Primary adenocarcinoma is the main cause of colon intussusception. Axial CT images (a, b) demonstrate a round mass with target pattern and central hypodense area of mesenteric fat in which vessels are seen as linear enhanced structures (arrow). Surgical management of intussusception in the adult. O. Catalano, Transient small bowel intussusception: CT findings in adults, British Journal of Radiology, vol. The https:// ensures that you are connecting to the Intussusception in adults: institutional review. 2019;23(4):31524. Adult intussusception is a rare occurrence and accountsfor only 5% of all intussusceptions(1). 21 Because 71.9% of the cases of adult intussusception were found to be related to tumors and polyps in this study, the results suggested that surgical treatment should be the preferred choice for adult intussusception patients. Considering the high incidence of primary adenocarcinoma, it should be resected without reduction in colonic intussusception (7). Lorigan JG, DuBrow RA. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Acid Reflux; . The typical bowel-within-bowel appearance [1, 810] is often found in asymptomatic patients, with transient intussusception and no underlying disease [1113]. It may result in small bowel obstruction. Clinical diagnosis can be difficult even in symptomatic patients with a leading point intussusception, because of the variety of clinical findings at presentation (crampy abdominal pain, nausea, vomiting, and bloody mucoid stools), depending on the underlying cause. The mean resection of small bowel was 17.8 cm, with a range of 8.0 to 40.0 cm. 1, pp. Computed tomography (CT) revealed a concentric circle change in the colon, as well as the mesenterium and arteries. Writingreview and editing: WM. During the exploration, severe small bowel dilatation located at 1.5m from the ligament of Treitz was found, and part of the small intestines was found slide inside the nearby part. Association with malignant tumors is more common in large bowel intussusception (6570% of cases), while small bowel intussusceptions are secondary to a malignancy in 3035% of cases only. Unlike intussusception in children, the incidence of intussusception in adults is extremely low, and most of them are secondary [1]. The one cecal lead point resulted in ileocolic intussusception, and the two colonic lead points resulted both in one colocolic and one sigmoid-rectal intussusception. 7476, 2004. Azar et al. Kao Y-K, Chen J-H. Before the widespread use of Multi-Detector Computed Tomography (MDCT), the diagnosis was based on surgical findings in patients with obstructive symptoms [4]. T. Azar and D. L. Berger, Adult intussusception, Annals of Surgery, vol. 2 As the global population ages, the incidence of colorectal cancer in older adults will . Conceptualization: QL. Back to Journals Cancer Management and Research Volume 12. 187188, 2005. 2, pp. 49, no. Sonographic diagnosis of intussusceptions in adults. Am J Roentgenol 1970; 109:72932. The diagnosis and treatment of adult intussusception is still a challenge for abdominal surgeons. Please enable scripts and reload this page. Bookshelf Therefore, when the clinical manifestations are difficult to diagnose, CT should be routinely performed to make a definite diagnosis. Adults with bowel intussusception caused by malignant tumors are fairly uncommon. 1994 Nov-Dec;94(6):314-7. HHS Vulnerability Disclosure, Help This work was supported by the Project of Innovative Foundation for Postgraduates in Yongchuan Hospital of Chongqing Medical University (YJSCX202012). CT images on axial (b) and oblique reformatting (c, d) demonstrate an intraluminal lesion with fat attenuation (arrow) that serves as the intussusception lead point. 134138, 1997. CT images on axial scans (b, c) and coronal and oblique reformatting (d, e) demonstrate lead point intussusception with invaginated mesenteric fat, vessels, and lymph nodes. Surgical exploration was performed on October 12, 2020, then. Clinical presentations, diagnosis and treatment of adult intussusception, a 20 years survey. The patient was discharged on the 6th day after the operation. Kitamura K, Kitagawa S, Mori M, et al. 23. In our series, US was performed in four patients; in three, the preoperative diagnosis was confirmed. Aminde LN, Bonko NM, Takah NF, Awungafac G, Teno D. Ethiop J Health Sci. Somma F, Faggian A, Serra N, Gatta G, Iacobellis F, Berritto D, Reginelli A, Di Mizio V, Cappabianca S, Di Mizio R, Grassi R. Radiol Med. Please try again soon. de Clerck F, Vanderstraeten E, De Vos M, Van Steenkiste C. Adult intussusception: 10-year experience in two Belgian centres. Considering the patients past medical history and immunohistochemistry results, the patients condition met the diagnostic criteria of colonic metastasis of cardia adenocarcinoma (Fig. The LT (16DBR 3000T0,16Fr, Dalian Create Medical Products Co., Ltd.) was placed on September 30, 2020 (Fig. 9. But the color of the intestine wall did not change. Mesenteric vessels appear as enhanced linear structures between hypodense mesenteric fats (arrow). 