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Adult Intussusception Detected at CT or MR Imaging: Clinical-Imaging Correlation¹

¹ From the Department of Radiology, University of North Carolina School of Medicine, Campus Box 7510, Rm 2016 Old Clinic Bldg, Manning Dr, Chapel Hill, NC 27599-7510. Received September 9, 1998; revision requested November 3; revision received December 9; accepted February 2, 1999. Address reprint requests to D.M.W. (e-mail: dmw@pop.unc.edu).

View larger version (111K): [in a new window]   Figure 1. Colocolic intussusception with a neoplastic lead point. Axial CT scan obtained in an 84-year-old man with colon cancer developing in a villous adenoma shows the longitudinal bowel-in-bowel appearance with mesenteric fat and vessels being drawn into the intussusception (arrow).

View larger version (106K): [in a new window]   Figure 2a. Axial CT scans obtained in a 44-year-old man show enteroenteric intussusception caused by immunoblastic lymphoma. (a) Image shows mesenteric and bowel-associated masses (arrows). (b, c) Images show enteroenteric intussusception forming a loop within the pelvis. The intussuscipiens (solid straight arrows), intussusceptum (open arrows), and mesenteric vessels within the intussusceptum (curved arrows) are shown. Images are 8-mm-thick axial sections; a and b were obtained 2.4 cm apart, and b and c were obtained 3.2 cm apart.

View larger version (104K): [in a new window]   Figure 2b. Axial CT scans obtained in a 44-year-old man show enteroenteric intussusception caused by immunoblastic lymphoma. (a) Image shows mesenteric and bowel-associated masses (arrows). (b, c) Images show enteroenteric intussusception forming a loop within the pelvis. The intussuscipiens (solid straight arrows), intussusceptum (open arrows), and mesenteric vessels within the intussusceptum (curved arrows) are shown. Images are 8-mm-thick axial sections; a and b were obtained 2.4 cm apart, and b and c were obtained 3.2 cm apart.

View larger version (95K): [in a new window]   Figure 2c. Axial CT scans obtained in a 44-year-old man show enteroenteric intussusception caused by immunoblastic lymphoma. (a) Image shows mesenteric and bowel-associated masses (arrows). (b, c) Images show enteroenteric intussusception forming a loop within the pelvis. The intussuscipiens (solid straight arrows), intussusceptum (open arrows), and mesenteric vessels within the intussusceptum (curved arrows) are shown. Images are 8-mm-thick axial sections; a and b were obtained 2.4 cm apart, and b and c were obtained 3.2 cm apart.

View larger version (139K): [in a new window]   Figure 3a. Axial CT scans obtained in a 42-year-old man show transient intussusception associated with local inflammation from pancreatitis. (a) At the level of the pancreatic head, the intussusceptum (arrowhead) is seen within the intussuscipiens (straight arrow). Note the calcifications (curved arrows) in the region of the pancreatic head and infiltration of anterior pararenal space fat. (b) Image obtained 5.2 cm caudad to a shows mesenteric vessels, fat, and bowel (arrows) entering the intussuscipiens. Small-bowel follow-through performed 1 day following CT showed fold thickening in the duodenum and proximal jejunum but no intussusception. CT performed 1 month later also showed no intussusception.

View larger version (132K): [in a new window]   Figure 3b. Axial CT scans obtained in a 42-year-old man show transient intussusception associated with local inflammation from pancreatitis. (a) At the level of the pancreatic head, the intussusceptum (arrowhead) is seen within the intussuscipiens (straight arrow). Note the calcifications (curved arrows) in the region of the pancreatic head and infiltration of anterior pararenal space fat. (b) Image obtained 5.2 cm caudad to a shows mesenteric vessels, fat, and bowel (arrows) entering the intussuscipiens. Small-bowel follow-through performed 1 day following CT showed fold thickening in the duodenum and proximal jejunum but no intussusception. CT performed 1 month later also showed no intussusception.

View larger version (153K): [in a new window]   Figure 4a. (a, b) Axial CT scans obtained in a 26-year-old man show enteroenteric intussusception associated with recent surgery. The patient had undergone ileocecectomy with ileoascending colon anastomosis 3 months previously for Crohn disease. The intussuscipiens (black arrow), intussusceptum (white arrow), fat (open arrow) within the intussusceptum, and a lower attenuation rim thought to represent the muscularis externa (arrowheads) of the intussusceptum are shown. The patient underwent repeat surgery on the day the scan was obtained. Although an intussusception was not demonstrated at surgery, ischemic changes were seen in the neoterminal ileum. Images are 8 mm thick and were obtained 1.6 cm apart.

