Purpose or Case Report: Intussusception is a common cause of bowel obstruction in the pediatric population that is important for the radiologist to recognize. A delay in diagnosis can lead to bowel obstruction and necrosis and ultimately bowel perforation. Radiographs and sonography are the primary modalities for diagnosis of the condition. Computed tomography use is of limited use due to radiation exposure but may be helpful when a pathologic lead point is suspected. The purpose of this educational review is to describe the clinical and characteristic radiographic and sonographic findings of intussusception in the pediatric population. Classic ileocolic intussusceptions will be discussed as well as imaging features that may predict failure to reduce with air enema. Small bowel small bowel intussusceptions and intussusceptions with lead points will also be reviewed. Finally, intussusceptions due to gastrojejunostomy tubes will be discussed.
Methods & Materials: A search of the radiology reports at our institution was performed from February 1, 2013 through October 1, 2017 for intussusception. Radiographs, ultrasounds, and, if applicable computed tomography and air contrast enema images were evaluated. Radiographs were evaluated for the presence of a soft tissue mass, absence of gas in the right lower quadrant on a decubitus image, and evidence of a small bowel obstruction. Additionally, in patients with gastrojejunostomy tubes, abnormal course of the tube was noted. Ultrasound images were evaluated for the size of the intussusception, the presence of color Doppler flow, trapped fluid within the intussusception, bowel wall edema, and free fluid. These findings were correlated with the ability to reduce with fluoroscopically assisted air enema.
Results: A variety of cases were obtained demonstrating:
a. Ileocolic intussusceptions reducible by air contrast enema
b. Ileocolic intussusceptions not reducible by air contrast enema
c. Small bowel small bowel intussusceptions
d. Ileocolic intussusceptions secondary to pathological lead points
e. Small bowel small bowel intussusceptions secondary to pathological lead points
f. Small bowel intussusceptions secondary to a gastrojejunostomy tubes


Conclusions: Accurate and timely diagnosis of intussusception is critical. The radiologist must maintain a high index of suspicion, particularly when reviewing emergency abdominal radiographs as classic findings may not be apparent. Knowledge of typical findings on radiographs and ultrasound will be helpful in making the diagnosis of intussusception.