Images in Clinical Medicine
Intussusception
N Engl J Med 2004; 350:e2January 15, 2004
- Article
An 80-year-old woman presented with a three-day history of passage of bright red blood from the rectum. She was afebrile and had a blood pressure of 70/52 mm Hg. The white-cell count was 10,100 per cubic millimeter, and the hematocrit was 32.5 percent. An abdominal radiograph showed minimal ileus. A colonoscopy revealed blood in the colon and a round, smooth, violaceous lesion in the ascending colon that nearly obstructed the colonic lumen and that could not be passed by the colonoscope. A single computed tomographic image of the abdomen showed two views of an intussusception. In a cross-sectional view (arrowhead), traces of contrast medium in the intussusceptum (the invaginated segment of the colon) formed a high-density center, the swollen wall of the intussusceptum and mesenteric fat formed a crescentic low-density layer, and contrast medium in the intussuscipiens (the portion of the bowel into which the intussusceptum telescopes) formed the outermost, high-density layer. In a longitudinal view (arrow), the swollen bowel walls formed the thickened outer layer, and the intraluminal mesenteric fat and vessels formed a denser signal than did the intraluminal air in the loop of bowel just above it. At surgery, the terminal ileum was found to have prolapsed into the cecum and up the ascending colon.
Duyen Dang, M.D.
University of Michigan Medical Center, Ann Arbor, MI 48019David Cromwell, M.D.
Johns Hopkins University School of Medicine, Baltimore, MD 21205- Citing Articles (1)
Citing Articles
1
Paul De Lay, Valerie Manda. (2005) Politics of monitoring and evaluation: Lessons from the AIDS epidemic. New Directions for Evaluation 2004:103, 13-31
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