pediatrics
Intussusception
Diagnosis of Intussusception
Ultrasonography Suspicion of the diagnosis must be high, particularly in children with atypical presentation, and studies and intervention must be done urgently, because survival and likelihood of nonoperative reduction decrease significantly with time. Approach depends on clinical findings. Ill children with signs of peritonitis require Resuscitation , broad-spectrum antibiotics (eg, Barium enema was once the preferred initial study because it revealed the classic coiled-spring appearance around the intussusceptum. In addition to being diagnostic, barium enema was also usually therapeutic; the pressure of the barium often reduced the telescoped segments. However, barium occasionally enters the peritoneum through a clinically unsuspected perforation and causes significant peritonitis. Currently, ultrasonography is the preferred means of diagnosis; it is easily done, relatively inexpensive, and safe; the characteristic finding is termed the target sign. At times, an intussusception is seen incidentally on an imaging study, such as a CT scan. If children have no symptoms of intussusception, they can be closely followed, and intervention may be delayed or in some cases unnecessary. Physicians should not wait for passage of a currant-jelly stool to suspect intussusception because it is a late occurrence. 