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Unenhanced CT Findings of Vascular Compromise in Association with Intussusceptions in Adults

Toshifumi Fujimoto1, Toshio Fukuda1, Masataka Uetani1, Yohjiro Matsuoka1, Kenji Nagaoki1, Nobuya Asoh1, Ichiro Isomoto1, Tomoaki Okimoto1, Hiroshi Ohtani2, Naofumi Matsunaga3, Hiromu Mori4 and Kuniaki Hayashi1

1 Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
2 Department of First Pathology, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan.
3 Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube 755-8505 Japan.
4 Department of Radiology, Oita Medical University, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan.



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  		Fig. 1. —Drawing of simple intussusception shows three cylindrical walls, intussuscipiens, returning wall of intussusceptum, and entering wall of intussusceptum. Note that intussuscipiens and returning wall make thick bowel wall complex when lumen between them has collapsed.

 


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  		Fig. 2. —Drawing of evaluated CT findings shows that fluid and gas collection are surrounded by returning wall in extraluminal space. Intraluminal fluid is inside dilated proximal bowel. Free peritoneal fluid is the ascitic fluid in peritoneal cavity.

 


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  		Fig. 3. —40-year-old man with enteric intussusception (CT stage 1, pathologic stage 2) that caused proximal bowel obstruction. CT scan obtained near base of intussusception shows thick bowel wall complex (bracket) that consists of two adjacent bowel walls, intussuscipiens (arrowhead), and returning wall of intussusceptum (straight arrow). Wall complex is uniformly dense except for small amount of intraluminal fluid. Note fluid collection in dilated proximal bowel (curved arrow).

 


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  		Fig. 4A. —80-year-old woman with colocolic intussusception (CT stage 2, pathologic stage 2). CT scan shows thick bowel wall complex (bracket) that is uniformly dense at base of intussusception. Note fatty component surrounded by returning wall continuous to sigmoid mesocolon.

 


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  		Fig. 4B. —80-year-old woman with colocolic intussusception (CT stage 2, pathologic stage 2). CT scan obtained 40 mm caudad to A shows hypodense layer in middle zone of returning wall of intussusceptum (arrow). Note intussuscipiens (arrowhead) peripheral to small amount of intraluminal gas.

 


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  		Fig. 5A. —65-year-old man with enteric intussusception (CT stage 3, pathologic stage 4). CT scan shows crescent-shaped fluid collection (open arrows) along inner aspect of returning wall with hypodense layer (thin solid arrows). Note entering wall of intussusceptum without hypodense layer (thick solid arrow).

 


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  		Fig. 5B. —65-year-old man with enteric intussusception (CT stage 3, pathologic stage 4). Photograph of cut gross specimen shows cavity formed by serosa of intestine and mesentery (open arrows), where extraluminal fluid was present. Note necrotic returning wall (thin solid arrow), and viable entering wall of intussusceptum (thick solid arrow).

 


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  		Fig. 6A. —47-year-old woman with enteric intussusception (CT stage 3, pathologic stage 2). CT scan shows fluid collection (arrow) surrounded by returning wall of intussusceptum at apex.

 


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  		Fig. 6B. —47-year-old woman with enteric intussusception (CT stage 3, pathologic stage 2). Sonogram obtained on same day as A shows anechoic area (arrow) corresponding to fluid collection seen on CT.

 


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  		Fig. 7. —34-year-old man with enteric intussusception (CT stage 4, pathologic stage 4). CT scan shows gas and fluid collection making air-fluid levels (arrowheads) in space surrounded by thick bowel wall complex. Note air-fluid levels are extraluminal, whereas they resemble intraluminal contents. Hypodense layer (arrows) is also shown in thick bowel wall complex. Small intestine that had developed gangrene was resected.

 

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