Three Part Question
In [a child with abdominal pain] does [plain abdominal radiography] assist in [the diagnosis of intussusception]?
A 10-month-old child is brought to the emergency department in the middle of the night, with a short history of episodic inconsolable crying, pulling his legs up and non-bilious vomiting. You suspect intussusception is the diagnosis, and you wonder whether a plain abdominal X-ray will assist in the diagnosis.
Medline 1966–04/07 using the OVID interface.
[Intussusception OR exp intussusception] AND [abdominal x-ray/ x-ray OR Radiology or Radio*] LIMIT to human & English.
Cochrane Library: Intussusception
A total of 395 papers were found, of which 388 were irrelevant or of insufficient quality. Details of the remaining seven papers are shown in the table
|Author, date and country
||Study type (level of evidence)
The study by Smith et al most accurately reflects the clinical scenario using paediatric emergency physicians rather than paediatric radiologists to assess the films, and by using the clinically relevant endpoint of requesting a barium enema. Despite a sensitivity of 80% and a specificity of 58%, however, a false negative rate of 20% would be clinically unacceptable. The most commonly used argument for performing a plain abdominal X-ray in a case of possible intussusception is to pick up small bowel obstruction (58% in the study by Hernandez et al) and to exclude perforation. None of the papers comment on the incidence of perforation picked up on plain abdominal radiography although Hernandez et al comment that perforation with intussusception is generally uncommon before reduction attempts. Abdominal ultrasound in comparison has 98–100% sensitivity and 88% specificity with a negative predictive value of 100% (Verschelden et al).
Clinical Bottom Line
Plain abdominal radiography adds little to the management of patients with suspected intussusception.
- Eklof O, Hartelius H. Reliability of the Abdominal Plain Film Diagnosis in Pediatric Patients with Suspected Intussusception. Pediatric Radiology 1980; 9:199-206.
- Ratcliffe J F, Fong S, Cheong I, O'Connell P. The plain abdominal film in intussusception: the accuracy and incidence of radiographic signs. Pediatric Radiology 1992; 22: 110-111.
- Smith D S, Bonadio W A, Losek J D, Walsh-Kelly C M, Hennes H M, Glaeser P W, Melzer-Lange M, Rimm A A. The role of abdominal x-rays in the diagnosis and management of intussusception. Pediatric Emergency Care 1992;8(6):325-327.
- Meradji M, Hussain M, Robben SGF, Hop WCJ. Plain film diagnosis in intussusception. British Journal of Radiology 1994; 67: 147-149. British Journal of Radiology 1994; 67: 147-149.
- Sargeant M A, Babyn P, Alton D J. Plain abdominal radiography in suspected intussusception: a reassessment. Pediatric Radiology 1994;24:17-20.
- Lee J M, Kim H, Byun J Y, Lee H G, Kim C Y, Shinn K S, Bahk Y W. Intussusception: characteristic radiolucencies on the abdominal radiograph. Pediatric Radiology 1994; 24:293-295.
- Hernandez JA, Swischuk LE, Angel CA. Validity of plain films in intussusception. Emerg Radiol 2004; 10: 323–6.
- Verschelden P, Filiatrault D, Garel L, et al. Intussusception in children: reliability of US diagnosis—a prospective study. Radiology 1992; 184: 741–4.