MedPix Medical Image Database

COW - Case of the WeekCase Contributor: Chun W ChenAffiliation: National Capital Consortium

MedPix No: 5810 - HistoryPt Demographics: Age = 49 y.o. Gender = woman49 y.o. woman with a history of chronic abdominal pain - rule out diverticular disease

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MedPix No: 5810 - EXAM & LABSNot available

Ileo-colic Intussusception

Supine and upright images. Multiple air-filled loops of small bowel. Sparse (if any) gas in the colon.- Incidental phleboliths in right pelvis.

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Ileo-colic Intussusception

Supine and upright images. Multiple air-filled loops of small bowel. Sparse (if any) gas in the colon.- Note Phleboliths in right pelvis

Downloaded by (-1)

Ileo-colic Intussusception

Supine and upright images. Multiple air-filled loops of small bowel. Sparse (if any) gas in the colon.- Note Phleboliths in right pelvis

Downloaded by (-1)

Ileo-colic Intussusception

Supine and upright images. Multiple air-filled loops of small bowel. Sparse (if any) gas in the colon.- Note Phleboliths in right pelvis

Downloaded by (-1)

Ileo-colic Intussusception

Oral contrast and fluid in multiple mildly dilated small bowel loops. In the right abdomen, there is a complex mass suggesting intussusception.- NOTE: the*jelly roll* of mesenteric fat drawn into the telescoping small bowel of the intussusception.

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Ileo-colic Intussusception

Oral contrast and fluid in multiple mildly dilated small bowel loops. In the right abdomen, there is a complex mass suggesting intussusception.- NOTE: the*jelly roll* of mesenteric fat drawn into the telescoping small bowel of the intussusception.

Downloaded by (-1)

Ileo-colic Intussusception

Oral contrast and fluid in multiple mildly dilated small bowel loops. In the right abdomen, there is a complex mass suggesting intussusception.- NOTE: the*jelly roll* of mesenteric fat drawn into the telescoping small bowel of the intussusception.

Downloaded by (-1)

Ileo-colic Intussusception

Oral contrast and fluid in multiple mildly dilated small bowel loops. In the right abdomen, there is a complex mass suggesting intussusception.- NOTE: the*jelly roll* of mesenteric fat drawn into the telescoping small bowel of the intussusception.

Downloaded by (-1)

Ileo-colic Intussusception

Oral contrast and fluid in multiple mildly dilated small bowel loops. In the right abdomen, there is a complex mass suggesting intussusception.- NOTE: the*jelly roll* of mesenteric fat drawn into the telescoping small bowel of the intussusception.

Downloaded by (-1)

Ileo-colic Intussusception

Oral contrast and fluid in multiple mildly dilated small bowel loops. In the right abdomen, there is a complex mass suggesting intussusception.- NOTE: the*jelly roll* of mesenteric fat drawn into the telescoping small bowel of the intussusception.

Downloaded by (-1)

Ileo-colic Intussusception

3D surface rendering (reconstruction) showing a *mass like* filling-defect inside the bowel lumen.

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Ileo-colic Intussusception

gross images

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Ileo-colic Intussusception

gross images

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FINDINGSSupine and upright plain films show a few air fluid levels along the right side and some dilated loops of small bowel.Axial CT images show a large mass in the right abdomen extending from the region of the ascending colon to the region of the transverse colon. The mass has low attenuation centrally and areas of higher attenuation surrounding it consistent with fat filled mesentery and surrounded by edematous bowel wall. The mass does not have a typical target appearance since most of the mass was imaged in the long axis and not axial plane.There are vessels (mesenteric) invaginating into the mass. There is a lower attenuation *leading point* mass - probably mesenteric fat.

DIFFERENTIAL DIAGNOSISWhat is your Differential Diagnosis?Intussusception- The differential for the causes include:- - cecal carcinoma- - lipoma- - idopathic- - polyps- - Meckel's diverticulum

Diagnosis: Intussusception, Carcinoma of CecumDx Confirmed by: Surgery

DISCUSSIONCompanion Images - http://goo.gl/nFAjOj- - Companion cases:- http://goo.gl/e9UVBI- http://goo.gl/ut2Lw7- - Additional references - https://www.clinicalkey.com/topics/surgery/intussusception.html- http://radiopaedia.org/articles/intussusception- http://www.mayoclinic.org/diseases-conditions/intussusception/basics/causes/con-20026823- http://www.chop.edu/service/surgery-general-thoracic-and-fetal/conditions-we-treat/pediatric-surgery-intussusception.html-