure of the patient. Although it is an organ that is spared from frequent disease, more precise and patient-friendly methods are needed. In the last three decades, new imaging techniques have been developed that have proven useful. Computerized tomography (CT), magnetic resonance imaging (MRI), wireless capsule endoscopy and double-balloon endoscopy are all relatively new additions to the diagnostic armamentarium. Compared with these methods, transabdominal bowel sonography (TABS), has the advantage of being cheap, portable, flexible and userand patient-friendly. There are challenges with depth penetration and intestinal air precluding optimal image quality, and the flexibility of ultrasonography (US) warrants a systematic approach by the examiner. However, the development of improved scanner technology and high-resolution transducers has provided the clinician with image data of high temporal and spatial resolution, thus making it a useful tool in the diagnosis of small intestinal diseases. When using US frequencies in the range of 7,5-14 MHz, the wall of the small intestine usually exhibits five different layers that correspond well to the histological layers.