Top Tips for scanning for intussusception
By Claire Ward, Radiographer Advanced Practitioner, Portsmouth Hospitals University NHS Trust
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History is key: Although a common pathological finding in paediatric patients, intussusception is rare in adults. Most adult intussusceptions are caused by an underlying pathology such as a polyp or tumour, or the result of a postoperative condition. It is key to assess the patient’s history fully prior to scanning. Thoroughly check the request, the medical notes and talk to the patient.
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Be dynamic: Initially perform a dynamic assessment of the full colon and small bowel using real-time imaging with both a high and low frequency transducer where possible, assessing bowel peristalsis and movement. Be mindful that the most common sites for intussusception are within the small bowel and the ileo-caecal region. If the request states any palpable mass, assess this focused area for potential intussusceptum within the intussuscipiens.
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"Target" the "Donut": Intussusception typically presents sonographically as a target or donut-shaped mass in transverse projection, with alternating hypoechoic and hyperechoic rings representing the layers of the bowel telescoping into each other.
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Grade compression: As with assessment of the colon and small bowel in other pathology, using the graded compression technique can be very useful. Applying gentle pressure with the transducer to the abdomen helps to identify the intussusception, by differentiating a compressible mass from surrounding structures.
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Find the lead: Once located, assess the intussusception for accompanying findings such as bowel wall thickening, mesenteric lymphadenopathy, or presence of a lead point (such as a polyp or tumour). This may highlight the causative underlying pathology. Assess for signs of vascular compromise within the intussusception with Doppler, which can indicate ischemia and other potential serious complications.