DOI: 10.1148/rg.263055100
Adult Intestinal Intussusception: CT Appearances and Identification of a Causative Lead Point1
Young H. Kim, MD,
Michael A. Blake, FFR(RCSI), FRCR,
Mukesh G. Harisinghani, MD,
Krystal Archer-Arroyo, MD,
Peter F. Hahn, MD, PhD,
Martha B. Pitman, MD and
Peter R. Mueller, MD
1 From the Department of Radiology, UMass Memorial, University of Massachusetts, 55 Lake Ave North, Worcester, MA 01655 (Y.H.K., K.A.A.); and the Departments of Radiology (M.A.B., M.G.H., P.F.H., P.R.M.) and Pathology (M.B.P.), Massachusetts General Hospital, Boston, Mass. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received April 21, 2005; revision requested June 8 and received August 22; accepted August 26. All authors have no financial relationships to disclose.
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Figure 1. Longitudinal (top) and cross-sectional (bottom) diagrams illustrate a typical transient type intussusception, with invagination of a segment of the gastrointestinal tract (intussusceptum) (solid arrows) into an adjacent segment (intussuscipiens) (open arrows). Note also the invagination of the mesentery (M) and mesenteric vessels (arrowheads). (Courtesy of B.I. Choi, MD, Department of Radiology, Seoul National University Hospital, Seoul, South Korea.)
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Figure 2. Small bowel intussusception in a 51-year-old man with recurrent left lower quadrant pain. Contrast material–enhanced CT scan of the abdomen demonstrates the typical multilayered appearance of a small bowel intussusception. The intussusceptum (black arrowhead), with an accompanying complex of mesenteric fat and blood vessels (arrow), is surrounded by the thick-walled intussuscipiens (white arrowhead).
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Figure 3a. Transient type small bowel intussusception in a 54-year-old woman. Contrast-enhanced CT scans of the abdomen demonstrate the classic findings of a targetlike (arrow in a), sausage-shaped (arrow in b and c) mass, findings that are pathognomonic for intussusception. Mesenteric fat and blood vessels are barely visible.
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Figure 3b. Transient type small bowel intussusception in a 54-year-old woman. Contrast-enhanced CT scans of the abdomen demonstrate the classic findings of a targetlike (arrow in a), sausage-shaped (arrow in b and c) mass, findings that are pathognomonic for intussusception. Mesenteric fat and blood vessels are barely visible.
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Figure 3c. Transient type small bowel intussusception in a 54-year-old woman. Contrast-enhanced CT scans of the abdomen demonstrate the classic findings of a targetlike (arrow in a), sausage-shaped (arrow in b and c) mass, findings that are pathognomonic for intussusception. Mesenteric fat and blood vessels are barely visible.
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Figure 4a. Transient type small bowel intussusception in a 49-year-old man with abdominal pain who had suffered a fall. (a) Contrast-enhanced CT scan demonstrates an amorphous mass (arrow) that is due to bowel wall edema, making differentiation difficult (cf Fig 9). (b) Contrast-enhanced CT scan shows invaginated mesenteric fat and vessels (arrowhead).
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Figure 4b. Transient type small bowel intussusception in a 49-year-old man with abdominal pain who had suffered a fall. (a) Contrast-enhanced CT scan demonstrates an amorphous mass (arrow) that is due to bowel wall edema, making differentiation difficult (cf Fig 9). (b) Contrast-enhanced CT scan shows invaginated mesenteric fat and vessels (arrowhead).
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Figure 5. Longitudinal (top) and serial cross-sectional (bottom) diagrams illustrate a lead point intussusception, with invagination of a segment of the gastrointestinal tract (intussusceptum) into the adjacent segment (intussuscipiens). Thick arrows indicate the lead mass. The intussusceptum appears irregular due to bowel wall edema. The classic three-layer appearance and anatomic detail are often lost.
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Figure 6a. Ileoileal intussusception in a 25-year-old man with right lower quadrant pain. (a) Contrast-enhanced CT scan demonstrates an ileoileal intussusception caused by an inverted Meckel diverticulum (arrow). (b, c) CT scan (b) and photograph of the gross surgical specimen (c) show the inverted Meckel diverticulum (arrowheads in b, arrows in c). The typical fat attenuation representing the inverted mesentery is not seen on the CT scan.
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Figure 6b. Ileoileal intussusception in a 25-year-old man with right lower quadrant pain. (a) Contrast-enhanced CT scan demonstrates an ileoileal intussusception caused by an inverted Meckel diverticulum (arrow). (b, c) CT scan (b) and photograph of the gross surgical specimen (c) show the inverted Meckel diverticulum (arrowheads in b, arrows in c). The typical fat attenuation representing the inverted mesentery is not seen on the CT scan.
