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Adult intussusception—a CT diagnosis

Departments of ¹Diagnostic Imaging, ³Surgery, Sheba Medical Center, Tel Hashomer 52621 and ²Department of Diagnostic Imaging, Sapir Medical Center, Kfar Saba, Israel

View larger version (64K): [in a new window]   Figure 1. Small bowel intussusception due to a benign tumour. A 57-year-old man with recurrent abdominal pain of 1-month duration, weight loss and right upper quadrant tenderness. The intussusception appears differently relative to the slice axis. (a) An oval mass with soft tissue at its periphery (arrow) represents the bowel wall of the intussuscipiens and the intussusceptum, with fat density in its centre, representing mesenteric fat. Soft tissue linear densities within the mesenteric fat (arrowhead) are mesenteric blood vessels. This appearance is caused by the axis of the intussusception being parallel with the CT beam. (b) The intussusception now appears as a round mass with a "half-moon" shaped hypodense area of fat density close to its centre (arrowhead), the mesenteric fat. The beam is perpendicular to the axis of the intussusception in this more caudal section.

View larger version (58K): [in a new window]   Figure 2. Lymphoma of the ileocaecal valve presenting as intussusception. A 56-year-old woman with abdominal pain of several weeks' duration. (a) CT image through the mid abdomen (parallel to the axis of the intussusception) shows an elongated mass lesion. A central sliver of contrast medium (arrow) represents the intussuscepted bowel loop, surrounded by mesenteric fat and the walls of the intussuscipiens. (b) Image 2 cm caudal to (a). A ring-shaped mass is now seen in the left midabdomen, with a thick soft tissue density representing opposing bowel walls. Mesenteric vessels course within the central low density mesenteric fat (arrow). Colocolic intussusception was found at surgery.

View larger version (103K): [in a new window]   Figure 3. Patient with unsuspected metastatic melanoma of the small bowel and colon, the colonic metastasis causing intussusception. A 60-year-old man with weight loss and abdominal pain. CT at the level of the pelvis shows a round, target-shaped mass in the left iliac fossa (arrow). It consists of a central hyperdense area (contrast medium in the lumen of the intussusceptum) and a thick soft tissue mass around it with two "half-moon" shaped hypodense areas representing intussuscepted mesenteric fat. A peripheral rim of contrast medium outlines the space between the opposing walls of the intussuscipiens and the intussusceptum (arrow). Another large soft tissue mass (m) is seen in the right iliac fossa around a distal small bowel loop. Both the distal ileum and part of the left colon were resected.

View larger version (128K): [in a new window]   Figure 4. Small bowel intussusception caused by a lipoma as a lead point (same patient as Figure 1). CT at the level of the midabdomen shows a round hypodensemass, measuring 1.5 cm, in the tip of the intussusception surrounded by contrast medium(arrow). The fat density is homogeneous, characteristic of a lipoma. Ileoileal intussusception was confirmed at surgery.

View larger version (91K): [in a new window]   Figure 5. Jejunojejunal intussusception caused by a tube. A 22-year-old man with a head injury. A feeding tube was inserted via jejunostomy. Abdominal pain subsequently occurred. CT at the level of the lower abdomen shows a round, target-shaped mass in the left abdomen (arrow). The mass consists of a central hyperdense focus (the tube), a "half-moon" shaped hypodense area medial to it, the intussuscepted mesenteric fat and a soft tissue rim representing the opposing walls of the intussuscipiens and the intussusceptum.

View larger version (66K): [in a new window]   Figure 6. Small bowel intussusception caused by metastatic leiomyosarcoma. A 42-year-old man with malignant leiomyosarcoma of the left atrium, which had been partially resected 3 months earlier. He was admitted with abdominal pain and weight loss. (a) CT of the chest shows a round hypodense lesion in the left atrium (arrowheads), representing the residual leiomyosarcoma. (b) CT of the abdomen shows a hypodense area in the centre of a small bowel loop in the left abdomen (white arrow), characteristic of invaginated mesenteric fat. The proximal bowel loops are dilated, some with an air–fluid level. Orally administered contrast medium is seen in the colon (open arrows) as evidence of only partial small bowel obstruction.

View larger version (61K): [in a new window]   Figure 7. Transient small bowel intussusception. A 37-year-old man with abdominal pain 3 weeks after lumbar spine surgery following a motor vehicle accident. (a) Post-contrast CT image at the level of the midabdomen shows a slightly dilated proximal small bowel loop with fatty tissue within, consistent with small bowel intussusception (arrow). (b) No intussusception was detected on a pre-contrast CT image 5 min before (a). The patient underwent another CT study 1 week later; this scan again did not demonstrate intussusception. The abdominal pain gradually subsided.