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Age: 2

Sex: Male

Indication: Abdominal pain

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Case #11


Findings

  • Telescoping of the terminal ileum into the cecum and ascending colon


Diagnosis

Ileocolic intussusception

Sample Report

Telescoping of the terminal ileum into the cecum and ascending colon, consistent with ileocolic intussusception


Discussion

  • Ileocolic intussusception is a common cause for an acute abdomen in young children and is most common between the ages of 6 months and 2 years
  • In children, a lead point is not usually identified, though non-reducibility or abnormal intussusception location (e.g. colocolonic) should prompt further search for a lead point
  • Intussusceptions in older children and adults commonly have an associated lead point, with the exception of transient short segment enteroenteric intussusceptions
  • Ultrasound is the preferred imaging modality for assessing pediatric patients with suspected intussusception
  • Look for telescoped appearance of the terminal ileum within the cecum and ascending colon
    • Imaged in cross-section, this creates a target appearance with the decompressed intussusceptum in the center surrounded by hyperechoic mesenteric fat surrounded by the intussuscipiens
    • Adding rings to the target appearance, the mucosal and muscularis bowel wall layers are typically hyperechoic whereas the submucosa is typically hypoechoic
  • Helpful terminology:
    • Intussusceptum: bowel segment that telescopes into another bowel loop (on the inside of the target)
    • Intussuscipiens: bowel segment that receives the intussusceptum (on the outside of the target)
  • First line treatment is air enema


Images

Ileocolic intussusception imaged in cross-section creating a target appearance with the intussusceptum in the center (red outline) surrounded by mesenteric fat (yellow outline) surrounded by the intussuscipiens (blue outline).

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