高频超声在小儿回结型肠套叠复位中的应用价值

肠套叠是婴幼儿期最常见的急腹症之一,多见于2岁以下的婴幼儿,尤其是4—10月的婴儿,高频超声诊断此病以快捷、无损伤、诊断率高应被广泛推广使用。但以往国内常用的治疗方法是X线引导下空气灌肠复位,我院自2005年以来应用超声引导下生理盐水灌肠对回结型肠套的复位治疗,取得较好效果,现报道如下。     

Ultrasonographic findings of small bowel intussusception, focusing on differentiation from ileocolic intussusception

The purpose of this study was to evaluate the typical ultrasonographic findings of transient small bowel intussusception (SBI) and to differentiate it from ileocolic intussusception (ICI) in paediatrics. 22 transient SBI (male:female = 13:9, age: 7-132 months (mean 38 months)) and 27 ICI (male:female = 19:8, age: 1-60 months (mean 13 months)) patients diagnosed on ultrasonography were retrospectively evaluated. The findings of location, diameter, thickness of outer rim, and inclusion of mesenteric lymph nodes within intussuscipiens were compared. In the transient SBI, the head of intussusception was located in the right lower quadrant (RLQ) in 11 (50%), the right upper quadrant (RUQ) in 2 (9.1%) and the periumbilical area in 9 (40.9%) cases. The anteroposterior (AP) diameter ranged from 0.84-2.4 cm (mean 1.38 cm), and thickness of outer rim ranged from 0.10-0.34 cm (mean 0.26 cm). No mesenteric lymph nodes were contained within the intussuscipiens. In the ICI, the head was located in the RUQ in 17 (63%), the epigastrium in 7 (25.9%) and the left upper quadrant in 3 (11.1%) cases. The AP diameter ranged from 1.89-3.32 cm (mean 2.53 cm), and the thickness of the outer rim ranged from 0.30-0.86 cm (mean 0.53 cm). Mesenteric lymph nodes were contained within the intussuscipiens in 26 (96.3%) cases. In conclusion, when compared with ICI, the transient SBI occurs predominantly in the RLQ or periumbilical region, has a smaller AP diameter, a thinner outer rim, and dose not contain mesenteric lymph nodes.     

Comparison of oxygen and barium reduction of ileocolic intussusception

Reports that gas reduction of ileocolic intussusception has a better success rate than traditional barium reduction prompted us to evaluate this technique and to compare the results with our previous experience with barium. Our method of intussusception reduction uses oxygen at a flow rate of 2 l/min and with a maximum pressure of 80 mm Hg. The results of 65 consecutive patients with 69 episodes of intussusception over a 9-month period were retrospectively reviewed. For eight episodes, gas enema was not used, including six patients who had barium reduction during the introduction of the gas technique and two patients in whom no intussusception was seen during gas enema were excluded. In the remaining 61 episodes, six patients were considered to be unacceptable risks for attempted therapeutic reduction with either oxygen or barium, according to our current criteria, and had primary surgery. Enemas with oxygen were attempted in 55 cases and were successful in 40 (73%). If all 61 cases with confirmed intussusception are included, the overall success rate with oxygen was 66%. We had greater success with oxygen than with barium (73% vs 53%), although identical pressures were used and the number of severely ill patients referred for therapeutic enema (90% vs 60%) had increased. The change in the referral pattern reflects the adoption of less conservative criteria for excluding patients from having therapeutic enema. No complications have occurred to date. We have had greater success with the use of oxygen than with that of barium, and have had no complications. Therefore, at our institution, oxygen has superseded barium for the therapeutic reduction of ileocolic intussusception.     

Coiled-spring sign of appendiceal intussusception

Appendiceal intussusception has been considered a rare entity that is difficult to diagnose radiographically. However, a characteristic coiled-spring appearance in the cecum with nonfilling of the appendix has been observed on double-contrast barium enema (DCE) examinations in 11 cases of apparent or proved appendiceal intussusception. In two surgically proved cases, the intussusception was precipitated by an appendiceal mucocele and by endometriosis implants in the appendix. In four other cases, the intussusception was transient and the coiled-spring defect in the cecum disappeared with filling of the appendix on the DCE examination (three cases) or on a subsequent barium enema study (one case). The remaining five cases were unproved, although two patients had undergone prior appendectomy and the coiled-spring finding presumably resulted from an intussuscepted appendiceal stump. Only one patient was found to have appendiceal-related symptoms. It appears that appendiceal intussusception often occurs as a transient phenomenon in asymptomatic patients, and that it can be diagnosed on the routine DCE examination by a characteristic coiled-spring defect in the cecum.     

Target sign of intussusception versus whirlpool sign of midgut volvulus

We report the case of a 2-month-old boy who presented with emesis and was initially thought to have an intussusception based on ultrasound findings, but was later found to have malrotation with midgut volvulus. He was surgically detorsed before any bowel necrosis occurred, but later developed recurrent volvulus due to a surgical adhesion acting as an anchor point. The aim of this report is to highlight the imaging similarities and differences between intussusception and the more serious midgut volvulus in order to expedite proper care and preserve bowel. Malrotation with midgut volvulus is a pediatric surgical emergency involving twisting of a congenitally shortened mesentery around the superior mesenteric artery, leading to rapid vascular compromise and ischemic necrosis of small bowel. Prompt diagnosis is critical but difficult, as imaging findings in volvulus can appear similar to those in intussusception. Treatment with a Ladd procedure can safely and effectively reduce the volvulus and prevent recurrence.     

