Portal de Periódicos da CAPES

Intussusception

1941; Radiological Society of North America; Volume: 36; Issue: 4 Linguagem: Inglês

10.1148/36.4.490

1527-1315

Hyman S. Abrams,

Gastrointestinal disorders and treatments

About 25 per cent of cases of intussusception occur after the age of two years and even these are more frequent in early childhood. It is predominant in the male in the proportion of about three to one. The acute type is rarely seen in an x-ray department. Predisposing conditions are frequently present in older children and adults. In infancy, there is usually no evident cause. According to Perrin and Lindsay (3), inflammatory changes in the lymphoid tissue of the small intestine constitute a significant factor. Intestinal spasm resulting from change in the diet at the time of weaning is said to be an etiologic agent, and a tumor of the bowel, Meckel's diverticulum, or ulcer is believed to account for about 70 per cent of cases of intussusception in adults (Christopher, 1). The barium enema, motor meal, and examination of the abdomen without opaque media are used to diagnose intussusception. The opaque meal or barium enema is preferred by many. There is an extensive literature on the subject of roentgen diagnosis, but relatively little deals with examination without the use of opaque media. Schatzki (5) reported on the roentgen appearance of intussuscepted tumors of the colon, with and without the use of barium. There can be no doubt that the simplest procedure which may be of diagnostic value should be used. When an acute condition is present or suspected, examination without opaque media is, therefore, preferable and is used routinely by the author. The roentgen signs of intussusception revealed by barium enema may also be present in this simpler type of examination. If the canal of the intussusceptum contains air, it will be surrounded by the walls of the intussusceptum and the intervening mesentery. Air in the intussuscipiens or ensheathing layer will partially, or apparently completely, surround the latter. In the absence of air in the canal of the invaginated portion, a homogeneous sausage-shaped shadow surrounded by a narrow radiolucent area may be seen. The latter may consist of a single layer or of multiple layers of air. The haustra of the bowel in the region of the mass may be distended. The defect may change in shape, position, and apparently in degree, in the recumbent and upright positions and in subsequent examinations. A mass is usually palpable in the region of the intraluminal defect. If stenosis ensues, the proximal bowel becomes distended and signs of intestinal obstruction are demonstrated. Free air in the peritoneal cavity is indicative of a complicating perforation. The accepted roentgen criteria are not always present and neither are all of them pathognomonic of intussusception. This is to be expected, because the signs are a graphic manifestation of the underlying pathologic changes. The presence or absence of air in the involved loop of intestine, extent of edema, congestion, presence of adhesions, necrosis, or of an exciting factor determine the roentgen signs.