SONOWORLD : Intussusception

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Abdomen » Gastrointestinal

Intussusception

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Author(s) :

Nirvikar Dahiya, MD

Presentation A young man presented at the clinic with colicky abdominal pain. Abdominal ultrasound was performed.

Caption: Longitudinal view.

Description: A section of bowel (dark) and mesentery (brightly echogenic) is seen within a section of edematous bowel (cursors).

Caption: Transverse view

Description: This image clearly shows the doughnut sign and the crescent sign because of the mesentry.

Caption: Longitudinal View

Description: This image shows a little fluid around the head of the intussusceptum.

Differential Diagnosis Intestinal Obstruction
Biliary Colic

Final Diagnosis Intussusception secondary to a leiomyoma, ileo-ileal type.

Discussion Doughnut or pseudo-kidney sign is the most common sign of intussusception. This is well demonstrated in the transverse image in this case.

The basic pathology is simple to understand. A portion of the bowel telescopes into the adjacent portion of the bowel. The outside bowel loop is the intussuscipiens or the receptor bowel, whereas the inner bowel loop is the intussusceptum or the donor bowel. This telescoping is seen well in the longitudinal images where even the mesentry with its blood vessels is seen herniating into the intussuscipiens. In transverse section also the mesentry can be appreciated. In the midportion of the intussusceptum, there is a hypoechoic crescent-shaped center caused by the mesentery, which is carried forward with the intussusceptum. This has been termed a crescent in a doughnut sign. The doughnut represents the outer walls, with the center representing the intussusceptum and the crescent representing the accompanying mesentery. Color Doppler sonography may be helpful in determining whether the intussusception is reducible. The absence of blood flow within the intussusception may be indicative of bowel wall necrosis. In this situation, rigorous attempts at reduction should not be performed.

Case References Verschelden P, Filiatrault D, Garel L, et al. Intussusception in children: reliability of US in diagnosis: a prospective study. Radiology 1992;184:741.
Shanbhogue RL, Hussain SM, Meradji M, et al. Ultrasonography is accurate enough for the diagnosis of intussusception. J Pediatr Surg 1994;29:324.
del-Pozo G, Albillos JC, Tejedor D. Intussusception: US findings with pathologic correlation: the crescent-in-doughnut sign. Radiology 1996;199:688.
Bowerman RA, Silver TM, Jaffe MH. Real-time ultrasound diagnosis of intussusception in children. Radiology 1982;143:527.

Technical Details All scans were performed using a 3.5 MHz tranducer on a General Electric Logic 500 Pro Series.

Follow Up The leading edge of the intussusceptum was found to be a leiomyoma on histopathology.

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