Intussusception is a concerning differential diagnosis in young children presenting with abdominal pain. Misdiagnosis is common, as classic clinical symptoms of intussusception are often not present and physical examination findings are non-specific. Delay in diagnosis can lead to significant morbidity and mortality. Ultrasound is the diagnostic modality of choice and POCUS is emerging as the standard screening modality for intussusception, and unlike barium or air contrast enema, it does not carry the risk of bowel perforation. 

 

Why Ultrasound?

In children presenting with intussusception, plain radiographs often do not show any abnormalities [1]. A recent systematic review and meta-analysis found that point of care ultrasound had excellent sensitivity of 98% and specificity of 98% in detecting intussusception in children, and that the diagnostic accuracy of POCUS for intussusception was not significantly different from radiology-performed ultrasound. [2] When POCUS is used by novice sonographers, studies have reported an acceptable sensitivity of 85-89% but an excellent specificity of 97-98% with narrower confidence intervals. [3,4] Thus, POCUS is described as “rule in” test, an attractive modality to diagnose intussusception at the bedside rapidly and accurately, while decreasing the length of stay in the Emergency Department and expediting reduction. [5]