Purpose or Case Report: Determine if a simple scoring system can accurately predict the reducibility of ileocolic intussusceptions with therapeutic enema, and eventual surgical outcomes in those patients failing reduction.
Methods & Materials: An IRB approved, retrospective study was performed. In previous, unpublished research, the authors identified several imaging findings associated with a significantly decreased success rate of therapeutic enema, including presence of bowel obstruction on plain film, trapped fluid and poor blood flow on ultrasound, and location of the leading edge of the intussusception at or beyond the splenic flexure. A scoring system was devised assigning 1 point to each of these findings. This scoring system was then retrospectively applied to the cases of ileocolic intussusception at our institution between September 2012 – August 2017 in which plain films and ultrasounds were both available. The cases were then stratified according to their scores, and correlated with enema results and surgical outcomes. Complicated surgical cases were defined as those that required more extensive surgery than a standard laparoscopic reduction, such as conversion to open laparotomy.

Results: 191 cases were reviewed. Following point assignment, the following categories were generated: Category 0 (114 cases), Category 1 (35 cases), Category 2 (32 cases), Category 3 (8 cases), and Category 4 (2 cases). Category 0 had the highest enema success rate (86%) and lowest rates of complicated surgery (3%) and bowel resection (3%). Lower rates of enema success, and higher rates of complicated surgery and bowel resection, were seen in higher categories. In grouped analysis, there was a statistically significant decrease in enema success rate between Categories 0-1 and Categories 2-4 (83% vs 19%, p < 0.0001), and increase in complicated surgeries (4% vs 40%, p < 0.0001) and bowel resections (3% vs 29%, p < 0.0001).


Conclusions: A simple scoring system based on imaging findings obtained in most cases of ileocolic intussusception can predict reducibility by therapeutic enema, as well as surgical outcomes in cases of failed reductions. This information can be useful to radiologists, surgeons, and emergency physicians when determining patient management, as some patients may be better served by proceeding to surgery rather than enema. Further research to validate the scoring system in a prospective fashion is planned.