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MDCT and 3D Imaging in Transient Enteroenteric Intussusception: Clinical Observations and Review of the Literature

¹ Both authors: Department of Radiology, Johns Hopkins Medical Institutions, 601 N Caroline St., Rm. 3253, Baltimore, MD 21287.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —73-year-old man with long-standing history of Crohn's disease who presented with abdominal pain. Patient had history of right hemicolectomy and two previous small-bowel obstructions as well as squamous cell cancer of tongue. MDCT with oral and IV contrast material administration was performed. Small-bowel series was performed next day (not shown), which showed only edematous jejunal loops but no intussusception, no mass, and no obstruction. Patient was treated conservatively, and his pain resolved. Axial image shows classic CT appearance of enteroenteric (jejunojejunal) intussusception (arrow). There was no evidence of obstruction, although small bowel was minimally dilated.

View larger version (176K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —73-year-old man with long-standing history of Crohn's disease who presented with abdominal pain. Patient had history of right hemicolectomy and two previous small-bowel obstructions as well as squamous cell cancer of tongue. MDCT with oral and IV contrast material administration was performed. Small-bowel series was performed next day (not shown), which showed only edematous jejunal loops but no intussusception, no mass, and no obstruction. Patient was treated conservatively, and his pain resolved. Coronal volume-rendered 3D image nicely shows invagination (arrows) of bowel as well as mesenteric fat and vessels.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —34-year-old man with polycythemia vera, factor II deficiency, and spherocytosis. Patient presented with abdominal pain. MDCT with only oral contrast administration was performed. Small-bowel series was also performed (not shown), which showed no evidence of intussusception. Patient was treated conservatively, and his symptoms resolved. Axial MDCT image shows intussusception (arrow) in left abdomen involving jejunum. This is likely jejunojejunal intussusception.

View larger version (175K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —34-year-old man with polycythemia vera, factor II deficiency, and spherocytosis. Patient presented with abdominal pain. MDCT with only oral contrast administration was performed. Small-bowel series was also performed (not shown), which showed no evidence of intussusception. Patient was treated conservatively, and his symptoms resolved. Coronal multiplanar reformation image shows short-segment intussusception (arrow) but no obstruction.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —34-year-old man with polycythemia vera, factor II deficiency, and spherocytosis. Patient presented with abdominal pain. MDCT with only oral contrast administration was performed. Small-bowel series was also performed (not shown), which showed no evidence of intussusception. Patient was treated conservatively, and his symptoms resolved. Axial image from repeat CT 2 days after A and B shows resolution of intussusception.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —31-year-old woman with remote history of Burkitt's lymphoma who presented for routine follow-up. Patient was asymptomatic. MDCT with administration of IV and oral contrast material was performed. Repeat CT 4 days later (not shown) did not show any intussusceptions. Given history of lymphoma, patient is being closely followed but has shown no evidence of recurrent intussusception or recurrence of her lymphoma over the past 12 months. Axial MDCT image shows short-segment intussusception (arrow) in left abdomen.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —31-year-old woman with remote history of Burkitt's lymphoma who presented for routine follow-up. Patient was asymptomatic. MDCT with administration of IV and oral contrast material was performed. Repeat CT 4 days later (not shown) did not show any intussusceptions. Given history of lymphoma, patient is being closely followed but has shown no evidence of recurrent intussusception or recurrence of her lymphoma over the past 12 months. Axial MDCT image shows short-segment intussusception (arrow) in right abdomen.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —31-year-old woman with remote history of Burkitt's lymphoma who presented for routine follow-up. Patient was asymptomatic. MDCT with administration of IV and oral contrast material was performed. Repeat CT 4 days later (not shown) did not show any intussusceptions. Given history of lymphoma, patient is being closely followed but has shown no evidence of recurrent intussusception or recurrence of her lymphoma over the past 12 months. Coronal multiplanar reformation (MPR) image shows same short-segment (arrow) in left abdomen as in A.

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —31-year-old woman with remote history of Burkitt's lymphoma who presented for routine follow-up. Patient was asymptomatic. MDCT with administration of IV and oral contrast material was performed. Repeat CT 4 days later (not shown) did not show any intussusceptions. Given history of lymphoma, patient is being closely followed but has shown no evidence of recurrent intussusception or recurrence of her lymphoma over the past 12 months. Coronal MPR image shows same short-segment (arrow) in right abdomen as in B.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —23-year-old woman with 2-week history of intermittent abdominal pain. Patient has had no nausea or vomiting but has had minimal diarrhea. MDCT with administration of IV and oral contrast material was preformed. Axial MDCT image shows jejunojejunal intussusception (arrow).

View larger version (163K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —23-year-old woman with 2-week history of intermittent abdominal pain. Patient has had no nausea or vomiting but has had minimal diarrhea. MDCT with administration of IV and oral contrast material was preformed. Coronal volume-rendered 3D image shows jejunojejunal intussusception, which measured 9 cm in length (arrows). There was no obstruction. Small-bowel series was performed same day (not shown), which was normal, without intussusception.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —23-year-old woman with 2-week history of intermittent abdominal pain. Patient has had no nausea or vomiting but has had minimal diarrhea. MDCT with administration of IV and oral contrast material was preformed. MDCT was repeated next day after small-bowel series. Coronal multiplanar reformation image shows no evidence of obstruction or intussusception. The patient's symptoms resolved over 24 hours, and she was discharged. She will undergo follow-up with gastrointestinal series for small-bowel capsule endoscopy.

