Ultrasonography-Based Prediction of the Need for Surgical Intervention in Pediatric Intussusception

OBJECTIVES: Intussusception is a major cause of acute intestinal obstruction in children. While most cases resolve with nonsurgical methods, some require surgical intervention. This study aimed to evaluate ultrasonographic features that may predict the need for surgery in pediatric intussusception. METHODS: Medical records of patients under 18 years diagnosed with intussusception between January 2020 and June 2023 at a tertiary hospital were retrospectively reviewed. Patients were categorized into surgical and nonsurgical groups. Ultrasound examinations were performed by staff radiologists at our hospital with patients in the supine position using high-frequency linear probes. Demographic data and imaging features (segment length, type) were recorded. Data were analyzed in Python 3.10 using χ2 tests, ROC analysis, and multivariable logistic regression (statsmodels, no regularization). ORs with 95% CIs were obtained, the optimal cutoff was determined by the Youden index, and bootstrap resampling was used to account for the limited number of surgical events. RESULTS: A total of 101 patients (53 males, 48 females; median age, 2.5 years (range, 0.5-15 years)) were included. Ileocolic intussusception was the most common type (n=60, 59.4%). Overall, 18 patients (17.8%) required surgical intervention, while 83 (82.2%) were managed nonsurgically. When stratified by type, surgical intervention was required in 21% (13/60; 95% CI, 11%-30%) of ileocolic intussusceptions and 12% (5/41; 95% CI, 5.3%-25.5%) of small-bowel intussusceptions. The median length of the intussuscepted segment was significantly greater in the surgical group [55 mm (IQR, 32.5 to 90)] than in the nonsurgical group [25 mm (IQR, 15 to 40); P < 0.001]. A 30-mm cutoff yielded 100% sensitivity and 53% specificity (AUC, 0.80), whereas a 91-mm cutoff achieved 100% specificity with 28% sensitivity. CONCLUSION: Ultrasonographic measurement of the invaginated segment length is a valuable noninvasive predictor of surgical necessity in pediatric intussusception. A dual-threshold approach may help guide conservative versus surgical management.