How does intussecception differ between children and adults?
The 2 chief differences are: 1. In children the cause (lead point) is usually benign (mesenteric adenitis) whereas in adults the cause is typically sinister (tumour). 2. The majority of paediatric intussecceptions are managed with pneumatic or saline reduction, whereas adults invariably require surgery.
Bowel-in-bowel sign in the right lower quadrant with layering of bowel wall and mesenteric fat. There is intussusception of the ileum into the caecum extending through to the mid-transverse colon. At the apex, a tumour is suspected. Bowel wall is thickened (the intussuscipiens), but there are patchy hypodense areas particularly distally, concerning for vascular compromise. Proximal to this there is a short segment of dilated small bowel, measuring up to 3.5cm. The remaining colon is unremarkable. Perihepatic, mesenteric, right colic gutter and pelvic free fluid. No free gas. Within liver segment IVa/II is a 1.2cm hypodensity (25HU).