Evaluation of critical diagnostic landmarks obtained from comparison of symptomatic small bowel intussusception relevant to surgically proven 16 pediatric cases

Abstract

BACKGROUND: This study aims to evaluate the clinical presentation, diagnostic modalities, treatment strategies, and outcomes of pediatric small bowel intussusception (SBI), with a particular focus on surgically treated cases. METHODS: Records of children diagnosed with SBI between January 2018 and December 2023 were retrospectively reviewed. Demographics, clinical presentation, imaging findings, treatment approaches, and surgical outcomes were analyzed. Statistical comparisons were performed between operative and non-operative groups, and receiver operating characteristic (ROC) curve analysis was used to determine the optimal ultrasound threshold for predicting the need for surgery. RESULTS: Among 618 patients diagnosed with intussusception, 72 (11.6%) had SBI, of which 16 (2.6%) required surgery. Operative patients were significantly older (median: 75 months) than those managed non-operatively (median: 32 months) (p<0.05). Vomiting was significantly more common in the operative group (100% vs. 44.6%, p<0.001). The mean ultrasonographic length of the intussuscepted segment was significantly greater in the operative group (5.7±1.33 cm) than in the non-operative group (3.27±1.18 cm) (p<0.001). A cut-off value of 4.0 cm was identified as predictive for surgical intervention, with 100% sensitivity and 73.1% specificity. Pathologic lead points were found in 87.5% of surgical cases, although none were identified preoperatively. Hydrostatic reduction was successful in 62.5% of non-operative patients. CONCLUSION: This study emphasizes that older age, longer intussuscepted segment on ultrasound, and severe symptoms are predictive of surgical need in pediatric SBI. A 4.0 cm cutoff aids decision-making, while the limited detection of pathologic lead points (PLP) underscores the importance of clinical evaluation. © 2025 Elsevier B.V., All rights reserved.