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Ileocolic Intussusception

Case Detail

Anatomy: Gastrointestinal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 4 years ago
Updated: over 4 years ago
Tags: PEDS
Modality/Study Types: US
Activities:
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History

22 month old with colicky abdominal pain intermittently for 5 days.


Case Images


Diagnosis

Ileocolic Intussusception

Findings

US – 5 cm mass with in RUQ. Centrally, the round hypoechoic foci represent lymph nodes and the hyperechoic area represents mesentery of the intussusceptum. Peripherally, the rim represents thickened and edematous bowel wall of the intussuscepiens. Color Doppler demonstrates flow in the intussusceptum.

Discussion

Ultrasound is the preferred method to diagnose intussusception; it is easy, accurate and does not involve radiation. Graded compression sonography of all 4 quadrants is performed. Intussusception appears as concentric rings transversely and a “pseudokidney” longitudinally.

Pathologic intussusception requiring reduction can be usually be differentiated from transient incidental intussusception by size and location. An intussusception > 2.5 cm in diameter is usually pathologic. Pathologic intussusceptions are usually peripheral in the abdomen, most common in the RUQ. Transient incidental intussusceptions are usually < 2.0 cm in diameter and located centrally or in the RLQ.

Presence of lymph nodes in the intussusception are pathognomotic for pathologic intussusception. A thickened outer rim of bowel >5 mm, absent color Doppler flow in the intussuscepiens, small bowel obstruction and ascites are poor predictors of reduction.

Reference

Park NH, et al. Ultrasonic findings of small bowel intussusception, focusing on differentiating from ileocolic intussusception. BJR 2007; 80:798-802.

Lim HK, Bae SH, LeeKH, Yoon GS. Assessment of reducibility of ileocolic intussusception in children: Usefulness of color Doppler sonography. Radiology 1994; 191:781-785.

Wiersma F, Allema JH, Holscher HC. Ileoileal intussusception in children: Ultrasonic differentiation from ileocolic intussusception. Pediatric Radiol 2006; 36:1177-1181.



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