Ultrasonographic Diagnosis of Intussusception in the Emergency Department

CPT. Katherine D. Percy*, Lt. Col. Massimo D. Federico and Larry B. Mellick

Ultrasonographic Diagnosis of Intussusception in the Emergency Department.

Distinguishing life-threatening causes of vomiting and diarrhea in infants is challenging. The ability to quickly and accurately differentiate causes of the acute abdomen at the bedside without radiation exposure is an extremely valuable skill.

Ultrasound is quickly becoming first line for many differentials of the acute abdomen including intussusception, appendicitis, and pyloric stenosis. Volvulus and mesenteric adenitis can also often be seen. This report details a case
of pediatric intussusception diagnosed in the emergency department by emergency medicine clinicians.

Additionally, we review the best technical approach to finding an intussusceptions using ultrasound. The sensitivity and specificity of ultrasound for intussusception approaches 100% with an experienced sonographer. Harnessing this skill has the potential to save a significant amount of time and lives.

Intussusception is the most common cause of pediatric small bowel obstruction. It occurs predominantly in 3 to 36 month old males1 and the annual incidence is approximately 56 cases per 100,000 cases. In contrast to adult intussusception, 2%-12% of intussusception cases in children contain a lead point such as Meckel’s diverticulum.

“Currant jelly stools” are commonly misconceived to be a frequent finding. However, this late marker of bowel ischemia is found in only a minority of cases.

Since history is limited in nonverbal children, the burden of diagnosis relies on a careful physical exam and particular attention to overall appearance, lethargy or inconsolability of the infant. Even then, the classic presentation is not reliable, particularly in cases of small bowel obstruction.

Emerg Med Open J. 2017; 3(1): 11-13. doi: 10.17140/EMOJ-3-132

LATEST ARTICLES

 - 
Arabic
 - 
ar
Bengali
 - 
bn
German
 - 
de
English
 - 
en
French
 - 
fr
Hindi
 - 
hi
Indonesian
 - 
id
Portuguese
 - 
pt
Russian
 - 
ru
Spanish
 - 
es