History: 2 yo female with abdominal pain
Solution: Intussusception
The images show an example of the "pseudokidney" and "doughnut" signs of intussusception. US is the preferred method of evaluation for intussusception in children because of its very high sensitivity (>95% in most studies) and lack of ionizing radiation. It can also be seen on CT, fluoroscopic studies and MRI.
Intussusception is the invagination of a proximal segment of bowel (intussusceptum) into a distal segment of bowel (intussuscipiens). It is the 2nd most common cause of an acute abdomen in children behind appendicitis and is most commonly idiopathic (lymphoid hyperplasia) in children, but associated with a lead mass in adults (often benign, but not always).
Transient, short segment intussusception is frequently seen on abdominal CT's and should not be a cause for concern. In this case, the intussusception is identified on the arterial phase, but not on the portal venous phase.
Acute treatment of an intussusception generally starts with an enema, unless the patient has peritoneal signs. Air contrast enema is used most frequently at our institution, but contrast enemas are also effective and some institutions use water enemas with US observation. Regardless, the concept is to push the intussusceptum back and untelescope the bowel. Success is directly related to the length of time that symptoms have been present and the associated degree of bowel wall edema. If the symptoms have been present more than 24 hours, then the chances of success go down significantly.
The images show an example of the "pseudokidney" and "doughnut" signs of intussusception. US is the preferred method of evaluation for intussusception in children because of its very high sensitivity (>95% in most studies) and lack of ionizing radiation. It can also be seen on CT, fluoroscopic studies and MRI.
Intussusception is the invagination of a proximal segment of bowel (intussusceptum) into a distal segment of bowel (intussuscipiens). It is the 2nd most common cause of an acute abdomen in children behind appendicitis and is most commonly idiopathic (lymphoid hyperplasia) in children, but associated with a lead mass in adults (often benign, but not always).
Transient, short segment intussusception is frequently seen on abdominal CT's and should not be a cause for concern. In this case, the intussusception is identified on the arterial phase, but not on the portal venous phase.
Acute treatment of an intussusception generally starts with an enema, unless the patient has peritoneal signs. Air contrast enema is used most frequently at our institution, but contrast enemas are also effective and some institutions use water enemas with US observation. Regardless, the concept is to push the intussusceptum back and untelescope the bowel. Success is directly related to the length of time that symptoms have been present and the associated degree of bowel wall edema. If the symptoms have been present more than 24 hours, then the chances of success go down significantly.
Ultrasound Images
