Korean J Radiol.  2004 Sep;5(3):178-184. 10.3348/kjr.2004.5.3.178.

US Features of Transient Small Bowel Intussusception in Pediatric Patients

• Kim JH

• KMID: 1118823
• DOI: http://doi.org/10.3348/kjr.2004.5.3.178

Abstract

OBJECTIVE
To describe the sonographic (US) and clinical features of spontaneously reduced small bowel intussusception, and to discuss the management options for small bowel intussusception based on US findings with clinical correlation. MATERIALS AND METHODS: During a five years of period, 34 small bowel intussusceptions were diagnosed on US in 32 infants and children. The clinical presentations and imaging findings of the patients were reviewed. RESULTS: The clinical presentations included abdominal pain or irritability (n = 25), vomiting (n = 5), diarrhea (n = 3), bloody stool (n = 1), and abdominal distension (n = 1), in combination or alone. US showed multi-layered round masses of small (mean, 1.5+/-0.3 cm) diameters and with thin (mean, 3.5+/-1 mm) outer rims along the course of the small bowel. The mean length was 1.8+/-0.5 cm and peristalsis was seen on the video records. There were no visible lead points. The vascular flow signal appeared on color Doppler images in all 21 patients examined. Spontaneous reduction was confirmed by combinations of US (n = 28), small bowel series (n = 6), CT scan (n = 3), and surgical exploration (n = 2). All patients discharged with improved condition. CONCLUSION: Typical US findings of the transient small bowel intussusception included 1) small size without wall swelling, 2) short segment, 3) preserved wall motion, and 4) absence of the lead point. Conservative management with US monitoring rather than an immediate operation is recommended for those patient with typical transient small bowel intussusceptions. Atypical US findings or clinical deterioration of the patient with persistent intussusception warrant surgical exploration.

Keyword

Children, gastrointestinal tract; Intussusception; Intestine, US

MeSH Terms

Abdomen/physiopathology
Abdominal Pain/etiology
Child
Child, Preschool
Diarrhea/etiology
Female
Humans
Infant
Intestine, Small/*ultrasonography
Intussusception/*ultrasonography
Irritable Mood
Male
Occult Blood
Ultrasonography, Doppler, Color
Vomiting/etiology

Figure

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  Fig. 1 Typical benign small bowel intussusception in a 9-year-old boy with abdominal pain after chemotherapy for mediastinal lymphoma. Transverse (A) and longitudinal (B) US scans show crescent-in-doughnut (A) and sandwich sign (B). The diameter of the doughnut is 1.9 cm and the length of the lesion is 2.5 cm.

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  Fig. 2 Small bowel intussusception associated with ileocolic intussusception in a 3-year-old girl. Immediate post-enema US reveals a multi-layered mass (solid arrow) suggesting small bowel intussusception, adjacent to the swollen reduced terminal ileum (open arrows). The small bowel intussusception spontaneously reduced during US examination and her abdominal pain subsided.

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  Fig. 3 Idiopathic postoperative small bowel intussusception in a 3 month-old-girl who underwent surgical reduction of the ileocolic intussusception. A. Plain radiography obtained 4 days after laparotomy shows the distended bowel and mass-like shadow at the right upper quadrant. B. Recurrent intussusception was suspected and US scan revealed a small (diameter, 1.3 cm) small bowel intussusception in the left abdomen. There was not any ieocolic intussusception corresponding to the right upper abdominal mass seen on A. Repeated US 5 hours later demonstrated the disappearance of the small bowel intussusception and follow-up radiography (C) shows improved bowel distension. The patient recovered uneventfully thereafter and was discharged.

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  Fig. 4 Fluid retention between the walls of invaginated bowel in a 2-year-old boy who presented with intermittent irritable crying. Longitudinal US scan shows the short-segmental small bowel intussusception with entrapped fluid (arrows) between the intussuscepient and intussusceptum. Repeated US 1 hour later did not demonstrate the small bowel intussusception any more and the patient discharged with an improved state.

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