From the Guidelines
Diagnostic Workup for Intussusception
The diagnostic workup for intussusception should include an assessment of the entire small intestine to rule out other causes of small bowel obstruction (SBO) such as adhesions, volvulus, and internal hernias [ 1 ].
- Key steps in the diagnostic workup include:
- Imaging studies: Although not explicitly mentioned in the provided evidence, in real-life clinical practice, imaging studies such as abdominal X-rays, CT scans, or ultrasound may be used to diagnose intussusception.
- Endoscopic evaluation: Endoscopy can be used to diagnose and potentially treat intussusception, especially in cases where the intussusception is accessible and not complicated [ 1 ].
- Surgical exploration: In cases where endoscopic evaluation is not possible or the patient is hemodynamically unstable, surgical exploration via laparoscopy or laparotomy may be necessary to diagnose and treat intussusception [ 1 ].
Classification and Management
Intussusception can be classified into antegrade and retrograde types, with retrograde being the most common form after laparoscopic Roux-en-Y gastric bypass (LRYGB) [ 1 ].
- Anatomical classification: The Schackman et al. classification categorizes jejunogastric intussusceptions into three types: Type I (afferent loop intussusception), Type II (efferent loop intussusception), and Type III (combined form) [ 1 ].
- Management: The management of intussusception may involve endoscopic reduction, surgical exploration with manual reduction, or resection of the affected segment [ 1 ].
- Resection: Resection of the invaginated segment is recommended to avoid recurrences, and can be performed via laparoscopy or open surgery [ 1 ].
- Surgical techniques: Other described surgical techniques include anchoring of the efferent limb to surrounding structures, Noble enteropexy, and reversal of the gastric bypass with conversion to another procedure [ 1 ].
From the Research
Diagnostic Workup for Intussusception
The diagnostic workup for intussusception involves several imaging modalities, including:
- Abdominal radiography to detect pneumoperitoneum or high-grade bowel obstruction 2
- Ultrasonography, which is the modality of choice for diagnosing intussusception in children 2, 3 and has excellent accuracy in detecting adult intussusception when performed by experienced examiners 4
- Computed tomography (CT) scans, which are widely regarded as the modality of choice for diagnosing intussusception in adults 5 and have excellent sensitivity in detecting intussusception and its complications 4
- Magnetic resonance imaging (MRI), which can also be used to diagnose intussusception, particularly in adults 5, 6
Imaging Modalities and Their Roles
The choice of imaging modality depends on the patient's age, symptoms, and clinical presentation. For example:
- In children, ultrasonography is the preferred initial imaging modality due to its high sensitivity and specificity in detecting intussusception 2, 3
- In adults, CT scans are often the initial imaging modality of choice due to their high sensitivity in detecting intussusception and its complications 5
- MRI can be used as a complementary imaging modality to CT scans or ultrasonography, particularly in cases where the diagnosis is uncertain or when further evaluation of the intussusception is needed 5, 6
Clinical Relevance and Treatment
The diagnostic workup for intussusception is crucial in guiding treatment, which may include:
- Nonoperative enema reduction, which is the treatment of choice for childhood intussusception in cases without signs of perforation or peritonitis 2
- Surgical intervention, which is often required in adult intussusception cases with suspected malignancy or other complications 5, 6
- Observation, which may be appropriate for asymptomatic or transient intussusceptions discovered incidentally on imaging studies 6