Purpose or Case Report: Ileocolic intussusception is a common cause of intestinal obstruction in young children. Most patients undergo image-guided enema reduction followed by a surgical reduction in enema fails. Many factors associated with decreased enema success have been described in the literature, although a concise scoring system to identify patients who are at risk for surgical intervention and complications does not exist. The goal of this project was to develop a scoring system to identify patients who are at increased risk for enema failure and surgical complications.
Methods & Materials: The radiology information system at our institution was queried for fluoroscopic exams for the keyword “intussusception” from 9/1/2017 – 3/31/2019. Exams other than a therapeutic enema for ileocolic intussusception were excluded. This search yielded 148 cases. The pre-enema imaging for each case, including radiographs or fluoroscopic scout, and ultrasound, were then reviewed for four findings: bowel obstruction, trapped fluid, poor blood flow within the intussusception, and location of the leading edge of intussusception (proximal vs distal to splenic flexure). The medical record was reviewed for enema success and surgical outcomes. A point score was assigned to each imaging finding when present, then summed to a total score. A total score was then correlated with enema success and surgical outcomes.
Results: A total of 148 cases were identified of which 140 met the inclusion criteria. Overall, successful enema reduction was achieved in 86% of patients. Several variations of the scoring system were tested. The simplest and most specific scoring paradigm had 2 points assigned to the presence of obstruction and 1 point for the rest, with a summed score of 3 or more considered high risk. Within the high-risk group, 58% of patients had surgical intervention and 41% had bowel resection compared to 6.5% and 0.8% of patients in the low-risk group respectively (p <0.001 for both). The sensitivity and specificity of this scoring system for identifying patients requiring bowel resection was 88% and 92% respectively.
Conclusions: A simple scoring system described can discriminate not only the patients that are at very high risk for failing therapeutic enema but also high risk for complications such as bowel resection. Utilization of such a scoring system can help to identify patients who may benefit from early surgical intervention, and prompt discussions between radiologists, clinicians, and surgeons regarding the best treatment approach.