Aortic dissection: The flood tide sign

Aortic dissection is a challenging medical and surgical problem. Its evolution depends on size and location of its intimal tears. We describe a case of contrast enhanced MD-CT with low out flow of the false lumen for an unbalanced between the entry and the reentry tears. This determined a delayed filling up of the false lumen on the arterial phase that was complete on the venous one.     

Therapeutic enema for pediatric ileocolic intussusception: using a balloon catheter improves efficacy

A therapeutic enema for pediatric intussusception may benefit by using a rectal catheter with an inflated balloon. We compared the efficacy of rectal catheters without and with an inflated balloon for air and liquid enemas. We retrospectively reviewed PACS images and hospital records of children who had a therapeutic enema for intussusception at our institution between January 2006 and May 2011. Sixty-two enemas in 60 children were included. Physician assistants with training in pediatric fluoroscopy and pediatric radiologists were more likely to use air enema (37/41 or 90 %), and general radiologists were more likely to use liquid enema (18/21 or 86 %). However, the reduction rate for air enema overall was only slightly higher than for liquid enema using an inflated balloon catheter (36/40 or 90 % versus 14/17 or 82 %) (P?=?0.653). For air enema, mean procedure time for successful reductions was shorter with an inflated balloon catheter than with a plastic catheter (7.6 versus 28.2 min) (P?<?0.009), but the reduction rate was not affected. For liquid enema, the reduction rate was higher with an inflated balloon catheter than without inflation (14/17 or 82 % versus 1/5 or 20 %; P?=?0.021), but the procedure time was not shortened. No procedural complications were directly attributed to using a rectal catheter with an inflated balloon. Using a rectal catheter with an inflated balloon appears to safely shorten the procedure time of a successful air enema and improve the reduction rate of liquid enema.     

MDCT diagnosis of ileocolic intussusception secondary to an appendiceal mucocele: value of multiplanar reformation

We describe an extremely rare case of an ileocolic intussusception with an appendiceal mucocele as the lead-point and cause of acute right lower quadrant pain in an adult patient. There are only few reported cases of this entity in the radiologic literature. We describe the multislice (computed tomography) CT features and emphasize the value of multiplanar reformations. We also discuss how specific findings on CT should allow for a correct preoperative diagnosis. This case report has not been presented previously at any Radiology meeting. No grants were received for this case report. The authors disclose no potential conflict of interest.     

"Bell-shaped ureter," a radiographic sign of antegrade intussusception

A unique case of a hitherto unreported antegrade intussusception of the ureter secondary to a lead pedunculated polypoid transitional cell tumor is presented. Radiological documentation and surgical verification are illustrated. An attempted explanation of the peculiar radiographic appearance proximal to and within the intussusception is given. The potential aid in preoperative recognition of such an entity is proposed.     

“Bell-shaped ureter,” a radiographic sign of antegrade intussusception

A unique case of a hitherto unreported antegrade intussusception of the ureter secondary to a lead pedunculated polypoid transitional cell tumor is presented. Radiological documentation and surgical verification are illustrated. An attempted explanation of the peculiar radiographic appearance proximal to and within the intussusception is given. The potential aid in preoperative recognition of such an entity is proposed.     

Successful reduction of recalcitrant ileocolic intussusception with a double-balloon-tipped catheter that prevents air leaks and catheter expulsion

Noninvasive reduction of ileocolic intussusception requires increasing intracolonic pressure via gas or liquid administered through a rectal catheter. A tight seal around the catheter is required to maintain intracolonic pressures and this tight seal is difficult to maintain with existing techniques. I describe the safe and effective use of a catheter with 2 balloons near the tip that surround the anus internally and externally to prevent leakage of air during an enema on a toddler after failure with a single-balloon tipped catheter.     

Plain film diagnosis of intussusception: prevalence of the target sign.

We describe a feature of intussusception seen on plain abdominal films that to our knowledge has not been previously described. The abnormality, termed the "target sign," consists of two concentric, circular, radiolucent lines to the right of the spine superimposed on the kidney. Four observers examined 280 plain abdominal films; 180 were of 94 patients who had had 100 episodes of intussusception and 100 films were of 80 control subjects. The target sign was observed by three or four observers on plain films in 24 (26%) of 94 patients with intussusception and on 4% of radiographs of control subjects. There was no concordance between observers on false-positive findings seen in the control subjects. Our experience suggests that circular radiolucent lines superimposed on the right kidney on plain abdominal radiographs (target sign) constitute a useful diagnostic feature of intussusception.     

Ileocolic intussusception: new sign on the supine cross-table lateral radiograph

The ability to detect ileocolic intussusception on the supine cross-table lateral radiograph of the abdomen in infants was prospectively evaluated in 12 cases (including two recurrences) over a 2-year period. The intussusceptions (including one recurrence) were directly depicted on five radiographs as a homogeneous water-density mass producing a convex interface with bowel gas at the anterior part of the abdomen. In another four patients, the intussusception produced an inappropriate craniocaudal separation of gas-filled bowel loops in the upper part of the abdomen, caudal to the liver shadow. The intussusception was prospectively recognized on the supine cross-table lateral radiograph in nine of 12 cases.