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Clinically Suspected Intussusception in Children: Evidence-Based Review and Self-Assessment Module

¹ Indiana University Department of Radiology, Riley Hospital for Children, 702 Barnhill Dr., Room 1053, Indianapolis, IN 46202.

View larger version (189K): [in a new window]   Fig. 1 —10-month-old boy with 1-day history of irritability, vomiting, and intermittent crying. Linear sonography of right mid lower abdomen shows target sign of bowel intussusception. There is bowel within bowel and thickened walls of these loops due to edema. No pathologic lead point is identified. [Image courtesy of Dr. Alan Daneman]

View larger version (153K): [in a new window]   Fig. 2 —10-month-old boy with 1-day history of irritability, vomiting, and intermittent crying. Liquid enema radiograph shows the intussusception mass at mid transverse colon with contrast media distal to it. [Image courtesy of Dr. Alan Daneman]

View larger version (162K): [in a new window]   Fig. 3 —14-month-old girl with poor feeding and intermittent vomiting. Linear sonography with color Doppler of the right mid lower abdomen intussusception shows little blood flow within bowel wall. This sign is predictive of lower probability of enema reduction and higher risk of bowel necrosis (and bowel resection at surgery). [Image courtesy of Dr. Alan Daneman]

View larger version (141K): [in a new window]   Fig. 4 —14-month-old girl with poor feeding and intermittent vomiting. Appearance of intussusception at air enema reduction. Intussusception is encountered at mid transverse colon, with baby in supine position (arrow). The more proximal bowel that herniates into more distal bowel is called intussusceptum and the bowel that contains it is called intussuscipiens. Goal of enema should be successful reduction in approximately 80% of such cases.

View larger version (127K): [in a new window]   Fig. 5 —14-month-old girl with poor feeding and intermittent vomiting. Trapped intraperitoneal fluid on sonography. Image shows anechoic fluid (curved arrow) between the two bowel walls of the intussusception. This sign is associated with lower probability of successful enema reduction and higher probability of bowel resection at surgery due to necrosis.

View larger version (33K): [in a new window]   Fig. 6A —2-year-old girl with Meckel's diverticulum. Shows nuclear medicine 99mTc pertechnetate scan of child with abnormal tracer uptake in midabdomen, just to right of midline (arrow), that was later shown at surgery to be hemorrhagic Meckel's diverticulum.

View larger version (119K): [in a new window]   Fig. 6B —2-year-old girl with Meckel's diverticulum. Intraoperative image shows surgical specimen of the hemorrhagic Meckel's diverticulum (arrow). [Image 6B courtesy of Dr. Alan Daneman]

View larger version (80K): [in a new window]   Fig. 7 —12-year-old boy with Burkitt's lymphoma. CT scan of pelvis shows small-bowel intussusception in right pelvis (curved arrow) within ileum. In separate ileal loop, there is tumor caking of wall of bowel (straight arrow) and some ascites.

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