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March 2009

Target shaped lesion in the left upper abdomen
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Clinical information

Pain and cramps in the abdomen. An ultrasound examination was requested to rule out an appendicitis or intussusception.

Ultrasound Images & Clips

5 year old boy, Pain and cramps in the abdomen. An ultrasound examination was requested to rule out an appendicitis or intussusception.

Transverse image of a target shaped lesion in the left upper abdomen. The multilayered lesion represents an intussusception.
Transverse image of a target shaped lesion in the left upper abdomen. The multilayered lesion represents an intussusception.
The same lesion in a longitudinal plane shows the typical bowel in bowel configuration of an intussusception.
The same lesion in a longitudinal plane shows the typical bowel in bowel configuration of an intussusception.
Cineloop 1 is made in the transverse plane of the lesion and shows peristaltic movements within the intussusception confirming that it is a small bowel intussusception.
Cineloop 2 is made in the longitudinal plane of the lesion and also shows the peristaltic movements in the intussusception.
Color Doppler shows normal vascularization of the bowel walls in the intussusception
Color Doppler shows normal vascularization of the bowel walls in the intussusception
In the right lower abdomen a normal appendix was found in a normal position. This eliminates an abnomal position of the cecum, confirming that the intussusception found in the left upper abdomen is not an iliocolic intussusception.
In the right lower abdomen a normal appendix was found in a normal position. This eliminates an abnomal position of the cecum, confirming that the intussusception found in the left upper abdomen is not an iliocolic intussusception.
Image of 2 mesenteric lymph nodes. The presence of mesenteric lymph nodes in children is non specific. No peritoneal fluid or bowel dilatation was found. The intussusception did not resolve during the time of the ultrasound examination. Because small bo
Image of 2 mesenteric lymph nodes. The presence of mesenteric lymph nodes in children is non specific. No peritoneal fluid or bowel dilatation was found. The intussusception did not resolve during the time of the ultrasound examination. Because small bo
Image of the left upper abdomen only shows normal small bowel.
Image of the left upper abdomen only shows normal small bowel.

Conclusion

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.

Details

  • Sex: Male
  • Age: 5

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photo Taco Geertsma
Author

Dr. Taco Geertsma

Retired Radiologist, Gelderse Vallei Hospital

Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. He was the head of the ultrasound department for many years.

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