Intussusception and Ultrasound
Intussusception is the most common cause of intestinal obstruction in young children. It is seen most commonly between 3 months and 6 years, peaking in the first year of life.
Formal ultrasound has been shown to be 98-100% sensitive and 88-100% sensitive. A prospective POCUS study by Riera et al. showed a sensitivity of 85% and specificity of 97%, NPV 97% and PPV 95%.
Technique and Diagnosis
Use a linear, high-frequency transducer, place the probe in the right lower quadrant and trace the length of the colon along it’s traverse axis. Ensure the depth is set to at least 6cm. Intussusception is identified by the finding of a “target” or “doughnut” which represents the layering of bowel wall caused from the telescoping of of a proximal area of bowel into a distal segment of bowel.
Ileocolic intussusception is measured from outer – to – outer wall of bowel.
Ileocolic intussusception ≥2.5cm
Small bowel-small bowel intussusception <2.5cm
Want to Read more? Check out these sources
Doniger SJ, Salmon M, Lewiss RE. Point-of-Care Ultrasonography for the Rapid Diagnosis of Intussusception: A case series. Pediatr Emergency Care. Feb 2016. Epub ahead of print.
Justice FA, de Campo M, Liem NT et al. Accuracy of ultrasonography for the diagnosis of intussusception in infants in Vietnam. Pediatr Radiol. 2007;37(2): 195-9.
Kim JH, Lee JY, Kwon JH et al. Point-of-care ultrasound could streamline the emergency department workflow of clinically nonspecific intussusception. Pediatric Emergency Care. September 2017. Epub ahead of print.
Riera A, Hsiao AL, Langhan ML et al. Diagnosis of intussusception by physician novice sonogrpahers in the emergency department. Ann Emerg Med. 2012;60(3):264-8.