View larger version (150K): [in a new window]   Figure 4b. (a, b) Axial CT scans obtained in a 26-year-old man show enteroenteric intussusception associated with recent surgery. The patient had undergone ileocecectomy with ileoascending colon anastomosis 3 months previously for Crohn disease. The intussuscipiens (black arrow), intussusceptum (white arrow), fat (open arrow) within the intussusceptum, and a lower attenuation rim thought to represent the muscularis externa (arrowheads) of the intussusceptum are shown. The patient underwent repeat surgery on the day the scan was obtained. Although an intussusception was not demonstrated at surgery, ischemic changes were seen in the neoterminal ileum. Images are 8 mm thick and were obtained 1.6 cm apart.

View larger version (163K): [in a new window]   Figure 5a. Axial CT scans obtained in a 47-year-old man without symptoms show idiopathic enteroenteric intussusception. (a) Image demonstrates vessels (arrow) entering the intussusception. (b) Image demonstrates fat (open black arrow) pulled into the intussusception (open white arrow) adjacent to a redundant portion of the intussusceptum (solid white arrow). (c) Image is the last section on which the intussusceptum (arrow) is visible and was obtained 4 cm below b. Results of small-bowel follow-through performed 4 days later were unremarkable. Repeat CT 8 months later showed no evidence of bowel lesion or intussusception. a and b are contiguous 1-cm-thick axial sections.

View larger version (164K): [in a new window]   Figure 5b. Axial CT scans obtained in a 47-year-old man without symptoms show idiopathic enteroenteric intussusception. (a) Image demonstrates vessels (arrow) entering the intussusception. (b) Image demonstrates fat (open black arrow) pulled into the intussusception (open white arrow) adjacent to a redundant portion of the intussusceptum (solid white arrow). (c) Image is the last section on which the intussusceptum (arrow) is visible and was obtained 4 cm below b. Results of small-bowel follow-through performed 4 days later were unremarkable. Repeat CT 8 months later showed no evidence of bowel lesion or intussusception. a and b are contiguous 1-cm-thick axial sections.

View larger version (146K): [in a new window]   Figure 5c. Axial CT scans obtained in a 47-year-old man without symptoms show idiopathic enteroenteric intussusception. (a) Image demonstrates vessels (arrow) entering the intussusception. (b) Image demonstrates fat (open black arrow) pulled into the intussusception (open white arrow) adjacent to a redundant portion of the intussusceptum (solid white arrow). (c) Image is the last section on which the intussusceptum (arrow) is visible and was obtained 4 cm below b. Results of small-bowel follow-through performed 4 days later were unremarkable. Repeat CT 8 months later showed no evidence of bowel lesion or intussusception. a and b are contiguous 1-cm-thick axial sections.

View larger version (138K): [in a new window]   Figure 6a. (a, b) Axial CT scans obtained in a 61-year-old man with back pain show idiopathic enteroenteric intussusception. Images demonstrate mesenteric vessels and fat (arrowheads) entering the intussusception, fat (open arrow) within the intussusceptum, and a lower attenuation line thought to correspond to the muscularis externa (solid arrows) of the intussusceptum. Results of small-bowel follow-through 2 days later showed no definite mass or intussusception. Repeat CT 1 month later also showed no small-bowel mass or intussusception. The patient was asymptomatic at subsequent clinical follow-up. Images a and b are contiguous 8-mm-thick sections.

View larger version (134K): [in a new window]   Figure 6b. (a, b) Axial CT scans obtained in a 61-year-old man with back pain show idiopathic enteroenteric intussusception. Images demonstrate mesenteric vessels and fat (arrowheads) entering the intussusception, fat (open arrow) within the intussusceptum, and a lower attenuation line thought to correspond to the muscularis externa (solid arrows) of the intussusceptum. Results of small-bowel follow-through 2 days later showed no definite mass or intussusception. Repeat CT 1 month later also showed no small-bowel mass or intussusception. The patient was asymptomatic at subsequent clinical follow-up. Images a and b are contiguous 8-mm-thick sections.

View larger version (15K): [in a new window]   Figure 7. Box plot of intussusception diameter for enteroenteric intussusceptions with a neoplastic lead point and those without. Nonneoplastic intussusceptions were significantly smaller in diameter (P = .002) than intussusceptions with a neoplastic lead point. Horizontal lines indicate 10th, 25th, 50th (median), 75th, and 90th percentiles. Values above the 90th and below the 10th percentiles are plotted as points.

View larger version (15K): [in a new window]   Figure 8. Box plot of intussusception length for enteroenteric intussusceptions with and those without a neoplastic lead point. Nonneoplastic intussusceptions were significantly shorter (P = .002) than intussusceptions with a neoplastic lead point. Horizontal lines indicate 10th, 25th, 50th (median), 75th, and 90th percentiles. Values above the 90th and below the 10th percentiles are plotted as points.