View larger version (48K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —46-year-old woman with 1-month history of intermittent abdominal pain. MDCT with administration of IV and oral contrast material was performed. Subsequent enteroclysis (not shown) showed rapid peristalsis but no intussusception. Small-bowel enteroscopy was performed and showed intussusception but no mass. Patient's symptoms continued, and she underwent exploratory laparotomy. No intussusception or mass was found. Axial MDCT images show intussusception (arrow, A) in left abdomen. No obstruction was noted.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —46-year-old woman with 1-month history of intermittent abdominal pain. MDCT with administration of IV and oral contrast material was performed. Subsequent enteroclysis (not shown) showed rapid peristalsis but no intussusception. Small-bowel enteroscopy was performed and showed intussusception but no mass. Patient's symptoms continued, and she underwent exploratory laparotomy. No intussusception or mass was found. Axial MDCT images show intussusception (arrow, A) in left abdomen. No obstruction was noted.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —33-year-old man with history of alcohol and drug abuse and untreated hepatitis C who presented to emergency department with abdominal pain. MDCT with administration of IV and oral contrast material was performed. Axial (A), coronal multiplanar reformation (MPR) (B), and sagittal MPR (C) MDCT images show short-segment jejunojejunal intussusception (arrows). Small-bowel series was performed immediately after CT (not shown) and was normal. Patient's symptoms resolved with conservative treatment.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —33-year-old man with history of alcohol and drug abuse and untreated hepatitis C who presented to emergency department with abdominal pain. MDCT with administration of IV and oral contrast material was performed. Axial (A), coronal multiplanar reformation (MPR) (B), and sagittal MPR (C) MDCT images show short-segment jejunojejunal intussusception (arrows). Small-bowel series was performed immediately after CT (not shown) and was normal. Patient's symptoms resolved with conservative treatment.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —33-year-old man with history of alcohol and drug abuse and untreated hepatitis C who presented to emergency department with abdominal pain. MDCT with administration of IV and oral contrast material was performed. Axial (A), coronal multiplanar reformation (MPR) (B), and sagittal MPR (C) MDCT images show short-segment jejunojejunal intussusception (arrows). Small-bowel series was performed immediately after CT (not shown) and was normal. Patient's symptoms resolved with conservative treatment.

View larger version (176K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —55-year-old man with history of groin hernia repair who presented with abdominal pain. MDCT with administration of IV and oral contrast material was performed. Small-bowel series was performed (not shown), which was normal. Pain resolved without treatment. Axial MDCT images show jejunojejunal intussusception (arrows) in left abdomen. There was no evidence of obstruction.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —55-year-old man with history of groin hernia repair who presented with abdominal pain. MDCT with administration of IV and oral contrast material was performed. Small-bowel series was performed (not shown), which was normal. Pain resolved without treatment. Axial MDCT images show jejunojejunal intussusception (arrows) in left abdomen. There was no evidence of obstruction.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —35-year-old woman with history of breast cancer and acute abdominal pain. MDCT with administration of IV and oral contrast material was performed. Patient was moderately tender on physical examination. Exploratory laparotomy was performed and revealed long-segment jejunojejunal intussusception with 3-cm lead-point mass. This was resected. Many additional polyps were found in remainder of small bowel, and two other lesions were resected. Pathology revealed hamartomatous polyps in patient with previously unsuspected Peutz-Jeghers syndrome. Large arrows point to intussusception. Axial MDCT images show long-segment (at least 15 cm) enteroenteric (jejunojejunal) intussusception in left abdomen.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —35-year-old woman with history of breast cancer and acute abdominal pain. MDCT with administration of IV and oral contrast material was performed. Patient was moderately tender on physical examination. Exploratory laparotomy was performed and revealed long-segment jejunojejunal intussusception with 3-cm lead-point mass. This was resected. Many additional polyps were found in remainder of small bowel, and two other lesions were resected. Pathology revealed hamartomatous polyps in patient with previously unsuspected Peutz-Jeghers syndrome. Large arrows point to intussusception. Axial MDCT images show long-segment (at least 15 cm) enteroenteric (jejunojejunal) intussusception in left abdomen.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8C —35-year-old woman with history of breast cancer and acute abdominal pain. MDCT with administration of IV and oral contrast material was performed. Patient was moderately tender on physical examination. Exploratory laparotomy was performed and revealed long-segment jejunojejunal intussusception with 3-cm lead-point mass. This was resected. Many additional polyps were found in remainder of small bowel, and two other lesions were resected. Pathology revealed hamartomatous polyps in patient with previously unsuspected Peutz-Jeghers syndrome. Large arrows point to intussusception. Axial MDCT images show long-segment (at least 15 cm) enteroenteric (jejunojejunal) intussusception in left abdomen.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8D —35-year-old woman with history of breast cancer and acute abdominal pain. MDCT with administration of IV and oral contrast material was performed. Patient was moderately tender on physical examination. Exploratory laparotomy was performed and revealed long-segment jejunojejunal intussusception with 3-cm lead-point mass. This was resected. Many additional polyps were found in remainder of small bowel, and two other lesions were resected. Pathology revealed hamartomatous polyps in patient with previously unsuspected Peutz-Jeghers syndrome. Large arrows point to intussusception. Coronal multiplanar reformation images nicely show length of involvement. Lead point (small arrows, E) is seen.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8E —35-year-old woman with history of breast cancer and acute abdominal pain. MDCT with administration of IV and oral contrast material was performed. Patient was moderately tender on physical examination. Exploratory laparotomy was performed and revealed long-segment jejunojejunal intussusception with 3-cm lead-point mass. This was resected. Many additional polyps were found in remainder of small bowel, and two other lesions were resected. Pathology revealed hamartomatous polyps in patient with previously unsuspected Peutz-Jeghers syndrome. Large arrows point to intussusception. Coronal multiplanar reformation images nicely show length of involvement. Lead point (small arrows, E) is seen.

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