Dirk Schaper, V. Hofmann (Kinderchirurgie St. Barbara-KH Halle)  

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3 Years  

Male  

GI-Small intestine  

unknown  

3 year-old boy with acute, colic abdominal pains, acute vomiting, normal bowel movements, periodic intervals of relief, no fever.
Abdomen soft, slight pain on palpation in the right lower quadrant, palpatory resistance in the right lower quadrant, bowel sounds normal.  

Often this has an inflammatory cause with lymph node swelling as a root of the invagination.  

<- view Ultrasound 1

Ultrasound 1: Bulls-Eye sign int he right lower quadrant.



<- view Ultrasound 2

Ultrasound 2: Bulls-Eye sign with vasculature.



<- view X-Ray 1

X-Ray 1: Airless abdomen in the upper and middle abdomen.





<- view X-Ray 2

X-Ray 2: Increasing aeration by insufflation rectally. Representation of the intestinal pathology.




<- view X-Ray 3

X-Ray 3: Air-filled colon with a short stop at the Bauhin's Valve (ileocecal valve).




<- view X-Ray 4

X-Ray 4: Success, Insufflation of the small intestines.




<- view Ultrasound 3

Ultrasound 3: Large lymph node at the ileocecal transition.



<- view Ultrasound 4

Ultrasound 4: Obvious increase in blood supply in cecum.

 

Imaging including endoscopy  

Small bowel invagination, colitis, Crohn's disease  

Proof of an ileocolic intussception, immediate pneumatic devagination (X-rays 1-4), after 6h re-intussception, therefore repeated pneumatic devagination. No following reoccurrence. In the sonographic follow-up examination, multiple enlarged lymph nodes can be found (ultrasound 3), the caecum shows a clear increase in vascularization (ultrasound 4). To what extent this condition is contingent upon an inflammatory response or due to the intussception can not be stated with certainty. In other cases, such an increase in circulation is rarely seen, so that one must assume that this is an inflammatory process. Supporting this theory is that the increase of circulation was seen days after the devagination as well.  

Note from the editor:
The pneumatic devagination is one of the possibilities to correct an intussception. Since the devagination with air is performed using x-ray, devaginations with better contrast media (namely water-soluble contrast media) is not expected, especially since the contrast media can travel to the small intestines.

Comments and questions to the advantages of one or the other methods are welcomed.

The devagination pressure should be 100 cm H2O, and should not go over this value. Everyone who has performed a devagination knows that this pressure is usually not sufficient to correct a devagination.  

N/A  

1. Medline:
Hofmann V, Bartsch H.
Changes in the diagnosis and therapy of invagination
Zentralbl Chir. 1990;115(19):1249-58

2. Medline:
Margarit Mallol J, Ribo Cruz JM, Martin Hortiguela ME, Barber Perez J, Claret Corominas
Acute intestinal invagination: hydrostatic reduction vs. pneumatic reduction
An Esp Pediatr. 1993 Jan;38(1):17-9.

3. Medline:
Dong AT, Mong HT, Van BN.
Acute intestinal invagination: pneumatic reduction (experience with 2033 cases)
Arch Pediatr. 1999;6 Suppl 2:317s-319s  

Invagination, Intussusception, ileocolic, Intussusceptum, Devagination, small bowel intussusception, child, childhood, pediatric radiology  

Dirk Schaper, V Hofmann. Ileocolic invagination, pneumatic devagination. PedRad [serial online] vol 3, no. 8.
URL: www.PedRad.info/?search=20030829214402