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Non-operative reduction has emerged as first line in the management of uncomplicated intussusception. The aim of this study was to compare the outcome of ultrasound-guided saline hydrostatic reduction and ultrasound-guided pneumatic reduction of intussusception in infants. This is a prospective study of infants with uncomplicated intussusception confirmed by ultrasound over a period of 21 months from December 2018 to August 2020. Fifty-two (69.3%) out of seventy-five infants were eligible and randomized based on simple random sampling technique into two groups: Group A included patients who had ultrasound-guided hydrostatic (saline) reduction; Group B included patients who had ultrasound-guided pneumatic (air) reduction. The success rates, time to reduction and complication rates were assessed. The success rates, between the saline hydrostatic reduction group and pneumatic reduction group, were comparable [17 (65.4%) versus 19 (73.1%); relative risk (RR) 0.8; 95% confidence interval (CI) 0.6–1.2; p  = 0.54]. The mean time to reduction was higher in the saline hydrostatic reduction group (15.4 ± 5.1 min versus 10.8 ± 4.1 min; p  = 0.003). There was no statistically significant difference in the perforation and recurrence rates between the two groups. Conclusion : Saline hydrostatic reduction and pneumatic reduction of uncomplicated intussusception under ultrasound guidance in infants might have comparable outcomes. However, pneumatic reduction may be faster. What is Known: • Ileocolic intussusception is the most common cause of intestinal obstruction in infants. • Ultrasonography is useful in the diagnosis and non-operative treatment of ileocolic intussusception. What is New: • Ultrasound-guided hydrostatic enema and ultrasound-guided pneumatic enema are similarly effective and safe techniques in the reduction of ileocolic intussusception. • Reduction of ileocolic intussusception under ultrasound guidance is a great technique that may prove useful in the developing world due to lower cost of required equipment.

Intussusception is a common etiology of acute abdominal pain in children. Over the last 70 years, there have been significant changes in how we diagnose and treat intussusception, with a more recent focus on the role of ultrasound. In this article we discuss historical and current approaches to intussusception, with an emphasis on ultrasound as a diagnostic and therapeutic modality.

Background Intussusception in adults is a rare condition characterized by a low incidence, which complicates the establishment of standardized management protocols unlike those readily available for pediatric cases. This study presents a case series from our institution alongside a systematic review of existing literature. The objective is to delineate effective management strategies for adult intussusception. Methods A systematic search of databases was conducted covering the period from January 2000 to May 2024. The study focused on adult patients diagnosed with intussusception either pre-operatively or intraoperatively and managed with either surgical intervention or conservative methods. The analysis also included retrospective review of patient records from our institution, specifically targeting individuals over 18 years of age, to determine the predominant types of intussusception and identify any pathological lead points associated with these cases. Results In our study, a total of 1,902 patients were included from 59 selected articles, with a mean age of 52.13 ± 14.95 years. Among them, 1,920 intussusceptions were diagnosed, with 98.3% of cases identified preoperatively. Computed tomography (CT) scan was the primary diagnostic modality used in 88.5% of cases. Abdominal pain was the predominant presenting symptom, observed in 86.23% of cases. Only 29 out of 1,920 cases underwent attempted reduction, while the majority required surgical resection due to the high incidence of malignancy in adult cases. The most common type of intussusception identified was colocolic (16.82%), followed by enteric (13.28%), ileocolic (4.89%), and ileocaecal (0.78%) types. A pathological lead point was observed in 302 out of 673 patients (44.84%), with a notably higher frequency of malignancy associated with colocolic intussusception. Conclusion Surgical management remains the cornerstone in treating adult intussusception, particularly in cases involving the colocolic type, where there is a significant risk of underlying malignancy. Attempts at reduction are generally avoided due to the potential risk of tumor dissemination, which could adversely impact patient outcomes. Contrast-enhanced computed tomography (CECT) of the abdomen is pivotal for accurately diagnosing intussusceptions and guiding appropriate management strategies. It is imperative to adhere strictly to oncological principles during surgical interventions to ensure optimal patient care and outcomes.

INTRODUCTION:The natural history of rectal intussusception (RI) is poorly understood. We hypothesized that decline in pelvic floor integrity and function leads to increasing RI grades.METHODS:Retrospective analysis of a registry of patients with defecatory disorders with high-resolution anorectal manometry and magnetic resonance defecography was performed. Association of risk factors on increasing RI grades was assessed using logistic regression.RESULTS:Analysis included a total of 238 women: 90 had no RI, 43 Oxford 1-2, 49 Oxford 3, and 56 Oxford 4-5. Age (P = 0.017), vaginal delivery (P = 0.008), and prior pelvic surgery (P = 0.032) were associated with increased Oxford grades. Obstructive defecation symptoms and dyssynergic defecation were observed at relatively high rates across groups. Increased RI grades were associated with less anal relaxation at simulated defecation yet, higher rates of normal balloon expulsion (P < 0.05), linked to diminished anal sphincter. Indeed, increased RI grades were associated with worsening fecal incontinence severity, attributed to higher rates of anal hypotension. Levator ani laxity, defined by increased levator hiatus length and its excessive descent at straining, was associated with increasing RI grades, independent of age, history of vaginal delivery, and pelvic surgeries and could independently predict increased RI grades. Concurrent anterior and posterior compartments, and visceral prolapse were associated with higher Oxford grades.DISCUSSION:Our data suggest that decline in pelvic floor integrity with abnormal levator ani laxity is associated with increased RI grades, a process that is independent of age, history of vaginal deliveries, and/or pelvic surgeries, and perhaps related to dyssynergic defecation.

