E5509. Taking a Closer Look at the Target Sign: An Overview of Pathologic Proximal Gastrointestinal Intussusception
Authors
Audrey Nisbet;
Department of Medical Imaging, University of Arizona
Paul Clark;
Brooke Army Medical Center
Unni Udayasankar;
Department of Medical Imaging, University of Arizona
Dorothy Gilbertson-Dahdal;
Department of Medical Imaging, University of Arizona
Background
Intussusception is a well-known entity in pediatric medicine and is regularly included in the differential diagnosis of acute abdominal pain in the pediatric population. Frequently, intussusception is ileocolic in the setting of hypertrophied lymphoid tissue – a familiar condition that is often amenable to enema reduction in the radiology suite. Another customary discovery in imaging is transient small bowel-small bowel intussusception, typically an incidental finding, rarely the cause of presenting symptoms, and almost never requiring treatment. However, it is incumbent upon the radiologist to recognize a third and less commonly encountered subset of intussusception: pathologic proximal gastrointestinal intussusception, which may require multidisciplinary treatment, intervention, and/or surgery.
Educational Goals / Teaching Points
This educational exhibit will provide an overview of the pathophysiology and imaging findings of intussusception, with an emphasis on pathologic proximal gastrointestinal intussusception. Utilizing a case-based format highlighting the clinical, imaging, and treatment course, this exhibit will supply the radiologist with the means to distinguish benign from pathologic proximal gastrointestinal intussusception to ensure timely, multidisciplinary care.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Pertinent etiologies of pathologic proximal gastrointestinal intussusception encountered in the pediatric population will include polyp, IgA vasculitis (Henoch-Schönlein purpura), and retrograde gastroesophageal intussusception. Multimodal imaging findings will be reviewed, including radiography, fluoroscopy, ultrasound, CT, and MRI.
Conclusion
The diagnosis and management of pathologic proximal gastrointestinal intussusception as a cause of acute abdominal pain in the pediatric patient, requires the acumen of clinical, imaging, and surgical providers. As an integral component in the care of our pediatric patients, radiologists must remain experts in the distinctive imaging features of pathologic proximal gastrointestinal intussusception that are less commonly encountered in day-to-day practice, may portend the need for additional treatment, and in some cases, may be the first diagnostic harbinger of an underlying disease.
