The diagnostic accuracy of ultrasonography in pediatric intussusception and its role in predicting the need for surgery

Objective Pediatric intussusception is a common gastrointestinal emergency requiring early diagnosis and appropriate treatment. Although ultrasonography (USG) is considered the first-line imaging modality for diagnosis, its potential value in identifying patients who may ultimately require surgical treatment remains uncertain. This study aimed to evaluate the diagnostic accuracy of ultrasonography in children with suspected intussusception and investigate associations of ultrasonographic findings and laboratory parameters with surgical management. Methods In this retrospective, single-center study, 113 patients with suspected intussusception who underwent abdominal ultrasound at the time of presentation between January and December 2025 were evaluated. The patients’ demographic characteristics, clinical findings, laboratory parameters, ultrasound findings, treatment methods, and clinical outcomes were analyzed. Diagnostic performance was assessed using a composite clinical reference standard based on operative confirmation, successful non-invasive reduction with clinical improvement, or exclusion of intussusception during documented clinical follow-up. Factors associated with surgical management were evaluated using comparative analyses and ROC curves. Results The mean age of the 113 patients was 2.3 ± 1.8 years, and 68.1% were male. Intussusception was detected on ultrasonography in 52 patients (46.0%). Non-invasive reduction was initially attempted in 47 of 52 patients; 42 were successfully reduced on the first attempt, while 5 proceeded to surgery after failed reduction. Five additional patients underwent primary surgery, resulting in 10 patients (19.2%) receiving surgical treatment. In patients who underwent surgery, intussuscepted segment length, free intraperitoneal fluid, white blood cell count, C-reactive protein level, and neutrophil-to-lymphocyte ratio were significantly higher ( p < 0.05 for all comparisons). In ROC analysis, cutoff values of 39.5 mm for intussuscepted segment length and 4.8 mg/dL for C-reactive protein demonstrated good discriminatory performance between final treatment groups. Conclusion Ultrasonography demonstrated high diagnostic accuracy for pediatric intussusception in this retrospective cohort. Longer intussuscepted segment length, free intraperitoneal fluid, and higher inflammatory markers were associated with surgical management. These findings may be useful for future risk-stratification approaches but should not be considered stand-alone indications for surgery. Prospective multicenter studies are needed to validate their clinical utility.