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. 2009 Jan;39(1):42-6.
doi: 10.1007/s00247-008-1039-y. Epub 2008 Nov 4.

Intramural and subserosal echogenic foci on US in large-bowel intussusceptions: prognostic indicator for reducibility?

Enno Stranzinger  1 , Michael A Dipietro, Sai Yarram, Shokoufeh Khalatbari, Peter J Strouse
Affiliations

Intramural and subserosal echogenic foci on US in large-bowel intussusceptions: prognostic indicator for reducibility?

Enno Stranzinger et al. Pediatr Radiol. 2009 Jan.

Abstract

Background: In large-bowel intussusceptions, several US signs are known to indicate a lower likelihood of reducibility by enema. US can demonstrate echogenic dots or lines (foci) in the bowel wall, which might indicate an ischemic bowel.

Objective: To determine the presence of echogenic intramural and subserosal foci in large-bowel intussusceptions and to evaluate the degree of correlation with reducibility.

Materials and methods: Between 2001 and 2008, 74 consecutive US examinations were retrospectively evaluated by two pediatric radiologists for intramural and subserosal echogenic foci, or trapped gas, in the intussusception. The degree of correlation between the sonographic findings and reducibility was evaluated.

Results: Of 73 intussusceptions examined by US, 56 (76%) were reducible and 17 (23%) were not reducible. Out of 10 intussusceptions with intramural gas, 11 with subserosal gas, and 14 with intramural and subserosal gas, 8 (80%), 6 (56%), 9 (64%), respectively, were not reducible. The presence of intramural gas or subserosal gas or both predicted a lower chance of reduction, but with regard to the effect of these findings together, intramural gas was the only significant predictor.

Conclusion: Having intramural gas in large-bowel intussusception significantly decreases the chance of reduction.

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Figures

Fig. 1
Fig. 1
8-year-old boy with ileocecal intussusception. Linear transducer shows a large bowel intussusception with intramural echogenic foci (circle).
Fig. 2
Fig. 2
5-month-old female had bilious emesis, became increasingly lethargic and was passing bloody currant jelly stools. Short axis view of the intussusception shows echogenic lines in a thickened edematous bowel wall (circle), subserosal echogenic foci (arrow) and a fluid cap sign (asterisk). Radiograph of the abdomen showed bubbly, gas filled bowel in the right lower quadrant concerning for pneumatosis (circle). No free abdominal gas or portal venous gas was noted.
Fig. 2
Fig. 2
5-month-old female had bilious emesis, became increasingly lethargic and was passing bloody currant jelly stools. Short axis view of the intussusception shows echogenic lines in a thickened edematous bowel wall (circle), subserosal echogenic foci (arrow) and a fluid cap sign (asterisk). Radiograph of the abdomen showed bubbly, gas filled bowel in the right lower quadrant concerning for pneumatosis (circle). No free abdominal gas or portal venous gas was noted.
Fig. 3
Fig. 3
7-week-old girl, transferred from outside hospital with intussusception. Short axis US shows thickened intussusceptum with echogenic foci (circle), subserosal echogenic foci (arrow) and absent flow within the bowel wall. 6 hours after successful pneumatic reduction the left lateral decubitus view of the abdomen shows free abdominal gas (asterisk) over the liver.
Fig. 3
Fig. 3
7-week-old girl, transferred from outside hospital with intussusception. Short axis US shows thickened intussusceptum with echogenic foci (circle), subserosal echogenic foci (arrow) and absent flow within the bowel wall. 6 hours after successful pneumatic reduction the left lateral decubitus view of the abdomen shows free abdominal gas (asterisk) over the liver.
Fig. 4
Fig. 4
4-year-old male with ileocecal intussusception. Short axis view of an ileocecal intussusception shows echogenic mucosal fold mimicking intramural gas (arrow). Long axis view of the intussusception shows echogenic foci as trapped intraluminal gas in a mucosal fold (circle).
Fig. 4
Fig. 4
4-year-old male with ileocecal intussusception. Short axis view of an ileocecal intussusception shows echogenic mucosal fold mimicking intramural gas (arrow). Long axis view of the intussusception shows echogenic foci as trapped intraluminal gas in a mucosal fold (circle).
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References

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