L. Hinz, H. Teichler (Halle)  

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GI-Large intestine  

physical  

typically acute, colicy pains, sudden screaming of otherwise unnoticeable infants, eventually palpatory resistance in the right lower abdominal quadrant, often afterwards a unsymptomatic interval, vomiting, later bloody-mucousy stools.  

Intussception of a section of the small intestine into a distal part thereof.
In the case of an iliocolic invagination (intussception), the transition between Ileum and Colon ( = ileocolic invagination) is affected.
This results in a problem of vascularization in the region of the intussception, which leads to edema and to a peristaltic interference.
This can result in a complete ileus, which may lead to a complete intestinal wall necrosis.
90% of intussceptions are seen as an idiopathic.
Frequently intestinal infections play a role.
The starting point of an intussception can both be an enlarged lymph node the course of a lymphadenitis, enlarged Peyer Plaques, little polyps, Lymphomas or a Meckel divertikulum. Also an inflamed appendix or, for example, askarides can be seen as a cause.  

<- view Ultrasound 1

Ultrasound 1: Proof of a typical corcade structure (target-ring form), mostly in the right lower/midgut area. In this case, representation of of a short segment in the right midgut, distal to the ileocecal pole. The outer ring is a representation of the edematously changed colon, within it the invagination from the terminal ileum with mesenterium and a small lymph node. Proof of minimal free fluid intraabdominally.




<- view X-Ray 1

X-ray 1: Colon contrast enema: Contrast media is abruptly stopped with a surrounding marking of the head of the invagination up until the hepatic flexure.



<- view X-Ray 2

X-ray 2: Contrast media is abruptly stopped, showing also the head of the invagination.



<- view X-Ray 3

X-ray 3: Devagination results.

 

Imaging including endoscopy  

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A large number of the intussceptions are usually associated with an infection of the GI tract, or also an episode of uncertain abdominal complaints. Many times, intussception occurs.

If an intussception is found in a sonographic examination, which often does not correct itself, the indication for a hydrostatic devagination (also a pneumatic devagination through air) is given.
When a late diagnosis occurs (a period of no symptoms!) with development of ileus symptoms and the possibility of a perforation, an emergency surgical repair is indicated.

In the later course of this illness, one may find symptoms of shock; the children are apathetic, what can often be misdiagnosed as an improvement of the situation.  

This case deals with a 9 month old girl. About 2 hours before the patient came to us, she suddenly started to have colicky stomach aches with violent screaming. The child was found in an obvious reduced general condition, was previously healthy, well-nourished and developed normally.

After the sonographically working diagnosis of an intussception had been confirmed, the colonic contrast enema with hydrostatic devagination was performed. Subsequently complete recovery, further course of illness was without complication.  

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1. Medline:
Rohrschneider W
Invagination
Radiologe 1997 Jun;37(6) 446-53

2. Medline:
Staatz G; Alzen G; Heimann G
Intestinal infection, the most frequent cause of invagination in childhood: results of a 10-year clinical study
Klin Padiatr 1998 Mar-Apr;210(2) 61-4

3. Medline:
Hoffmann V
Ultraschalldiagnostik in Pädiatrie und Kinderchirurgie.
Thieme, Stuttgart New York (1996) 302-305  

Ileocolic, invagination, intussusception, ileocolic intussusception, ileocolic invagination, cocarde, bull's eye, target sign, devagination, colon enema, intussuscipiens, intussusceptum, child, childhood, pediatric radiology  

L Hinz, H Teichler. Ileocolic invagination. PedRad [serial online] vol 2, no. 1.
URL: www.PedRad.info/?search=20020118111724