Intussusception ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

An ultrasound may be helpful in the diagnosis of intussusception. Findings on an ultrasound suggestive of/diagnostic of Intussusception include target sign or doughnut sign and pseudokidney sign. If the ultrasonographer is experienced then sensitivity, specificity and negative predictive value can be close to 100%.

Ultrasound

  • Ultrasound is the gold standard imaging modality used to diagnose intussusception[1]
  • If the ultrasonographer is experienced then [2]
  • Target or doughnut sign[3]
    • Edematous intussuscipien forms an external ring around the centrally located intussusceptum
    • Target sign is usually seen in right lower quadrant
  • Layers of intussusception forms pseudo-kidney appearance on the transverse view
  • Ultrasound in adults:
    • Less accurate than in children
    • Target sign or doughnut sign
    • Pseudo-kidney sign - It can be visualized in longitudinal view
    • The intussuscepted segment of bowel mimics a kidney
  • Ultrasound can be used to diagnose ileo-ileal intussusception which is a rare form. Fluoroscopy can miss this form of intussusception
  • Ultrasound can detect the pathology in 2/3rd of cases.[4]
  • Color duplex can detect ischemia of intussusception. It detects lack of perfusion
  • Small bowel intussusception:
    • Jejuno-jejunal or jejuno-ileal, rather than ileocolic intussusception :
      • If the intussusception is outside of the right lower quadrant - paraumbilical or left abdominal region
      • Lesion size ≤3 cm
    • In children if small bowel intussusception is suspected and the symptoms are mild
      • Repeat the ultrasound to see if the finding persists as small bowel intussusceptions mostly reduce spontaneously
      • If the finding persist then next step is to evaluate using a CT scan. CT scan can detect if there is a lead point
    • The length of the intussusceptum is measured using ultrasound or CT scan. It helps to determine the prognosis so that management is started accordingly
  • Limitations of ultrasound:[5]
    • In cases of bowel distension and morbid obesity, massive air can result in reduced rate of detection and diagnosis of intussusception.
Target Sign . Source: Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/6502">rID: 6502</a>
Intussusception - Transverse view on ultrasound Source: Case courtesy of Dr Eric F Greif, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/29373">rID: 29373</a>
Intussusception on transverse view on ultrasound. Source:Case courtesy of Dr Eric F Greif, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/29373">rID: 29373</a>
Intussusception - longitudinal view on ultrasound Source:Case courtesy of Dr Eric F Greif, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/29373">rID: 29373</a>
Pseudo - kidney sign seen on ultrasound Source:Case courtesy of Dr Ali Basim, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/49591">rID: 49591</a>

References

  1. Ko HS, Schenk JP, Tröger J, Rohrschneider WK (2007). "Current radiological management of intussusception in children". Eur Radiol. 17 (9): 2411–21. doi:10.1007/s00330-007-0589-y. PMID 17308922.
  2. Hryhorczuk AL, Strouse PJ (2009). "Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception". Pediatr Radiol. 39 (10): 1075–9. doi:10.1007/s00247-009-1353-z. PMID 19657636.
  3. Boyle MJ, Arkell LJ, Williams JT (1993). "Ultrasonic diagnosis of adult intussusception". Am. J. Gastroenterol. 88 (4): 617–8. PMID 8470658.
  4. Navarro O, Dugougeat F, Kornecki A, Shuckett B, Alton DJ, Daneman A (2000). "The impact of imaging in the management of intussusception owing to pathologic lead points in children. A review of 43 cases". Pediatr Radiol. 30 (9): 594–603. doi:10.1007/s002470000261. PMID 11009295.
  5. Mrak K (2014). "Uncommon conditions in surgical oncology: acute abdomen caused by ileocolic intussusception". J Gastrointest Oncol. 5 (4): E75–9. doi:10.3978/j.issn.2078-6891.2014.044. PMC 4110501. PMID 25083311.