Paediatric, Abdominal Pain (Acute Non-Traumatic)

Pathway Home

Population Covered By The Guidance

This pathway provides guidance on imaging a child with non-traumatic abdominal pain.

Date reviewed: July 2014

Date of next review: July 2023

Published: July 2014

Quick User Guide

Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level of each imaging investigation is displayed in the pop up box.

SYMBOL	RRL	EFFECTIVE DOSE RANGE
	None	0
	Minimal	< 1 millisieverts
	Low	1-5 mSv
	Medium	5-10 mSv
	High	>10 mSv

Images

Image Gallery Note: These images open in a new page

1a		Intussusception Image 1a (longitudinal), 1b (transverse) and 1c (doppler) (Ultrasound): Intussusception with oedematous bowel walls.
1b
1c
2		Image 2: Resection of a caecal intussusception showing the relationship between the intussusceptum and intussuscipiens.

enematherapy

Enema Therapy for Intussusception

Treatment options for intussusception include enema therapy and surgery. Contrast enema therapy is the treatment of choice for reduction of intussusception 3
The rationale for enema therapy is to exert pressure on the apex of the intussusceptum and in doing so push it back from the pathological to the normal position 3
Contraindications for enema therapy include untreated shock, evidence of bowel perforation and/or peritonitis 3
There are a number of agents used to perform enema therapy including air, barium, water-soluble contrast. There are few randomised control trials, one of which showed no significant difference. However the consensus among paediatric radiologists in Australia employing fluoroscopic guided reduction is the use of air enema if there is no clinical evidence of bowel perforation 22,38-41
Compared to barium, there is a smaller risk of bowel perforation using air as the agent for enema therapy 41
If required, fluid resuscitation should occur prior to enema therapy
If the initial attempt is unsuccessful, the enema can be repeated 1-3 hours later
The technique of ultrasound guided saline enemas has been shown to be an option that does not require exposure to radiation but is not widely used due to the lack of expertise and concern regarding its ability to detect the occurrence of perforation 3
Rates of perforation when enema reduction is attempted are reported to be generally <1% and factors like free fluid in peritoneum, bowel wall necrosis, long duration of symptoms and younger patients (<7 months) may be associated with increased risk of perforation 41
Recurrence rates following enema reduction using either hydrostatic or pneumatic have been reported to be around 10% and most recurrences occur soon after the initial reduction 41,42,43
Children with high recurrence rate, non-reduction of intussusception should be investigated for pathological lead points (e.g. Meckel's diverticulum, polyps, lymphomas) which may need surgical intervention

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Paediatric, Abdominal Pain (Acute Non-Traumatic)

Pathway Home

Population Covered By The Guidance

Date reviewed: July 2014

Date of next review: July 2023

Published: July 2014

Quick User Guide

Pathway

Pathway Diagram

Images

Image Gallery

Teaching Points

Teaching Points (Acute non-traumatic abdominal pain)

axr

Plain Radiography

Bilious Vomiting

Intussusception

contrast

Contrast Upper GI Series

cxr

Chest Radiography

enema

Contrast Enema

enematherapy

Enema Therapy for Intussusception

surgery

Surgery

us

Ultrasound

Intussusception

Malrotation / Volvulus

Appendicitis

Gynaecological Disorders

References

References

Information for Consumers

Information for Consumers

Information from this website

Information from the Royal Australian and New Zealand College of Radiologists’ website

copyright

File Formats