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Intussusception: The Use of Delayed, Repeated Reduction Attempts and the Management of Intussusceptions due to Pathologic Lead Points in Pediatric Patients

¹ All authors: Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON M5G 1X8, Canada.

View larger version (94K): [in a new window]   Fig. 1A. —9-month-old girl with ileoileocolic intussusception due to inverted Meckel's diverticulum. Dual image of transverse sonogram of right lower quadrant shows intussusception with teardrop-shaped hypoechoic structure (M) at its apex that proved to be Meckel's diverticulum.

View larger version (157K): [in a new window]   Fig. 1B. —9-month-old girl with ileoileocolic intussusception due to inverted Meckel's diverticulum. Magnified image of A shows thickened wall of inverted Meckel's diverticulum.

View larger version (144K): [in a new window]   Fig. 2A. —2-year-old girl with ileocolic intussusception due to enteric duplication cyst of ileocecal junction. Sonogram of right flank shows bilobed cystic structure (C) within layers of intussusceptum.

View larger version (134K): [in a new window]   Fig. 2B. —2-year-old girl with ileocolic intussusception due to enteric duplication cyst of ileocecal junction. Sonogram obtained at different level of intussusception again shows duplication cyst (C). Anterior to cystic lead point, characteristic crescentic shape of intussuscepted mesentery (arrows) is seen.

View larger version (140K): [in a new window]   Fig. 2C. —2-year-old girl with ileocolic intussusception due to enteric duplication cyst of ileocecal junction. Fluoroscopic image of abdomen obtained immediately after successful air enema reduction of intussusception reveals residual, persistent elongated mass (arrows) projecting into cecum because of presence of duplication cyst.

View larger version (136K): [in a new window]   Fig. 2D. —2-year-old girl with ileocolic intussusception due to enteric duplication cyst of ileocecal junction. Sonogram of right lower quadrant obtained after air enema confirms reduction of intussusception. Bilobed duplication cyst persists as fluid-filled structure with well-defined wall, which in part shows so-called gut signature (inner hyperechoic layer and outer hypoechoic rim).

View larger version (113K): [in a new window]   Fig. 3A. —7-year-old boy with ileocolic intussusception due to Burkitt's lymphoma of distal ileum. Sonogram of right flank shows presence of hypoechoic mass (arrow) at apex of intussusception.

View larger version (168K): [in a new window]   Fig. 3B. —7-year-old boy with ileocolic intussusception due to Burkitt's lymphoma of distal ileum. Magnified image of lead point obtained with linear array transducer shows better detail of hypoechoic mass, which proved to be Burkitt's lymphoma.

View larger version (158K): [in a new window]   Fig. 4A. —2-month-old boy with irreducible ileocolic intussusception due to necrosis. Sonogram of hypogastrium shows intussusception of complex appearance, due to presence of fluid (arrows) trapped between layers of intussusceptum. Entering limb of intussusceptum, which is partially surrounded by fluid, appears hyperechoic with loss of definition of bowel wall (asterisk).

View larger version (162K): [in a new window]   Fig. 4B. —2-month-old boy with irreducible ileocolic intussusception due to necrosis. Color Doppler sonogram of intussusception obtained at low gain settings shows scant flow in intussuscepted bowel. Surgery after two unsuccessful air enema reduction attempts revealed full-thickness necrosis of colon.

View larger version (171K): [in a new window]   Fig. 5A. —7-month-old boy with intestinal obstruction due to ileocolic intussusception. Upright abdominal radiograph shows multiple dilated loops of small bowel with air–fluid levels. No free intraperitoneal air is seen.

View larger version (119K): [in a new window]   Fig. 5B. —7-month-old boy with intestinal obstruction due to ileocolic intussusception. Fluoroscopic image of abdomen obtained during air enema reduction attempt shows partial reduction of intussusception (arrows) to hepatic flexure.

View larger version (125K): [in a new window]   Fig. 5C. —7-month-old boy with intestinal obstruction due to ileocolic intussusception. Fluoroscopic image of right upper quadrant obtained immediately after B with patient in semiprone position shows intraperitoneal free air outlining liver and loops of bowel, indicating bowel perforation. At surgery, small right colonic perforation was found without evidence of necrosis.

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