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What is the Yield of Abdominal X-ray in Suspected Intussusception?

February 29, 2024

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Written by Chris Thom

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In this retrospective study of pediatric patients with suspected intussusception, abdominal radiographs occasionally identify alternate clinical diagnoses.       

Can we cut the radiation out of the intussusception evaluation…
This retrospective study included children who were evaluated for suspected intussusception in a single tertiary care pediatric emergency department (ED). The time period was from January 1, 2018 to December 31, 2020, and children 6 years old or younger at the time of ED evaluation were included. The medical imaging database was used to identify examinations where intussusception was the listed indication for the exam. The authors note that their institutional protocol requires the performance of supine and left lateral decubitus abdominal radiographs prior to ultrasound evaluation in suspected intussusception.

1,115 patient encounters were identified, and 1,090 had screening abdominal radiographs. The final diagnosis was intussusception in 83 (7%) of the patients. The abdominal radiograph showed features concerning for intussusception in 82 (8%) of cases. 635 (58%) of abdominal radiographs were read as normal, 263 (24%) showed a significant stool burden, 107 (10%) showed generalized bowel distension, 22 (2%) showed abnormal gastric distention, 8 (<1%) had a radiopaque foreign body, 3 (<1%) showed pneumonia, 2 (<1%) showed pneumatosis intestinalis, and 1 (<1%) showed a diaphragmatic hernia.

How will this change my practice?
One can look at these study results from two disparate perspectives. On the one hand, abdominal radiographs did not often provide useful diagnostic findings of intussusception. On the other hand, they did occasionally find pertinent pathology that may or may not have been on the ordering physician’s differential diagnosis (e.g. – constipation, foreign body ingestion). The answer may lie in the physician’s pretest probability for intussusception and whether alternate pathologies are suspected. In cases where one is considering alternate pathology in addition to intussusception, an abdominal radiograph may occasionally assist with ascertaining the correct diagnosis.  

Yield of abdominal radiographs in children with suspected intussusception; rate of pneumoperitoneum and other abdominal pathologyAm J Emerg Med. Published online December 22, 2023. 

What are your thoughts?