Abstract
Background
Identification of intussusception is feasible with emergency department (ED) point-of-care
ultrasound (PoCUS) due to its ease-of-use and high accuracy. Little is known about
the clinical characteristics and outcomes of small bowel-small bowel intussusception
(SB-SBI) relative to ileocolic intussusception (ICI) identified by PoCUS.
Methods
We conducted a retrospective cohort study at a single, tertiary care, urban pediatric
ED of intussusception identified by PoCUS. Demographic information, clinical data,
and outcomes, including clinical course, intussusception characteristics, recurrence
rates, and interobserver agreement (Cohen's kappa), were evaluated.
Results
ED PoCUS identified thirty-seven patients with intussusception over a 4-year period.
Twenty-one patients (57%) identified were SB-SBI. The median age was 54 months (IQR
35–76 months) for SB-SBI and 8 months (IQR 5.8–13.5 months) for ICI. The mean diameter
was 1.68 cm (SD 0.52 cm) for SB-SBI and 2.74 cm (SD 0.43 cm) for ICI (p < 0.05). Two of 21 (9.5%) SB-SBI subjects required surgical intervention, while the
rest spontaneously reduced. Fourteen of 16 (88%) ICI subjects required intervention.
There were two (9.5%) recurrences of SB-SBI and 1 (6.3%) recurrence of ICI confirmed
on PoCUS. Cohen's kappa was 0.85 (95% CI 0.68–1.0).
Conclusions
SB-SBI may be identified more frequently than previously thought when screened with
ED PoCUS. Older children with SB-SBI may have underlying lead-points and may require
surgical intervention. PoCUS can help differentiate between variants of intussusception
that range from a surgical emergency to a transient source of abdominal pain that
may be recurrent and otherwise unexplained, allowing clinicians to better manage these
patients accordingly.
Keywords
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Article Info
Publication History
Published online: June 17, 2019
Accepted:
June 13,
2019
Received in revised form:
June 10,
2019
Received:
April 27,
2019
Footnotes
☆The content of this manuscript were presented at
- -Society of Academic Emergency Medicine 2019 Annual Meeting (Las Vegas, NV. May 14–17, 2019)
- -Pediatric Academic Societies 2019 Annual Meeting (Baltimore, MD. April 24–May1, 2019)
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
