A Pediatric Radiology Textbook and Pediatric Radiology Digital Library
Pediatric Small Bowel-Small Bowel Intussusception
Etiology: — Usually transient — Is invagination or telescoping of proximal segment of small intestine (intussusceptum) into distal segment of small intestine (intussuscipiens)
Imaging: — Target sign of less than ~ 3 centimeters in diameter on transverse image or pseudokidney sign on sagittal image that does not involve colon — Should go away within 5 minutes — Never see lymph nodes in small bowel-small bowel intussusceptum
DDX: Ileocolic intussusception which is larger in size and does not go away in 5 minutes
Complications:
Treatment: None as it is usually a transient phenomenon
Clinical: If not transient consider investigation for pathological lead point
Radiology Cases of Small Bowel-Small Bowel Intussusception
Radiology Cases of Transient Small Bowel-Small Bowel Intussusception
Transverse greyscale US (upper left) of the left lower quadrant of the abdomen shows a soft tissue mass demonstrating a target sign measuring less than 2 cm in diameter which on transverse color doppler US (upper right) shows normal vascularity. Sagittal greyscale US of the area shows a pseudokidney sign (below). A repeat US 15 minutes later showed the mass was gone.
Radiology Cases of Small Bowel-Small Bowel Intussusception Due to Burkitt Lymphoma
Axial (above), coronal (lower left) and sagittal (lower right) CT with contrast of the abdomen shows multiple dilated loops of small bowel and a soft tissue mass in the right upper quadrant just beneath the gall bladder that shows the target sign on the sagittal image and the pseudokidney sign on the transverse and coronal images. The soft tissue mass was still present on an US performed 1 hour later.Axial CT with contrast of the abdomen (above) shows a round soft tissue mass on the left side of the pelvis that has a target sign appearance. Coronal (below left) and sagittal (below right) CT show multiple large mesenteric lymph nodes and that the soft tissue mass arises in the pelvis and also has a pseudokidney sign appearance.
Radiology Cases of Duodenal-Jejunal Intussuception Due to Gastrojejunostomy Tube
Axial (above) CT with contrast of the abdomen shows a round soft tissue mass to the right of the vertebral body that has a target sign appearance and that has a jejunostomy tube coursing in the center of it. Coronal CT (below) shows the soft tissue mass to be long in length and to comprise the second and third parts of the duodenum and the proximal jejunum and to have the jejunostomy tube coursing throughout its length.
Surgery Cases of Small Bowel-Small Bowel Intussusception
Surgery Cases of Small Bowel-Small Bowel Intussusception Due to Non-Hodgkin Lymphoma
Laparoscopic surgical image (above) shows the small bowel-small bowel intussusception. Surgical image of the small bowel after reduction of the intussusception (below) shows the serosa is pink-tan and intact with a 1.5 x 0.6 cm puckered, red, firm area that when opened in pathology revealed a 2.6 x 2.0 cm red-pink mass.
Gross Pathology Cases of Small Bowel-Small Bowel Intussusception
Gross Pathology Cases of Small Bowel-Small Bowel Intussusception Due to Burkitt Lymphoma
Gross pathological images of the resected segment of intussuscepted small bowel shows on its serosal surface (above) a 2.0 x 1.2 cm irregular, tan-white centrally ulcerated and umbilicated firm area. The opened image of small bowel (below) reveals a 3.4 x 2.9 x 1.2 cm irregular, tan-white, smooth, firm mass which was sectioned to reveal smooth, tan-white, glistening, homogenous cut surfaces.