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Figure 6c. Ileoileal intussusception in a 25-year-old man with right lower quadrant pain. (a) Contrast-enhanced CT scan demonstrates an ileoileal intussusception caused by an inverted Meckel diverticulum (arrow). (b, c) CT scan (b) and photograph of the gross surgical specimen (c) show the inverted Meckel diverticulum (arrowheads in b, arrows in c). The typical fat attenuation representing the inverted mesentery is not seen on the CT scan.
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Figure 7a. Ileoileal intussusception in a 15-year-old girl with recurrent abdominal pain, gastrointestinal bleeding, and anemia. (a, b) Contrast-enhanced CT scans demonstrate an ileoileal intussusception with multiple lead points (arrows). (c) Coronal reformatted CT image demonstrates the entire intussusception (arrowheads) and lead mass (arrow). (d) Photograph of the gross specimen shows multiple venous malformations as lobulated masses (arrows). Scale is in centimeters.
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Figure 7b. Ileoileal intussusception in a 15-year-old girl with recurrent abdominal pain, gastrointestinal bleeding, and anemia. (a, b) Contrast-enhanced CT scans demonstrate an ileoileal intussusception with multiple lead points (arrows). (c) Coronal reformatted CT image demonstrates the entire intussusception (arrowheads) and lead mass (arrow). (d) Photograph of the gross specimen shows multiple venous malformations as lobulated masses (arrows). Scale is in centimeters.
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Figure 7c. Ileoileal intussusception in a 15-year-old girl with recurrent abdominal pain, gastrointestinal bleeding, and anemia. (a, b) Contrast-enhanced CT scans demonstrate an ileoileal intussusception with multiple lead points (arrows). (c) Coronal reformatted CT image demonstrates the entire intussusception (arrowheads) and lead mass (arrow). (d) Photograph of the gross specimen shows multiple venous malformations as lobulated masses (arrows). Scale is in centimeters.
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Figure 7d. Ileoileal intussusception in a 15-year-old girl with recurrent abdominal pain, gastrointestinal bleeding, and anemia. (a, b) Contrast-enhanced CT scans demonstrate an ileoileal intussusception with multiple lead points (arrows). (c) Coronal reformatted CT image demonstrates the entire intussusception (arrowheads) and lead mass (arrow). (d) Photograph of the gross specimen shows multiple venous malformations as lobulated masses (arrows). Scale is in centimeters.
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Figure 8a. Ileoileal intussusception and small bowel obstruction caused by an inflammatory fibroid polyp in the distal ileum in a 49-year-old woman. (a) Contrast-enhanced CT scan demonstrates invaginated mesenteric fat and vessels (arrow) as well as bowel wall thickening of the intussusceptum and intussuscipiens that obscures the lead mass (arrowhead). (b) Photograph of the gross specimen shows a large (6-cm) pedunculated polypoid mass (arrow). Scale is in centimeters.
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Figure 8b. Ileoileal intussusception and small bowel obstruction caused by an inflammatory fibroid polyp in the distal ileum in a 49-year-old woman. (a) Contrast-enhanced CT scan demonstrates invaginated mesenteric fat and vessels (arrow) as well as bowel wall thickening of the intussusceptum and intussuscipiens that obscures the lead mass (arrowhead). (b) Photograph of the gross specimen shows a large (6-cm) pedunculated polypoid mass (arrow). Scale is in centimeters.
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Figure 9a. Intussusception in a 71-year-old woman with abdominal pain. Contrast-enhanced CT scans of the abdomen demonstrate an intussusception (arrow in a and b) with a round soft-tissue mass serving as a lead point (arrow in c). The mass is isoattenuating relative to bowel wall edema, making differentiation difficult (cf Fig 4). The patient was found to have metastatic large B-cell lymphoma of the jejunum.
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Figure 9b. Intussusception in a 71-year-old woman with abdominal pain. Contrast-enhanced CT scans of the abdomen demonstrate an intussusception (arrow in a and b) with a round soft-tissue mass serving as a lead point (arrow in c). The mass is isoattenuating relative to bowel wall edema, making differentiation difficult (cf Fig 4). The patient was found to have metastatic large B-cell lymphoma of the jejunum.
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Figure 9c. Intussusception in a 71-year-old woman with abdominal pain. Contrast-enhanced CT scans of the abdomen demonstrate an intussusception (arrow in a and b) with a round soft-tissue mass serving as a lead point (arrow in c). The mass is isoattenuating relative to bowel wall edema, making differentiation difficult (cf Fig 4). The patient was found to have metastatic large B-cell lymphoma of the jejunum.
