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Adult Intussusception

9/12/12 -  This week's image of the week comes to us from Drs. Doug Chesson and Jeff Seigleman in an adult patient who presented with abdominal pain, nausea, and vomiting. 

In Image 1 below, notice the dilated bowel >4cm. As mentioned in prior emails, small bowel dilated >2.5 cm is highly suggestive small bowel obstruction.  

Image 1

dilated small bowel 

However, look at the attached Image 2. Does this image give you an idea of what is causing the obstruction?

Image 2

intusseusception

This is a case of adult intussusception. Recall the texbook presentation of intussusception is abdominal pain, currant jelly stools, and a palpable "sausage-like" mass in the RUQ of a toddler-aged child.  In children, intussusception is the most common cause of intestinal obstruction in the age 3mo-6yrs. In adults, the diagnosis is rare occurring in 1-3% of cases of bowel obstruction. The classic US sign of intussusception is the "bulls eye" or "target sign."  Unfortunately that cross section view is not seen here, rather we do see another common view - bowel telescoping inside itself (see Image 2). Note the thickened hypoechoic rim representing the edematous outer bowel and the compressed inner loop.

 To obtain these image the curvilinear probe was used. If a mass is palpated this area should be scanned first and images obtained in two planes.  If there is no mass, the entire abdomen can be scanned in a systematic fashion. 

Thank you for your excellent images!