Ultrasound of Intussusception

Summary

In this episode of Radiologist Headquarters, Dr. Dan Koval explores the ultrasound diagnosis of intussusception in children, sponsored by Samsung Ultrasound. Through three illustrative case studies, he discusses the key ultrasound findings, such as the target sign and mesenteric involvement, distinguishing between iliocolic and small bowel intussusception. The video emphasizes the importance of ultrasound as the gold standard for diagnosis, highlighting treatment options, and warning signs for complications like ischemia and perforation. This educational session offers valuable insights for healthcare professionals in pediatric radiology.

Takeaways

• 😀 Intussusception occurs when a segment of the intestine folds into another, leading to potential bowel ischemia and perforation.
• 👩‍⚕️ Iliocolic intussusception is the most concerning type in children, often resulting from hypertrophic lymphoid tissue after an infection.
• 🔍 Ultrasound is the gold standard for diagnosing intussusception, with a sensitivity and specificity of 98% and a false negative rate of less than 1%.
• 🎯 Key ultrasound findings include a targetoid appearance, with concentric rings indicating intussusception, and a hypercoex center representing mesenteric fat.
• 🚨 Children presenting with colicky abdominal pain, vomiting, and a palpable abdominal mass may have intussusception, but this triad is seen in fewer than 50% of cases.
• 🩸 Red currant jelly stool, a mixture of blood and mucus, can indicate bowel ischemia in cases of intussusception.
• 🌬️ Air or contrast material enema is the preferred treatment for reducing iliocolic intussusception, with high success rates.
• 📏 Measurements of the intussusception's AP diameter greater than 2 cm and length exceeding 3 cm are suggestive of an iliocolic type.
• 💧 The presence of free fluid and irregular bowel wall appearance on ultrasound raises suspicion for ischemia or necrosis.
• ⚠️ If signs of ischemia or necrosis are evident, it's crucial to alert surgical teams due to the increased risk of perforation.

Q & A

What is intussusception?

Intussusception is a condition where a part of the intestine telescopes into an adjacent segment, leading to potential obstruction and ischemia.

What are the two main types of intussusception discussed in the video?

The two main types are iliocolic intussusception and small bowel to small bowel intussusception.

What is the significance of iliocolic intussusception in children?

Iliocolic intussusception is concerning because if not reduced, it can lead to bowel ischemia and perforation.

What are common presenting symptoms of intussusception in children?

Common symptoms include colicky abdominal pain, vomiting, and sometimes a palpable abdominal mass. There may also be a history of red currant jelly stool.

What is the gold standard for diagnosing intussusception?

Ultrasound is considered the gold standard for diagnosing intussusception due to its high sensitivity and specificity.

What typical ultrasound findings indicate iliocolic intussusception?

Typical findings include a target sign on short axis, hyperchoic center representing mesenteric fat, and an outer hypochoic bowel wall. The AP diameter is typically greater than 2 cm.

What differentiates small bowel small bowel intussusception from iliocolic intussusception?

Small bowel intussusception usually presents in the left lower quadrant, has a smaller AP diameter (less than 2 cm), and often measures shorter in length (less than 3 cm).

What imaging features may indicate ischemia or necrosis in intussusception?

Findings such as fluid trapped within the intussusception, lack of vascular flow on color Doppler, and an irregular bowel wall may indicate ischemia or necrosis.

What is the typical treatment for iliocolic intussusception?

The typical treatment for iliocolic intussusception is reduction via an air or contrast enema.

What were the key teaching points emphasized in the presentation?

Key teaching points include recognizing the symptoms of intussusception, understanding ultrasound findings, differentiating between types of intussusception, and identifying signs of complications.