Case of the Month, March 2017, Page 2

Imaging

CT Abdomen and Pelvis

CT scan of the pelvis (transverse and sagittal section) showing nondilated small bowel loops and a nearly 20 cm segment of distended sigmoid colon (solid arrow) containing a "bowel-within-bowel" target sign appearance slightly to the left of midline. A loop of sigmoid bowel (solid arrow) is telescoped into the distal sigmoid colon (open arrow). There is a long segment intussusception of the rectosigmoid colon measuring up to 20 cm in length. The intussusceptciens is fluid-filled. The intussusceptum is decompressed. The distal large bowel is decompressed and there is no evidence of bowel obstruction. No pelvic free fluid or adenopathy is seen. No lead point mass is identified. The differential diagnosis for this finding includes primary bowel mass, endoluminal metastatic disease, transient incidental intussusception, and endometrial implants mimicking intussusception.

 

 

 

Long segment nonobstructing sigmoid-sigmoid colon intussusception is identified in this patient. Which of the following statements is false?

  1. A) In adults, intussusception may present as intermittent pain, vomiting and red blood in stool.
  2. B) Most adult intussusceptions are long segment, transient and non-obstructing, requiring no treatment.
  3. C) Endometrial implants on bowel walls may mimic intussusception on CT.
  4. D) Intussusception is more common in children, typically in the setting of lymphoid hyperplasia.

 

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