Presentation
Presented to the ER with abdominal pain and "red currant jelly" like bloody stools.
Patient Data
Transverse scan reveals multiple layers and concentric rings of bowel within bowels and central echogenic mesenteric fat and round to oval hypoechoic mesenteric lymph nodes giving "target sign".
Longitudinal scan reveals "pseudokidney sign" which represents the invagination or telescoping of proximal bowel segments (intussusceptum) into the lumen of the next distal segments (intussuscipiens). It also shows multiple enlarged lymph nodes that have been drawn into the intussusception.
Transverse color Doppler ultrasound reveals normal vascularization of the invaginated bowel walls within the intussusception.
Case Discussion
Intussusception is invagination or telescoping of proximal bowel segments (intussusceptum) into the lumen of the next distal segments (intussuscipiens).
It is the leading cause of small bowel obstruction in children aged 6 months to 4 years. It is associated with pathological lead points such as Meckel’s diverticulum, intestinal lymphoma, hypertrophied Peyer's patches, polyps, and lipomas.
In children, ileocolic is the most common type, accounting for almost 80% of cases, followed by ileoileal. However, it can also be found in colocolic segments.
Ultrasound has high accuracy in diagnosing intussusception, approaching a sensitivity of almost 100%. It also helps to find radiological evidence of bowel perforation in cases of intussusception and is valuable for predicting bowel reducibility.
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