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Figure 10a. Intussusception in a 66-year-old woman with a small bowel obstruction caused by metastatic malignant fibrous histiocytoma. (a, b) Contrast-enhanced CT scans of the abdomen demonstrate a typical intussusception with a lead point (arrow) and associated bowel wall thickening. (c) Contrast-enhanced CT scan shows enhancement of the lead point (arrowheads), a finding that facilitates its identification. (d) Photograph of the gross specimen shows multiple nodules (arrow and arrowheads), the largest of which (arrow) is a pedunculated polypoid mass measuring 5 cm. Scale is in centimeters.
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Figure 10b. Intussusception in a 66-year-old woman with a small bowel obstruction caused by metastatic malignant fibrous histiocytoma. (a, b) Contrast-enhanced CT scans of the abdomen demonstrate a typical intussusception with a lead point (arrow) and associated bowel wall thickening. (c) Contrast-enhanced CT scan shows enhancement of the lead point (arrowheads), a finding that facilitates its identification. (d) Photograph of the gross specimen shows multiple nodules (arrow and arrowheads), the largest of which (arrow) is a pedunculated polypoid mass measuring 5 cm. Scale is in centimeters.
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Figure 10c. Intussusception in a 66-year-old woman with a small bowel obstruction caused by metastatic malignant fibrous histiocytoma. (a, b) Contrast-enhanced CT scans of the abdomen demonstrate a typical intussusception with a lead point (arrow) and associated bowel wall thickening. (c) Contrast-enhanced CT scan shows enhancement of the lead point (arrowheads), a finding that facilitates its identification. (d) Photograph of the gross specimen shows multiple nodules (arrow and arrowheads), the largest of which (arrow) is a pedunculated polypoid mass measuring 5 cm. Scale is in centimeters.
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Figure 10d. Intussusception in a 66-year-old woman with a small bowel obstruction caused by metastatic malignant fibrous histiocytoma. (a, b) Contrast-enhanced CT scans of the abdomen demonstrate a typical intussusception with a lead point (arrow) and associated bowel wall thickening. (c) Contrast-enhanced CT scan shows enhancement of the lead point (arrowheads), a finding that facilitates its identification. (d) Photograph of the gross specimen shows multiple nodules (arrow and arrowheads), the largest of which (arrow) is a pedunculated polypoid mass measuring 5 cm. Scale is in centimeters.
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Figure 11a. Ileocolic intussusception in a 41-year-old man with metastatic melanoma who presented with gastrointestinal bleeding. (a, b) Contrast-enhanced CT scans demonstrate an ileocolic intussusception. The tumor that serves as the lead point (arrows in a) originates in the cecum. An intussusception (arrow in b) of the distal ileum is seen extending into the ascending colon. (c) Photograph of the gross specimen shows a large pedunculated polypoid mass (arrow). Scale is in centimeters.
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Figure 11b. Ileocolic intussusception in a 41-year-old man with metastatic melanoma who presented with gastrointestinal bleeding. (a, b) Contrast-enhanced CT scans demonstrate an ileocolic intussusception. The tumor that serves as the lead point (arrows in a) originates in the cecum. An intussusception (arrow in b) of the distal ileum is seen extending into the ascending colon. (c) Photograph of the gross specimen shows a large pedunculated polypoid mass (arrow). Scale is in centimeters.
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Figure 11c. Ileocolic intussusception in a 41-year-old man with metastatic melanoma who presented with gastrointestinal bleeding. (a, b) Contrast-enhanced CT scans demonstrate an ileocolic intussusception. The tumor that serves as the lead point (arrows in a) originates in the cecum. An intussusception (arrow in b) of the distal ileum is seen extending into the ascending colon. (c) Photograph of the gross specimen shows a large pedunculated polypoid mass (arrow). Scale is in centimeters.
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Figure 12. Colocolic intussusception secondary to lipoma in a 73-year-old woman. Contrast-enhanced CT scan of the abdomen demonstrates an intraluminal mass with fat attenuation (arrow).
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Figure 13a. Colocolic intussusception secondary to adenocarcinoma in an 83-year-old woman. Contrast-enhanced CT scans of the abdomen demonstrate the classic findings of a lead point intussusception (arrowheads) with invaginated mesenteric fat and vessels (arrows).
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Figure 13b. Colocolic intussusception secondary to adenocarcinoma in an 83-year-old woman. Contrast-enhanced CT scans of the abdomen demonstrate the classic findings of a lead point intussusception (arrowheads) with invaginated mesenteric fat and vessels (arrows).
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Copyright © 2006 by the Radiological Society of North America.
