Pathologic Lead Points

Pathologic lead points are found in about 5-7% of all intussusceptions [3, 18, 21]. The commonest are Meckel diverticulum, polyps, Henoch-Schonlein purpura and cystic fibrosis. Less common causes are lymphoma, duplication cyst (Fig. 8) and various inflammatory lesions of the bowel. Management of these patients remains a challenge.

The contrast or air enema techniques are not always diagnostic in documenting the presence of a pathologic lead point. Sonography is extremely useful in this regard, as it has been shown that it may depict two thirds of pathologic lead points and may provide a specific diagnosis in one third of these [3, 18, 21] (Fig. 8). However,

Fig. 8. Intussusception in a young child due to a duplication cyst (C). The sonogram has been obtained longitudinally through the intussusception (arrow). The duplication cyst is easily identified as a pathologic lead point

Fig. 8. Intussusception in a young child due to a duplication cyst (C). The sonogram has been obtained longitudinally through the intussusception (arrow). The duplication cyst is easily identified as a pathologic lead point it remains a diagnostic challenge as to how to search for pathologic lead points in those patients in whom there is a high index of suspicion for such a lesion and in whom the sonogram is negative. In such cases, the choice of which other imaging modalities to use will depend on the clinical situation in each particular patient.

We recommend attempted enema reduction in all patients with a lead point if there is no contraindication to nonoperative reduction [3, 18].

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