Our purpose was to compare phase-inversion harmonic imaging (PIHI) with conventional B-mode ultrasound (US) regarding image quality in the evaluation of bowel pathology. Forty-one patients prospectively underwent intestinal ultrasound scans with US and PIHI in randomly chosen order. Crucial technical parameters were standardized. Bowel morphology as well as perienteric pathology and complications were documented. In 24 cases, the ultrasound results were compared to those of other imaging modalities. Three radiologists evaluated (1) overall image quality, (2) lesion conspicuity and diagnostic confidence, and (3) detection of free fluid on hardcopy films. The ratings for image quality were compared using the two-sample paired t test for means and Bowker's test for symmetry (p=0.05). Compared to US, PIHI provided significantly better overall image quality, lesion conspicuity and diagnostic confidence, as well as better detection of free fluid (p< 0.05). Bowel wall pathology, detected by both modalities, showed good correlation to additional imaging modalities. In 12 patients (29.3%), a gain of crucial diagnostic information was observed with PIHI when compared to US. PIHI significantly enhances sonography of the intestine by offering better overall image quality, better visualization of bowel pathology and associated changes. Additionally, PIHI adds crucial diagnostic information in several patients.

Gastroduodenal intussusception is a rare but important cause of gastric outlet obstruction, particularly in elderly patients. We present the case of an 81-year-old female who arrived at the emergency department with complaints of epigastric pain, nausea, and vomiting. A CT scan revealed gastroduodenal intussusception, while subsequent endoscopy identified a submucosal mass, raising suspicion for either a gastrointestinal stromal tumor (GIST) or pancreatic rest. This case report highlights the diagnostic process, therapeutic considerations, and clinical outcomes, with a review of the relevant literature.

A 57-year-old woman presented with a 3-hour history of abdominal pain and vomiting. An abdominal ultrasound showed small bowel contracting inside an outer layer of free fluid and small bowel (shown in videos).

Background Intussusception is the leading cause of acute abdominal conditions in infants, yet it is frequently under-recognised in those younger than 3 months, potentially resulting in serious complications such as bowel necrosis, peritonitis, or even death if not promptly treated. This retrospective study aims to enhance clinicians’ understanding of the diagnosis and management of acute intussusception in this age group to prevent poor prognosis. Methods The clinical data of 38 infants aged ≤ 3 months diagnosed with intussusception at Wuhan Children’s Hospital between January 2013 and July 2024 were retrospectively analyzed. Patients were categorized into two groups based on the outcome of nonoperative reduction: the successful group and the failed group. The study examined demographic characteristics, clinical presentations, imaging findings, treatment modalities, and outcomes to identify patterns and evaluate the effectiveness of diagnostic and therapeutic approaches. Results During the study period, 12,206 children were diagnosed with intussusception, including 38 (0.31%) infants aged 3 months or younger (mean age: 73.6 days; 20 males and 18 females). The most frequently reported symptoms were vomiting (36 cases), bloody stool (27 cases), and intermittent crying (18 cases). Ultrasonography (USG) confirmed the diagnosis in 97.4% of cases. A total of 27 (71.1%) infants treated with enema reduction, with a success rate of 48.1% (13/27). Enema-related perforation occurred in 2 cases (7.4%). An additional 11 cases (28.9%) proceeded directly to laparotomy, with 5 (15.8%) diagnosed as secondary intussusception. Bowel resection was necessary in 6 of the 25 surgical cases due to necrosis. Each infant responded well to treatment and was discharged in stable condition. Conclusions The clinical manifestations of intussusception in infants aged 3 months and below are sometimes atypical. Early USG should be performed to make a clear diagnosis, and the effect of early intervention is satisfactory. In infants with good general condition, enema reduction can be attempted first with appropriate pressure monitoring to avoid bowel perforation.

Small-Bowel Intussusception in a ChildA 3-year-old boy who had been born prematurely had a 1-day history of intermittent abdominal pain, nausea, and vomiting. Ultrasonography of the right lower abdomen showed a target-sign lesion.

Objective This study aimed to investigate the risk factors of intestinal necrosis in children with intussusception and intestinal necrosis was established. Methods The clinical data of children diagnosed with intestinal necrosis after surgical treatment in our hospital were retrospectively analyzed and assigned to the bowel necrosis group.A control group was established treated successfully with air enema, without bowel necrosis, during the same period. Ultrasonic manifestation and clinical features were recorded and analyzed. Factors associated with bowel necrosis were analyzed using univariate and multivariate unconditional logistic regression analyses. Results (1) The bowel necrosis group included a higher proportion of children under 12 months of age, and had more cases with blood flow signal < grade 4, peritoneal effusion, and bloody stools ( P  < 0.05) than the non-intestinal necrosis group. The values for roundness, concentric ring thickness, length of the intussuscepted segment, head-to-neck diameter ratio, bowel wall thickness, and neutrophil-to-lymphocyte ratio ( NLR) were all higher in the bowel necrosis group ( P  < 0.05). (2) The logistic regression analysis indicated that roundness (×100) [odds ratio ( OR ) = 1.397, 95% confidence interval ( CI ): 1.086–1.796] and blood flow signal (< grade 4) ( OR  = 0.099, 95% CI : 0.018–0.543) were independent predictors of bowel necrosis in intussusception. Conclusions Roundness and blood flow signal grading are independent predictors for diagnosing bowel necrosis in pediatric intussusception.