Info

Assessment for Reducibility

Ultrasound may also be used to make some assessment as to whether the intussusception is suitable for non-surgical reduction and the likelihood of success. Various sonographic signs have been evaluated, including a thick peripheral hypoechoic rim of the intussusception, free intraperitoneal fluid, trapped fluid within the intussusception and the absence of blood flow in the intussusception on Doppler interrogation. There appears to be no relation between the reduction rate and thickness of the external hypoechoic rim (Verschelden et al. 1992), and free intraperitoneal fluid is commonly associated due to transudation of fluid from the congested intussusception which is present in at least 50% of cases. Fluid trapped within the serosal layers of the entering and returning limbs of the intussusception has been shown to be associated with a lower reduction rate but at least 26% of these cases can still be reduced. Similarly the absence of flow on Doppler interrogation reduces the rate of successful reduction but does not preclude it, reduction still being successful in approximately 31% of cases (Kong et al. 1997). The absence of visualized blood flow on Doppler interrogation is therefore not a contra-indication for attempted air enema reduction. Similarly the identification of a pathological lead point does not necessarily mean that an intussusception will be irreducible (Navarro et al. 2000; Navarro and Daneman 2004).

Fig. 6.7a-e. Ultrasound appearances of intussusception. a Transverse (TS) image showing the 'crescent and doughnut sign' as hyperechoic mesenteric fat is pulled into the intussusception. b Longitudinal image showing the 'sausage' appearance of the intussusception. c TS image with Doppler showing some blood flow present within the intussusception. d TS image showing dilated fluid-filled loops of small bowel which should not be mistaken for the intussusception which lies deep to them. Note the absence of the echogenic layers in the small bowel loops. e TS image showing lymph nodes pulled into the intussusception

Fig. 6.7a-e. Ultrasound appearances of intussusception. a Transverse (TS) image showing the 'crescent and doughnut sign' as hyperechoic mesenteric fat is pulled into the intussusception. b Longitudinal image showing the 'sausage' appearance of the intussusception. c TS image with Doppler showing some blood flow present within the intussusception. d TS image showing dilated fluid-filled loops of small bowel which should not be mistaken for the intussusception which lies deep to them. Note the absence of the echogenic layers in the small bowel loops. e TS image showing lymph nodes pulled into the intussusception b a c

Was this article helpful?

0 0
51 Tips for Dealing with Endometriosis

51 Tips for Dealing with Endometriosis

Do you have Endometriosis? Do you think you do, but aren’t sure? Are you having a hard time learning to cope? 51 Tips for Dealing with Endometriosis can help.

Get My Free Ebook


Post a comment