Pain and cramps in the abdomen. An ultrasound examination was requested to rule out an appendicitis or intussusception.
Small bowel intussusceptions can be found incidentally in asymptomatic children and in symptomatic pediatric patients like in this case.
There is a difference between the small bowel intussusception and the ileocolic intussusception. The ileocolic intussusception nearly always needs hydrostatic or even surgical treatment . The small bowel intussusception in many cases is a self limiting disease. It is important to look for signs that help differentiating the self limiting small bowel intussusceptions from the ones that need surgical treatment.
Transient small bowel intussusceptions resolve during the examination or are resolved during a short term follow up examination.
Signs to look for in a small bowel intussusception are
Length of the intussusception
Wall thickness
Vascularity of the bowel wall
Identifiable lead point
Signs of obstruction
Signs of peritonitis
Signs found in intussusceptions that need surgical treatment are
Longer length of the intussusception (usually more than 3,5 cm.)
Bowel wall thickening
Identifiable lead point
Small bowel dilatation
Free peritoneal fluid
Signs of peritonitis
Signs found in intussusceptions that can be followed up are
Shorter length
No bowel wall thickening
Normal vascularity
No signs of obstruction or peritonitis
References
Park NH, Park SI, Park CS, Lee EJ, Kim MS, Ryu JA, Bae JM. Ultrasonographic findings of small bowel intussusception, focusing on differentiation from ileocolic intussusception
Br J Radiol. 2007 Oct;80(958):798-802
Mateen MA, Saleem S, Rao PC, Gangadhar V, Reddy DN. Transient small bowel intussusceptions: ultrasound findings and clinical significance.
Abdom Imaging. 2006 Jul-Aug;31(4):410-6.
Munden MM, Bruzzi JF, Coley BD, Munden RF. Sonography of pediatric small-bowel intussusception: differentiating surgical from nonsurgical cases.AJR Am J Roentgenol. 2007 Jan;188(1):275-9.