Ileocolic intussusception

Case contributed by Mahmoud Yacout Alabd

Presentation

Abdominal pain, vomiting.

Patient Data

Age: 5 y
Gender: Male
x-ray

Scout image showing absent intestinal gases at the right iliac fossa which raised the suspicion of an abdominal soft tissue mass or appendicular mass.

ct

The cecum and proximal ascending colon show intramural small bowel segment most evidently depicted by its mesentery (mesenteric fat and enhancing vessels), giving the typical lamellar and target sign appearance on axial images. The cecum and terminal ileal loops are dilated and filled with fluid. Multiple prominent right iliac lymph nodes are seen which are likely to be the initiating pathology of intussusception. Still no definite leading point is seen. Mild related fluid collection can also be seen. 

Case Discussion

Ileocolic or ileocecal intussusception with fluid filled terminal ileum and cecum turned to be the underlying cause of the absent intestinal gases at the right ilac fossa seen on x-ray. The cecum and proximal ascending colon show intramural small bowel segment (terminal ileum) most evidently depicted by its mesentery (mesenteric fat and enhancing vessels), giving the typical lamellar and target sign appearance on axial images. The cecum and terminal ileal loops are dilated and filled with fluid. Multiple prominent right iliac lymph nodes are seen which are likely to be the initiating pathology of intussusception. Still no definite leading point is seen.Intussusception in pediatric age usually occur due to underlying enlarged lymphnodes rather than the other associated pathologies that are usually seen in adults such as intestinal malignancies and polyps. 

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