IS Case 363: Intussusception

Brian Thorpe, MD


2009 URMC Imaging Sciences
Publication Date: 2010-03-02

History

Patient is a 20-month-old female with abdominal pain.

Findings

Soft tissue mass seen in the right lower quadrant on radiographs, which is confirmed on fluoroscopic imaging. This mass, which appears to be at the iliocecal junction, persists through two attempts at reduction with air contrast enema. On the third attempt, the mass is reduced and air is seen in the small bowel.

Diagnosis

Intussusception

Discussion

Intussusception is the most common cause of obstruction in children 3 months to 6 years old. It is more common in males than in females. In patients less than 3 months old and those greater than 3 years old there is more likely to be a lead point, i.e., a discrete lesion responsible for the intussusception.

Patients may present with varying signs and symptoms, including lethargy, abdominal pain, fever, bloody bowel movements, and signs of obstruction. Diagnosis is obtained with ultrasound, CT, fluoroscopically, and can be suggested on radiographs. CT is usually performed in older patients with nonspecific complaints, whereas if intussusception is strongly suspected air-contrast enema is the preferred method as it can be diagnostic and therapeutic.

Therapy is typically with air-contrast enema. If this fails surgery is required. Three attempts with air-contrast enema are usually attempted. Once the air column reaches the intussusception point air is pumped for three minutes. If there is no reduction, two more attempts are made. A pop-off valve is used to ensure that intraluminal pressures do not exceed 120 mmHg. Early intervention with air contrast enema is more effective than delayed intervention (ideally within 24 hours).

References

  1. Navarro OM, Daneman A, Chae A. Intussusception: the use of delayed, repeated reduction attempts and the management of intussusceptions due to pathologic lead points in pediatric patients. AJR Am J Roentgenol. May 2004;182(5):1169-76. PMID: 15100113

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