11. 8. 6, pp. While it is common in children, adult intussusception accounts for only 1% of intestinal obstruction and less than 5% of all cases of intussusception (1, 2). A case of iatrogenic intussusception in adults: a rare case report. Sigmoidorectal intussusception fibroma sigmoid lipoma. A 69-year-old female complained of recurrent abdominal pain with reduced flatus passage and frequency of bowel movement for 10 days was admitted to the hospital. 29. The appearance of an intussusception on CT images is similar to that of a target mass when the CT beam is perpendicular to the longitudinal axis of the intussusception and to that of a sausage mass when the CT beam is parallel or oblique to the longitudinal axis [10] (Figure 2). Genetic testing: Desmin(+), MSH2(+), MSH6(+), MLH1(+), PMS2(+), Muc-2(+), Muc-6(), Muc-5AC(+), CD34(+), S-100(+), P53(+), Ki-67(+,20%), CerbB-2(), CK7(+), CK20(+), CDX-2(+). METRICS PDF Intussusception in adults is rare. Enterocolonic (ileocaecocolonic) intussusception caused by intestinal lymphoma, with proximal bowel obstruction. In this case, the patients intestine was not necrotic. Wolters Kluwer Health, Inc. and/or its subsidiaries. Intussusception was first described by Paul Barbette [ 1] as the proximal portion of the intestine (intussusceptum) invaginating into the distal portion of the intestine (intussuscipiens) in a telescope-like fashion. Intussusception in Adults: The Role of MDCT in the Identification of In previous reports, adult intussusception occurred is mostly secondary to intestinal tumors, and other causes leading to adult intussusception are rarely reported in clinic settings. P. Jain and S. W. Heap, Intussusception of the small bowel discovered incidentally by computed tomography, Australasian Radiology, vol. Google Scholar. An official website of the United States government. Eventually, this patient was diagnosed with intussusception by CT and confirmed benign and malignant lesions by colonoscopy biopsy. If resection of a long segment of the bowel is required, intraoperative reduction can be attempted to reduce the resection length (9). When clinical manifestations are difficult to diagnose intussusception, CT is the most accurate method for a definite diagnosis. To help guide treatment decisions, it is important to diagnose the organic intussusception lesion. For further diagnosis and treatment, she was treated in our hospital with a chief complaint of the color Doppler ultrasonography finding an abdominal mass. Enterocolic (ileocaecocolonic) intussusception caused by a caecal carcinoma. J Pediatr Surg. Intussusception in adults: Institutional review - ScienceDirect 89101, 2012. 6). Because malignant diseases are highly correlated with intussusception in adults, surgical resection without reduction should be limited to primary malignant disease. Signs of small bowel obstruction are seen on axial scans (a, b) and coronal (c) and sagittal (d) reformatting. doi:https://doi.org/10.1016/j.jpedsurg.2019.07.022. A color Doppler ultrasonography of the abdomen revealed a low echo mass in the right middle abdomen. All rights reserved. In the article that accompanies this editorial, Montroni et al 4 report prospectively collected 3-month and 6-month postoperative quality-of-life and functional recovery data after elective colorectal cancer resections among 625 older adults and demonstrated that approximately 70% will have preserved or improved quality of life, and 76% will have postoperative functional recovery over this . Colonoscopy is also a useful tool for evaluating intussusception, especially when the presenting symptoms indicate a large bowel obstruction. 8894, 1997. sharing sensitive information, make sure youre on a federal Patients present with nonspecific symptoms if any, like vague abdominal pain. We hypothesized that the main causes of the intussusception, in this case, are: (1) The speed of tube withdrawal was too fast. The purpose of these instructions is to ensure the intestines have sufficient time to adapt to the removal process and to prevent intussusception. National Library of Medicine The presence of a lead point, the configuration of the lead mass, the degree of bowel wall edema, and the amount of invaginated mesenteric fat all affect the radiological aspect of an intussusception. 