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Society for Pediatric Radiology – Poster Archive
Final ID: Poster #: CR-003
Colocolic Intussusception in Children with Colonic Polyp as the Lead Point
Purpose or Case Report: Acute colocolic intussusception is a rare in the pediatric population and generally involves a pathologic lead point, which usually necessitates surgical or endoscopic intervention. No prior published reports have demonstrated presurgical imaging findings of colonic polyp in cases of pediatric colocolic intussusceptions. We will present two pediatric cases from our institution that feature colocolic intussusception with an intestinal polyp as a lead point, with a goal to demonstrate specific sonographic and MR findings.
Methods & Materials:
Case 1
A 2-year-old girl with recurrent "intussusceptions" (s/p multiple enema reductions as well as negative work-up with EGD and an elective exploratory laparotomy) was brought to the emergency department. An ultrasound and MRI abdomen/pelvis demonstrated a short segment colocolic intussusception at the hepatic flexure with suggestion of a polypoidal leadpoint. The ileocolic junction was normal. She was admitted to surgery for a second exploratory laparotomy, which revealed a colocolic intussusception involving the hepatic flexure with a polyp (3.4 x 2.2.cm) acting as a lead point which was resected. The patient did well after the procedure and was discharged to her home.
Case 2
A 5-year-old boy initially presented to the emergency department with acute exacerbation of chronic abdominal pain and bloody diarrhea. An MRI abdomen/pelvis showed a short segment transient colo-colic intussusception with possibility of an intraluminal polypoidal mass. The patient returned a week later with worsening symptoms and an ultrasound study showed intussusception involving the transverse, descending and sigmoid colon as well as a pedunculated, well-defined heterogeneous intraluminal mass (measured 1.9 x 1.8 cm). An air enema successfully reduced the intussusception. Colonoscopy was performed the following day, which revealed a 2-cm transverse colonic polyp that was removed endoscopically. T
Results:
Conclusions: Colocolic intussusception is a rare subtype in the pediatric population, and when present can suggest the presence of a pathologic lead point. While colocolic intussusception is difficult to differentiate from ileocolic intussusception on ultrasound imaging alone, a mass acting as a lead point should make it a diagnostic consideration. MRI abdomen/pelvis may be helpful as a complementary examination to better delineate the colocolic nature of the intussusception as well as the mass acting as a lead point, thereby directing the appropriate treatment.
Methods & Materials:
Case 1
A 2-year-old girl with recurrent "intussusceptions" (s/p multiple enema reductions as well as negative work-up with EGD and an elective exploratory laparotomy) was brought to the emergency department. An ultrasound and MRI abdomen/pelvis demonstrated a short segment colocolic intussusception at the hepatic flexure with suggestion of a polypoidal leadpoint. The ileocolic junction was normal. She was admitted to surgery for a second exploratory laparotomy, which revealed a colocolic intussusception involving the hepatic flexure with a polyp (3.4 x 2.2.cm) acting as a lead point which was resected. The patient did well after the procedure and was discharged to her home.
Case 2
A 5-year-old boy initially presented to the emergency department with acute exacerbation of chronic abdominal pain and bloody diarrhea. An MRI abdomen/pelvis showed a short segment transient colo-colic intussusception with possibility of an intraluminal polypoidal mass. The patient returned a week later with worsening symptoms and an ultrasound study showed intussusception involving the transverse, descending and sigmoid colon as well as a pedunculated, well-defined heterogeneous intraluminal mass (measured 1.9 x 1.8 cm). An air enema successfully reduced the intussusception. Colonoscopy was performed the following day, which revealed a 2-cm transverse colonic polyp that was removed endoscopically. T
Results:
Conclusions: Colocolic intussusception is a rare subtype in the pediatric population, and when present can suggest the presence of a pathologic lead point. While colocolic intussusception is difficult to differentiate from ileocolic intussusception on ultrasound imaging alone, a mass acting as a lead point should make it a diagnostic consideration. MRI abdomen/pelvis may be helpful as a complementary examination to better delineate the colocolic nature of the intussusception as well as the mass acting as a lead point, thereby directing the appropriate treatment.
More abstracts on this topic:
Imaging Spectrum of Pediatric Intussusception
Sintim-damoa Akosua, Eovaldi Benjamin, Cohen Harris
Feasibility of a scoring system to predict reducibility and surgical outcomes of ileocolic intussusceptions in children.Richer Edward, Patel Dhruv, Braithwaite Kiery, Milla Sarah, Loewen Jonathan
Poster____CR-003.pdf
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