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  1. 1.  A young 30 years female patient presents with acute left sided abdominal pain  With nausea and vomiting.
  2. 2. On examination  Tachycardia  Abdominal guarding with tenderness on the left side.
  3. 3. lab investigation  Blood picture was normal with normal LFTS and RFTS.
  4. 4.  On imaging , her CT abdomen reveals  This specific appearance.
  5. 5.  The Invagination or telescoping of a proximal segment of bowel (intussusceptum) into the lumen of a distal segment (intussuscipiens)
  6. 6.  This can often result in an obstruction. The part that prolapses into the other is called the intussusceptum, and the part that receives it is called the intussuscipiens.
  7. 7.  The invaginated segment is carried distally by peristalsis.  Mesnetery and vessels become involved with the intraluminal loop and are squeezed within the engulfing segment causing venous congestion.  Types: enteroenteric, enterocolic, and colocolic.
  8. 8. Pathogenesis, aetiology and prevalence  Intussusception can be classified according to location (small bowel or colon) or according to the underlying aetiology (neoplastic (benign or malignant), non-neoplastic or idiopathic).  Intussusception arises in the small bowel in two-thirds of cases. The aetiology of intussusception in the small bowel and the colon is quite different.
  9. 9.  Most common in infants and children  Accounts for 95% of all cases of intussusception  Ranks 2nd to appendicitis as a cause of acute abdomen  90% of the cases in children are idiopathic  Most common in children of 6 months to 2 years in age
  10. 10.  Rare in adults: accounts for 0.003% to 0.02% of all hospital admissions  Accounts for 1% of all bowel obstructions in adults  80-90% of cases have and underlying cause  65% are due to neoplasm
  11. 11.  Location ◦ Adults: ileoileal > ileocolic > colocolic ◦ Children: ileocolic > ileoileal > colocolic
  12. 12. Idiopathic (most common in children)  Neoplasm ◦ Benign (more common in small bowel)  Polyp, Leiomyoma, Lipoma, Lymphoma, Adenoma of appendix, Appendiceal stump granuloma ◦ Malignant  Primary (more common in colon)  Metastatic (more common in small bowel)
  13. 13.  Postoperative (more common in small bowel)  Meckel’s diverticulum  Colitis  Many cases thought to be related to viral gastroenteritis in children
  14. 14.  Children: ◦ Well nourished infant ◦ Cramping abdominal pain ◦ Poor feeding / Vomiting ◦ Diarrhea ◦ A palpable, tender, sausage shaped mass in the abdomen ◦ Hx of abdominal surgery
  15. 15.  Adults ◦ Intermittent pain ◦ Nausea and vomiting ◦ Often red blood per rectum ◦ Often nonspecific complaints
  16. 16.  CT is the most accurate detecting 78% of the cases.  Ultrasound is often used in children  Barium studies are also very useful
  17. 17.  Abdominal films often show signs of small bowel obstruction
  18. 18.  Erect films often show fluid levels in the small bowel  Free intraperitoneal gas
  19. 19.  Show a classic “coiled spring” appearance due to trapping of contrast between layers of bowel.
  20. 20.  Ultrasound: transverse scan shows a target sign
  21. 21.  Ultrasound is today considered the imaging modality of choice for diagnosis and exclusion of intussusception due to its high accuracy and lack of radiation. A target-like mass, usually around 3 cm in diameter, confirms the diagnosis
  22. 22.  53-year-old woman who had history of total gastrectomy due to advanced gastric cancer with retrograde jejunojejunal intussusception caused by adhesive band. Sonogram along longitudinal axis of intussusception shows typical “pseudokidney” sign
  23. 23.  Intussusception can be confidently diagnosed on CT because of its virtually pathognomonic appearance.  It appears as a complex soft tissue mass, consisting of the outer intussuscipiens and the central intussusceptum.  There is often an eccentric area of fat density within the mass representing the intussuscepted mesenteric fat, and the mesenteric vessels are often visible within it
  24. 24.  A rim of orally administered contrast medium is sometimes seen encircling the intussusceptum, representing coating of the opposing walls of the intussusceptum and the intussuscipiens
  25. 25.  The intussusception will appear as a sausage-shaped mass when the CT beam is parallel to its longitudinal axis but will appear as a “target” mass when the beam is perpendicular to the longitudinal axis of the intussusception
  26. 26.  Target sign is also seen in CT.  Can also see a sausage shaped mass
  27. 27.  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).
  28. 28.  Differential diagnosis  Intussusception has three main differential diagnoses. These are acute gastroenteritis, Henoch–Schönlein purpura, and rectal prolapse.  Abdominal pain, vomiting, and stool with mucus and blood are present in acute gastroenteritis, but diarrhea is the leading symptom.
  29. 29.  Rectal prolapse can be differentiated by projecting mucosa that can be felt in continuity with the perianal skin, whereas in intussusception the finger may pass indefinitely into the depth of sulcus. Henoch– Schönlein purpura presents the characteristic rash.
  30. 30.  Air reduction is the treatment of choice for children and is successful 75-90% of the time  Contrast reduction was more frequently used a decade ago
  31. 31.  Adults require surgical exploration and resection of the intussuscepted bowel loops  Reduction is not recommended in adults due to the risk of spreading/seeding malignant cells, potential perforation of the intussuscepted bowel, and venous embolization at the ulcerated mucosa area