191, no. Past medical history: On April 2, 2018, laparoscopic radical gastrectomy was performed in our hospital for cardia adenocarcinoma. Ultrasonic appearance of. Terms and Conditions, Although theexact mechanism is unknown, adult intussusceptionformation is hypothesized to be due to abnormal peristal-sis from a bowel irritant. No color change of the intestinal wall was detected, suggesting that no necrosis was present. Pediatr Radiol 1985; 15:38891. We report our experience in an attempt to clarify the usefulness of CT scan and the optimal treatment in adult intussusception. Angiographic diagnosis of small intestinal intussusception. A color Doppler ultrasonography of the abdomen revealed a low echo . 9). Felix EL, Cohen MH, Bernstein AD, et al. Abdominal CT after the procedure showed no significant relief of the bowel obstruction (Fig. Inflammatory fibroid polyp, inverted Meckel's diverticulum, postoperative intussusception, and idiopathic intussusception accounted for one each of the others. 16. N. Lvoff, R. S. Breiman, F. V. Coakley, Y. Lu, and R. S. Warren, Distinguishing features of self-limiting adult small-bowel intussusception identified at CT, Radiology, vol. 4. 58, no. Emergency abdominal CT showed small bowel intussusception. J Clin Gastroenerol 1995; 21:257. The original online version of this article was revised: Following the publication of the original article, we have been notified that Jianfeng Shi was incorrectly listed twice in the authorship list, once in the second position and incorrectly spelled as Jinfeng Shi, and once in the last position. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Keyword Highlighting Intussusception of the bowel in adults: a review. Seidman DS, Heyman Z, Ben-Ari GY, et al. 212, no. Cookies policy. The authors declare that there is no conflict of interests regarding the publication of this paper. In addition, colonoscopy is recommended only when intussusception is located in the ileocecal and colon, which can not only assist the diagnosis, but also provide a reference for surgical methods. An intestinal resection should be performed promptly. Am Fam Physician. Most Adult Intussusceptions are Caused by Tumors: A Single-Centre Anal D. Merine, E. K. Fishman, B. Jones, and S. S. Siegelman, Enteroenteric intussusception: CT findings in nine patients, American Journal of Roentgenology, vol. The bowel openings were evenly aligned and closed using the linear cutter and occluder. Ultrasonographically the findings are that of a bowel mass with concentric layers of hyper- and hypoechogenicity. Seven patients were identified who had a diagnosis of intussusception. Listen. Neoplasms account for about 70% of intussusceptions in adults. Sonographic examiners need enough clinical experience for them. MDCT has the ability to differentiate between presence and lack of a leading point. Enhanced vessels are often seen within the mesenteric fat (Figure 1). Intussusception in adults. Thomas AW, Mitre R, Brodmerkel GJ. Ghaderi H, Jafarian A, Aminian A, Mirjafari Daryasari SA. This way, the incidence of iatrogenic complications will be minimized. It is found in less than 1 in 1300 abdominal operations and the adult to child ratio is 1:20 [].Intussusception describes the condition in which a proximal segment called "intussusceptum" telescopes into the lumen of the adjacent distal segment of the gastrointestinal tract . 5, pp. Case report: An adult intussusception caused by ascending colon cancer Heterogeneous target mass with the intussuscipiens, intussusceptum, and vessels within the invaginated mesenteric fat. Stewardson RH, Bombeck CT, Nyhus LM. In these settings, preoperative endoscopy can be performed to confirm the presence of pathology and/or cancer (6). . ; Hara, Takashi M.D., Ph.D.; Kori, Takayuki M.D. Plain abdominal radiography suggest intestinal obstruction, CT of the abdomen reveals incomplete colonic obstruction, No intussusception was found on abdominal CT before operation. In about 90% of adult intussusceptions, there is a lead point, which is a well-definable pathologic abnormality. Marsicovetere P, Ivatury SJ, White B, Holubar SD. 28. Acta Chir Belg. It is determined according to the length of the affected intestine in patients with intussusception. Abstract Adult intussusception is a rare occurrence and, unlike in childhood, is usually associated with an underlying tumor. 