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Idiopathic Intussusception located within the mid-transverse colon

USU Teaching File MUTF - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Idiopathic Intussusception located within the mid-transverse colon

History: 5 mo old female with questionable bilious vomiting with blood “flecks” and diarrhea.

Findings: Plain Film: Paucity of bowel gas in the transverse colon, distal colon, and rectum. US of palpable area: Midline and to the right of midline superior to the level of the umbilicus is a hyperechoic/hypoechoic/hyperechoic ‘tube within a tube’ appearance is noted in both the longitudinal and transaxial directions. A blind-end loop is seen within the right upper quadrant with a ‘tube-in-tube’ appearance. Barium Enema (Therapeutic): 4:1 Gastrografin mixture was instilled in a retrograde manner into the rectum under fluoroscopic observation with the patient in the prone position. Contrast flowed easily into the mid transverse colon where a large filling defect was noted. The Gastrografin bag was raised approximately 3 feet above the level of the table. The filling defect then progressed to the region of the hepatic flexure. Three attempts total were made to reduce the intussusception, without complete reduction. The intussusception ended up in the ascending colon.

Ddx: Intussusception, ileocolic vs. ileo-ileo-colic, jejuno-jujunal, jejuno-ileal. Idiopathic (no lead point) intussusception vs. lead point intussusception from small bowel lymphoma, lymphoid hyperplasia from a viral infection or other, Meckel diverticulum, polyps, duplication cysts.

Exam: An abdominal mass is palpable just above the umbilicus from the pt’s midline to right upper quadrant.

No MeSH data available.


Midline and to the right of midline superior to the level of the umbilicus is a hyperechoic/hypoechoic/hyperechoic ‘tube within a tube’ appearance is noted in both the longitudinal and transaxial directions. A blind-end loop is seen within the right upper quadrant with a ‘tube-in-tube’ appearance.
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MPX2138_synpic17098: Midline and to the right of midline superior to the level of the umbilicus is a hyperechoic/hypoechoic/hyperechoic ‘tube within a tube’ appearance is noted in both the longitudinal and transaxial directions. A blind-end loop is seen within the right upper quadrant with a ‘tube-in-tube’ appearance.


Idiopathic Intussusception located within the mid-transverse colon

USU Teaching File MUTF - MedPix

Midline and to the right of midline superior to the level of the umbilicus is a hyperechoic/hypoechoic/hyperechoic ‘tube within a tube’ appearance is noted in both the longitudinal and transaxial directions. A blind-end loop is seen within the right upper quadrant with a ‘tube-in-tube’ appearance.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2138&req=5

MPX2138_synpic17098: Midline and to the right of midline superior to the level of the umbilicus is a hyperechoic/hypoechoic/hyperechoic ‘tube within a tube’ appearance is noted in both the longitudinal and transaxial directions. A blind-end loop is seen within the right upper quadrant with a ‘tube-in-tube’ appearance.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Idiopathic Intussusception located within the mid-transverse colon

History: 5 mo old female with questionable bilious vomiting with blood “flecks” and diarrhea.

Findings: Plain Film: Paucity of bowel gas in the transverse colon, distal colon, and rectum. US of palpable area: Midline and to the right of midline superior to the level of the umbilicus is a hyperechoic/hypoechoic/hyperechoic ‘tube within a tube’ appearance is noted in both the longitudinal and transaxial directions. A blind-end loop is seen within the right upper quadrant with a ‘tube-in-tube’ appearance. Barium Enema (Therapeutic): 4:1 Gastrografin mixture was instilled in a retrograde manner into the rectum under fluoroscopic observation with the patient in the prone position. Contrast flowed easily into the mid transverse colon where a large filling defect was noted. The Gastrografin bag was raised approximately 3 feet above the level of the table. The filling defect then progressed to the region of the hepatic flexure. Three attempts total were made to reduce the intussusception, without complete reduction. The intussusception ended up in the ascending colon.

Ddx: Intussusception, ileocolic vs. ileo-ileo-colic, jejuno-jujunal, jejuno-ileal. Idiopathic (no lead point) intussusception vs. lead point intussusception from small bowel lymphoma, lymphoid hyperplasia from a viral infection or other, Meckel diverticulum, polyps, duplication cysts.

Exam: An abdominal mass is palpable just above the umbilicus from the pt’s midline to right upper quadrant.

No MeSH data available.