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US features of transient small bowel intussusception in pediatric patients.

Kim JH - Korean J Radiol (2004 Jul-Sep)

Bottom Line: There were no visible lead points.The vascular flow signal appeared on color Doppler images in all 21 patients examined.All patients discharged with improved condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-gu, Seoul, Korea. jhkate.kim@samsung.com

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.

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Related in: MedlinePlus

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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Figure 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.

Mentions: On US, SBI appeared as a crescent-in-doughnut (Fig. 1) or a multi-layered round mass (Figs. 2, 3B) on a transverse scan and the short segmental sandwich sign (mean 1.8±0.5 cm, range 1.1-2.8 cm) was seen on a longitudinal scan (Fig. 1). The location of the SBI was the right abdomen in 21 patients, left abdomen in 10, and the paraumbilical region in one, along the course of the small bowel. The outer diameter ranged between 1-2.5 cm (mean: 1.5±0.3 cm, range: 1-2.5 cm) and the thickness of the outer rim ranged from 2 and 5 mm with a mean thickness of 3.5mm. Real time evaluation on the video records showed peristalsis of the invaginated bowel wall in all of the 14 patients that were recorded. The blood flow signal appeared on color Doppler images for all the 21 patients we examined. One patient exhibited fluid retention between the intussuscepient and the intussusceptum (Fig. 4) without wall thickening. In this patient, the intussuscepted bowel exhibited active wall motion that was reduced during the US evaluation. While a specific leading cause was not found, mesenteric lymph nodes (n = 29) and swollen adjacent bowel wall (n = 2) were seen. Free fluid collection was not noted in any patient.


US features of transient small bowel intussusception in pediatric patients.

Kim JH - Korean J Radiol (2004 Jul-Sep)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698160&req=5

Figure 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.
Mentions: On US, SBI appeared as a crescent-in-doughnut (Fig. 1) or a multi-layered round mass (Figs. 2, 3B) on a transverse scan and the short segmental sandwich sign (mean 1.8±0.5 cm, range 1.1-2.8 cm) was seen on a longitudinal scan (Fig. 1). The location of the SBI was the right abdomen in 21 patients, left abdomen in 10, and the paraumbilical region in one, along the course of the small bowel. The outer diameter ranged between 1-2.5 cm (mean: 1.5±0.3 cm, range: 1-2.5 cm) and the thickness of the outer rim ranged from 2 and 5 mm with a mean thickness of 3.5mm. Real time evaluation on the video records showed peristalsis of the invaginated bowel wall in all of the 14 patients that were recorded. The blood flow signal appeared on color Doppler images for all the 21 patients we examined. One patient exhibited fluid retention between the intussuscepient and the intussusceptum (Fig. 4) without wall thickening. In this patient, the intussuscepted bowel exhibited active wall motion that was reduced during the US evaluation. While a specific leading cause was not found, mesenteric lymph nodes (n = 29) and swollen adjacent bowel wall (n = 2) were seen. Free fluid collection was not noted in any patient.

Bottom Line: There were no visible lead points.The vascular flow signal appeared on color Doppler images in all 21 patients examined.All patients discharged with improved condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-gu, Seoul, Korea. jhkate.kim@samsung.com

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.

Show MeSH
Related in: MedlinePlus