Demographics
23 y.o. female
23 y.o. female
Caption
Jejunojejunal intussusception
Plane
Axial
Modality
CT w/contrast (IV)
ACR Codes
7.1
(
This image was
last edited on 2009-09-01
)
Quiz
case
Transient adult jejunojejunal intussusception secondary to IBD (Crohn disease).
History
23 y/o female smoker w/ history of inflammatory bowel disease (IBD) type disease s/p partial colectomy with intermittent abdominal symptoms.
Exam
Unremarkable except for an enterocutaneous fistula intermittently draining yellow fluid in the vicinity of a surgical scar.
Findings
Contrast enhanced axial CT of the abdomen demonstrates extraluminal mesenteric fat located around a proximal jejununal segment (intussusceptum) telescoping into the lumen of an adjacent and more distal jejunal segment (intussuscipiens).
Differential Diagnosis
• Transient enteroenteric intussusception (adult)
- IBD-associated
- Idiopathic
- Other inflammatory or malabsorption syndromes
- Giardiasis
- HIV-associated (infectious, inflammatory)
• Lead point enteroenteric intussusception (adult) - Benign tumors - Malignant tumors (metastases, primary) - Meckel diverticulum - HIV or AIDS-associated (tumor)
• Lead point enteroenteric intussusception (adult) - Benign tumors - Malignant tumors (metastases, primary) - Meckel diverticulum - HIV or AIDS-associated (tumor)
Case Diagnosis
Transient adult jejunojejunal intussusception secondary to IBD (Crohn disease).
Diagnosis By
Diagnosis was confirmed with Promethius IBD Serology 7
Treatment & Follow Up
Evidence suggests transient adult enteroenteric intussusception may be more common than originally thought. Many of these intussusceptions are more readily identified now with the increased use of multidetector CT. In patients that are asymptomatic or minimally symptomatic, many of these may be managed conservatively. Proximal small bowel intussusceptions with a target appearance and without a lead point or obstruction that measure less than 3.5 cm in length, will likely be self-limiting. Intussusceptions measuring greater than 3.5 cm without lead point or obstruction should probably be further evaluated with additional imaging (eg. small bowel series, enteroclysis, CT enteroclysis, CT or MR enterography). However, cases demonstrating ischemia, obstruction, or a lead point, require surgical exploration.
Discussion
Adult intussusception has traditionally been regarded as rare and usually associated with an identifiable cause such as a tumor functioning as a lead point. However, with recent advancements and increased use of CT technology, transient enteroenteric intussusceptions are being identified; many of which are in asymptomatic or minimally symptomatic patients.
An intussusception is a medical condition in which a part of the intestine invaginates into another section of intestine, similar to a collapsible telescope. The part that prolapses into the other is called the intussusceptum, and the part that receives it is called the intussuscipiens. Usually the intussusception occurs in an antegrade fashion following the direction of peristalsis. The peristaltic tightening of smooth muscle in the intussuscipiens around the intussusceptum can lead to obstruction, ischemia and necrosis.
Presenting symptoms can vary depending on the underlying condition. Although, ultrasound is generally considered the imaging modality of choice in a young child, CT is more frequently the imaging study by which adult intussusceptions are identified.
The three CT patterns of intussusception are the target appearance, reniform pattern, and sausage-shaped pattern. The target appearance is felt to correspond to an early intussusception without ischemia.
Proximal transient enteroenteric intussusceptions without an identifiable lead point that measure less than 3.5 cm in length are likely to be self limiting not requiring surgical intervention. Intussusceptions measuring greater than 3.5 cm without lead point or obstruction should probably be further evaluated with additional imaging (eg. small bowel series, enteroclysis, CT enteroclysis, CT or MR enterography). However, cases demonstrating ischemia, obstruction, or a lead point, require surgical exploration.
Horton KM, Fishman EK. MDCT and 3D imaging in transient enteroenteric intussusception: clinical observations and review of the literature. AJR Am J Roentgenol. 2008 Sep;191(3):736-42.
IBD Serology 7
Saccharomyces cerevisiae Ab IgA-15.3Ehrlich Units/ml (0.0-19.9)
Saccharomyces cerevisiae Ab IgG-33.2Ehrlich Units/mL(0.0-39.9)
OmpC Ab IgA-13.4 Ehrlich Units/mL(0.0-16.4)
Cbir1 Flagellin Ab-26.6(H)Ehrlich Units/mL(0.0-20.9)
Neutrophil Spec Nuclear Ab- <12.1Ehrlich Units/mL(<12.1)
Neutrophil Spec Nuclear Ab Perinuc Pattern-Detected (H)
Neutrophil Speci Nuclear Ab Dnase Sens-DNAse Sensitive
IBD Autoab Profile >>>>> IBD/Crohn Disease Predicted
View Topic Images
topic
Adult Enteroenteric Intussusception
Disease Discussion
Adult intussusception has traditionally been regarded as rare and usually associated with an identifiable cause such as a tumor functioning as a lead point. However, with recent advancements and increased use of CT technology, transient enteroenteric intussusceptions are being identified; many of which are in asymptomatic or minimally symptomatic patients.
An intussusception is a medical condition in which a part of the intestine invaginates into another section of intestine, similar to a collapsible telescope. The part that prolapses into the other is called the intussusceptum, and the part that receives it is called the intussuscipiens. Usually the intussusception occurs in an antegrade fashion following the direction of peristalsis. The peristaltic tightening of smooth muscle in the intussuscipiens around the intussusceptum can lead to obstruction, ischemia and necrosis.
Presenting symptoms can vary depending on the underlying condition. Although, ultrasound is generally considered the imaging modality of choice in a young child, CT is more frequently the imaging study by which adult intussusceptions are identified.
The three CT patterns of intussusception are the target appearance, reniform pattern, and sausage-shaped pattern. The target appearance is felt to correspond to an early intussusception without ischemia.
Proximal transient enteroenteric intussusceptions without an identifiable lead point that measure less than 3.5 cm in length are likely to be self limiting not requiring surgical intervention. Intussusceptions measuring greater than 3.5 cm without lead point or obstruction should probably be further evaluated with additional imaging (eg. small bowel series, enteroclysis, CT enteroclysis, CT or MR enterography). However, cases demonstrating ischemia, obstruction, or a lead point, require surgical exploration.
Horton KM, Fishman EK. MDCT and 3D imaging in transient enteroenteric intussusception: clinical observations and review of the literature. AJR Am J Roentgenol. 2008 Sep;191(3):736-42.
ACR Code
7.2
Location
Gastrointestinal
Category
Inflammatory, NOS
Keywords
inflammatory bowel disease
(
This topic was
added on 2009-09-04
)
Original Source
Colin R Young
Colin R Young
Author
Colin R Young
Colin R Young
Author Affiliation
Uniformed Services University
Uniformed Services University
Approved By
Grant Lattin, Jr.
Grant Lattin, Jr.
Approver Affiliation
Uniformed Services University
Uniformed Services University
Case Affiliation
Uniformed Services University
Uniformed Services University
Author
Colin R Young
Colin R Young
Author Affiliation
Uniformed Services University
Uniformed Services University
Approved By
Grant Lattin, Jr.
Grant Lattin, Jr.
Approver Affiliation
Uniformed Services University
Uniformed Services University
Topic Affiliation
Uniformed Services University
Uniformed Services University
Author
Colin R Young
Colin R Young
Affiliation
Uniformed Services University
Uniformed Services University
Approved By
Grant Lattin, Jr.
Grant Lattin, Jr.
Affiliation
Uniformed Services University
Uniformed Services University