Small intussusception

The first rotavirus vaccine was a tetravalent rhesus rotavirus strain. It was licensed in the United States in 1998 and subsequently withdrawn from the market due to an association with intussusception. A pentavalent human-bovine reassortant rotavirus vaccine was approved by the FDA in February 2006. The exact mechanism by which the vaccine produces an immune response is unknown however, this live virus vaccine replicates in the small intestines and induces immunity. 

Riebel et al. 1993 Wang and Liu 1988). Because deep penetration of the ultrasound beam is not necessary in small children, a high-resolution transducer (5-10 MHz) can be used to improve the definition of the image. The majority of intussusceptions (i.e. the ileocolic type) occur in the... 

Most childhood cases of intussusception are idiopathic. Intussusception lead points such as a Meckel diverticulum, duplication cyst, polyp, or tumor (e.g. lymphoma) are uncommon in infants (<5% of cases). Intussusception lead points are more common in neonates, older children (> 5 years old), and cases restricted to the small intestine. For example, intussusception of the small intestine is common in Peutz-Jeghers syndrome, Schonlein-Henoch purpura, and after surgery. US allows... 

Besides perforated appendicitis and intussusception, the most common causes of small howel obstruction are incarcerated hernias and adhesions. Other causes of small bowel obstruction comprise a miscellaneous group of rare conditions, such as midgut volvulus, Meckel s diverticulum, advanced stages of Crohn s disease, and bezoars. Adhesions usually result from prior surgery and are often multiple. There is an increasing tendency for initial conservative management rather than immediate operative intervention, as a proportion of cases will resolve spontaneously. 

Fig. 1.74). Luminal narrowing and ascites may be significant. Some transient small bowel intussusceptions can be observed. SchOnlein-Henoch syndrome, in general, is a self-limited process with a very good clinical outcome. 

Kassner EG, Kottmeier PK (1975) Absence and retention of small bowel gas in infants with midgut volvulus mechanisms and significance. Pediatr Radiol 4 28-30 Katz M, Phelan E, Carlin JB et al (1993) Gas enema for the reduction of intussusception relationship between clinical signs and symptoms and outcome. AJR Am J Roentgenol 160 363-366... 

Stringer MD, Pablot SM, Brereton RJ (1992) Paediatric intussusception. Br J Surg 79 867-876 Strouse PJ (2004) Disorders of intestinal rotation and fixation ( malrotation ). Pediatr Radiol 34 837-851 Strouse PJ, DiPietro MA, Saez F (2003) Transient small-bowel intussusception in children on CT. Pediatr Radiol 33 316-320... 

Diseases in Older Children 180 Small Bowel Intussusception 180 Ileus 181... 

Some of the pathologies of the small intestine are discussed in Chapter 1. In the current chapter, therefore, little or no attention will be paid to (midgut volvulus) malrotation, the atresias, meconium ileus, meconium peritonitis, duplication cysts, necrotizing enterocolitis (NEC) and intussusception. 

Small bowel intussusceptions can be found incidentally when searching for other pathology, in which case patients will have no complaints. 

Fig. 5.17. a Transient small bowel intussusception. The intraluminal mass with layered appearance is the small bowel, b Small bowel (jejunal) intussusception caused by a bezoar... 

Idiopathic, transient small bowel intussusceptions need no treatment. The transient nature of the small bowel intussusception will be confirmed by reinvestigation of the small bowel, preferably by sonography, after a few minutes or hours. The intussusception will in most cases have then disappeared (Parker 2003 Strouse et al. 2003). 

Paralytic ileus, due to intrinsic abnormalities of the bowel wall, can be caused for example by drugs, after laparotomy, sepsis or peritonitis. Obstructive ileus is most often due to extrinsic causes, for example adhesions (in 70% of cases), incarcerated hernia, small bowel wall hematoma posttraumatic, neoplasms, Crohn disease and intussusception (Parker 2003 Devos and Meradji 2003). Clinically the child has a distended and tender abdomen with failure to pass stools or no defecation and possibly (bilious) vomiting. 

Fig. 5.19. a,b Paralytic ileus. Note the extremely dilated small bowel loops and also the colonic loops containing gas and fluid levels, c CT image shows multiple dilated loops of almost equal caliber indicative of paralytic ileus. Arrow indicates small bowel intussusception... 

Strouse PJ, DiPietro MA, Saez F (2003) Transient small-howel intussusception in children on CT. Pediatr Radiol... 

Fig. 6.6. AXR of a patient with intussusception. Note the soft tissue mass of the intussusception in the right iliac fossa and the dilated small bowel loops of obstruction...

Fig. 6.8a,b. Appearance of intussusception during reduction by air enema, a The soft tissue mass of the intussusception can be seen in the right flank and the remainder of the large bowel is distended by air. Air has not yet flooded back into the small bowel, which would indicate successful reduction, b Air enema in a different patient the intussusception is shown as a soft tissue mass but perforation of the bowel has occurred... 

Fluid within the bowel may comes into direct contact with that the mass indicating the mass arises from the bowel. There may be vascular structure in the mass visualized by Doppler study. Small bowel intussusception can be diagnosed by demonstration of bowel-within-bowel by recognizing characteristic multiple concentric rings, caused by invaginating layers of telescoped bowel, seen in cross section of the bowel loop. 

Kenney IJ (1990) Ultrasound in intussusception a false cystic lead point. Pediatr Radiol 20 348 Kim JH (2004) US features of transient small bowel intussusception in pediatric patients. Korean J Radiol 5 178-184 Kohli A, Vig A, Azad T (1997) Intrathoracic gastric volvulus acute and chronic presentation. J Indian Med Assoc 95 522-523... 

Other less common manifestations of CD that can be revealed by abdominal US are the presence of mesenteric lymph node cavitation and transient small bowel intussusception. 

Transient small bowel intussusception is a rare event that has been described in case reports of both paediatric and adult patients, in some of whom it was demonstrated by US (Cohen and Lintott 1978 Gonzales et al. 1998 Mushraq et al. 1999). 

Cohen MD, Lintott DJ (1978) Transient small bowel intussusception in adult coeliac disease. Clin Radiol 29 529-534... 

Mushraq N, Marven S, Walker J et al (1999) Small bowel intussusception in celiac disease. J Pediatr Surg 3 1833-1835 Peck RJ, Jackson A, Gleeson D (1997) Case report ultrasound of coeliac disease with demonstration of response to treatment. Clin Radiol 52 244-245... 

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