Background While intussusception is relatively common in children, it is a rare clinical entity in adults, where the condition is almost always secondary to a definable lesion. Data sources Thirteen cases of intussusception occurring in individuals older than 16 were encountered at our institute between 1981 and 1994. Results Presenting signs/symptoms included recurrent bowel obstruction, intermittent pain, and red blood per rectum. Correct preoperative diagnosis was made in six patients using colonoscopy, flexible sigmoidoscopy, upper gastrointestinal (GI) series and computed tomography (CT). At surgery the lead point was identified in the small intestine in eight cases, in the colon in four cases, and one small intestinal intussusception was considered idiopathic. Twelve patients underwent laparotomy and one patient was both diagnosed and treated by colonoscopy alone. Conclusions Adult intussusception is an unusual cause of bowel obstruction. The likelihood of neoplasia, particularly in the colon as a cause, is high. Operative management is thus almost always necessary.

The diagnosis and management of adult intussusception.

Children with symptomatic ileocolic or ileo-ileocolic intussusceptions can be successfully managed in one of a number of different ways. The nonoperative enema reduction technique has major advantages over surgical reduction and high success rates can be achieved using pneumatic or hydrostatic reduction techniques under fluoroscopic or sonographic guidance. This article highlights current concepts and some controversial issues related to management of intussusception, including patient selection for attempted enema reduction, the advantages and disadvantages of each technique, complications, the value of delayed, repeated reduction attempts, the role of imaging after attempted enema reduction, and recurrence of intussusception.

Intussusception. Part 2: An update on the evolution of management.

Keywords Intussusception.Infantsandchildren.Enema.BowelobstructionIntroduction and goals of imagingIntussusception is an invagination of the bowel into itself,usually involving both small and large bowel. The moreproximal bowel that herniates into more distal bowel iscalled the intussusceptum and bowel that contains it is calledthe intussuscipiens. It is an emergent condition where delayin diagnosis is common, which may lead to bowelperforation, obstruction, and necrosis. Most cases in infantsand young children are ‘idiopathic’ in that the etiology of theintussusception is due to hypertrophied lymphoid tissue inthe terminal ileum which results in ileocolic intussusception.The goal of initial bowel imaging is early detection (orexclusion)ofintussusceptiontoenableenemareductionoftheintussusception.Additionalimagingstudiesmaybeperformedto further characterize indeterminate results, possible leadpoints,incompletereduction,andrecurrenceofintussusception.EpidemiologyIntussusception is second only to pyloric stenosis as a causeof obstruction in children; it is the most common cause ofsmall bowel obstruction in children and occurs in at least 56children/100,000/year in the USA [1]. Viruses are associ-ated with intussusception, particularly adenovirus [1].Intussusception occurs most commonly in infants aged 5–9 months (67% occur by age 1 year) [2]. The classic triad ofcolicky abdominal pain, vomiting, and bloody stools ispresent in less than 25% children [3–5]. Delay in diagnosisand treatment is not uncommon, making enema reductionless successful, bowel resection more likely, and death dueto bowel ischemia possible [2, 6–8]. There were 323intussusception-associated deaths in American infantsreported to the Centers for Disease Control (CDC) between1979 and 1997.Abdominal radiographsThe presence of a curvilinear mass within the course of thecolon (the crescent sign), particularly in the transversecolon just beyond the hepatic flexure, is a nearly patho-gnomonic sign of intussusception. The absence of bowelgas in the ascending colon is one of the most specific signsof intussusception on radiographs [9]. However, abdominalradiographs have low sensitivity (45%) and therefore arenot recommended to diagnose intussuception.The increasing role of ultrasoundIntussusception can be reliably diagnosed when a ‘donut’,‘target’ or ‘pseudokidney’ sign is seen with sonography[10–13].The optimal US technique in this population iswell described and includes the use of a linear transducer[11–15]. US also plays a role in the evaluation ofreducibility of the intussusception, the presence of apathologic lead point (PLP) mass, intussusception limitedto small bowel, the diagnosis or exclusion of residual

Intussusception in children: evidence-based diagnosis and treatment

The vast majority of symptomatic intussusceptions in children arise in the ileum and are either ileocolic or ileoileocolic. The clinical diagnosis of these "idiopathic" intussusceptions may be difficult to make. Failure to make a prompt diagnosis and initiate appropriate treatment may lead to bowel ischemia, perforation, peritonitis, shock and even death. The clinician, therefore, may have to rely on imaging procedures to diagnose or exclude the presence of intussusception promptly and accurately. The imaging diagnosis of intussusception can be made with sonography or plain abdominal radiographs or by contrast (including air) enema examinations of the colon. This article highlights the current concepts and some controversial issues related to the imaging diagnosis of intussusception.

Intussusception. Part 1: a review of diagnostic approaches.

To review clinical, radiological and histopathological findings of adult intussusception and its management, 18 adult patients who had been treated surgically because of intussusception were reviewed. Of the patients, 5 (27.8%) had idiopathic intussusceptions, while the other 13 (72.2%) had a definable intraluminal pathology. The site of the intussusception was more common in the small bowel (83.3%) than the colon (16.7%). Ultrasonography and computed tomography were successful in demonstrating "target lesion" in 80% and 75% respectively. Patients with idiopathic intussusception were treated with simple reduction, while the others underwent segmental resection because of the possibility of malignant tumour. In contrast to intussusception in childhood, intussusception in adults usually has a definable lead point and resection of the involved bowel, rather than simple reduction, is indicated.

Intussusception in Adults

Six neonates with midgut malrotation and volvulus were explored with ultrasonography before surgery. In each case, ultrasound detected an abnormal position of the superior mesenteric vein with regard to the superior mesenteric artery, indicating a midgut malrotation. In 4 patients, a propeller-like image was present around the superior mesenteric axis, demonstrating an associated volvulus. In 2 patients, there was a tumor-like presentation of the volvulated small intestine. Compared to the intestinal opacification, ultrasound seems to be a simple and rapid method to explore the neonate with vomiting or acute abdomen.

Echographic aspects of midgut malrotation with volvulus in the newborn infant

A Hematoma of the right adrenal gland was found by computed tomography and ultrasonography in two 4 year-old boys following a mild traumatism. Such traumatic adrenal hematomas appear to be very rare in children. Their pathogenicity is discussed.

[Ultrasonic and x-ray computed tomographic diagnosis of isolated traumatic hematomas of the adrenal glands in children. Apropos of 2 cases].

High-resolution real-time sonography (US) has been used for many years in departments of pediatric radiology to image soft tissues and joints in children. The purpose of this study was to review the main indications and results of US in assessing the hip (except for congenital dislocation and subluxation) and the soft tissues of the thigh and groin in children. The technical and anatomical factors relative to the optimal imaging of the hip joint and thigh muscles are also discussed and a variety of conditions considered, ranging from painful hips to soft tissue masses. In conclusion, high-resolution US emerges as a particularly useful tool in the study of children with acute hip pain (hip joint effusion), suspected osteomyelitis (fluid collection around the femoral saft) and various soft tissue of the thigh.

Sonography of the hip and soft tissues of the thigh in children.

Acute intestinal intussusception in children. Contribution of ultrasonography (145 cases).

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Echographic aspects of midgut malrotation with volvulus in the newborn infant

[Ultrasonic and x-ray computed tomographic diagnosis of isolated traumatic hematomas of the adrenal glands in children. Apropos of 2 cases].

Sonography of the hip and soft tissues of the thigh in children.

Acute intestinal intussusception in children. Contribution of ultrasonography (145 cases).