2019 Apr 5;19(1):324. doi: 10.1186/s12885-019-5505-8. doi:https://doi.org/10.1007/s10151-019-01980-5. This study was conducted under approval of the Ethics Committee of Tongde Hospital of Zhejiang Province. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. You may be trying to access this site from a secured browser on the server. In this series, the CT scan proved to be the most useful, with US being the second most accurate. A manual reduction was performed. Following an electronic colonoscopy, it was discovered that the colonic giant proliferative lesions had stenosis (Figure2). and transmitted securely. 227, no. 2,911. Pathology after colonic surgery suggests moderate to poorly differentiated adenocarcinoma (HE*100), CT of the abdomen suggests intussusception(concentric circle sign), Gastrointestinal radiography suggests small bowel obstruction. Colonoscopic diagnosis of ileocecal intussusception. 5). 14491452, 1980. After the operation, the patient had nothing by mouth and received parenteral nutrition. de Mesquita GHA, Carvalho BJ, de Almeida Medeiros KA, Nii F, Martines DR, Pipek LZ, Jardim YJ, Waisberg DR, Obara MT, Sitnik R, Meyer A, Mangueira CLP. Appendiceal intussusception is rare and difficult to diagnose radiologically [24]. Association of Cardiovascular Health With Life Expectancy Free of Methodology: GZ. Purpose: Hope is vital for cancer patients to cope with their illnesses. Determining the site and causes of colonic obstruction with sonography. J. O. Waits, R. W. Beart Jr., and J. W. Charboneau, Jejunogastric intussusception, Archives of Surgery, vol. It is often not easy to distinguish the distinct anatomic features of the lead mass, because of poor recognisability of the edematous intestinal wall and the lead mass. The CT scan is most useful in making the diagnosis of intussusception. Background: Intussusception in adults is often diagnosed on computed tomography (CT), and the optimal treatment of this entity is not universally agreed upon. After successful reduction, the intussusception length of about 70cm was discovered. J. Anthony/Stocksy. (2) The water in the balloon of the LT was not evacuated completely. Extraparietal air indicates local perforation (arrow). Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. Although computed tomography (CT) imaging can identify an intussusception and point toward a cause, diagnosis is challenging if it is only intermittent. Epub 2014 Aug 13. 2010;75(1):469. official website and that any information you provide is encrypted During the operation, radiological examination results were confirmed. Gross examination of the resected specimen showed that the intestinal canal was 23cm long, which contained the ascending colon tumor with a volume of 7.5cm6.0cm3.5cm. Use of magnetic resonance imaging in pregnancy to diagnose intussusception induced by colonic cancer. Obstructing enteroenteric intussusceptions, often caused by a lead point, may present at CT with thickening and alterated enhancement of the bowel wall and engorgement of mesenteric vessels (Figure 10). Swischuk LE, Hayden CK, Boulden T. Intussusception: indications for ultrasonography and an explanation of the doughnut and pseudokidney signs. Clin Radiol 1998; 53:537. Eisen et al. Adult intussusception is rare, which only accounts for 5% of all intussusception cases. Inclusion in an NLM database does not imply endorsement of, or agreement with, This is an open access article distributed under the. Although color Doppler ultrasound showed an abdominal mass, no obvious mass was touched during abdominal palpation. Copyright 2016 Viola Valentini et al. Z. T. Stockinger and N. McSwain Jr., Intussusception caused by abdominal trauma: case report and review of 91 cases reported in the literature, Journal of Trauma, vol. A 64-year-old woman was previously admitted to a local hospital 1 day ago for dizziness, hypodynamia, and loss of appetite. After the reduction, the bowel should be carefully examined for tumor, polyp, diverticulum, focal necrosis, and other types of lesions. Transient and Non-Transient Intussusceptions of the Large Bowel in Adults: Two Case Reports. Adult Intussusception Caused by Descending Colon Cancer during Data related to presentation, diagnosis, treatment, and pathology were analyzed. Am J Case Rep. 2022 Dec 5;23:e938124. Enteroenteric (ileoileal) intussusception caused by lymphoma. Patients and methods: The medical records and imaging studies of all patients 16 years of age with intussusception, who were managed at our hospitals, were retrospectively reviewed. doi: 10.12659/AJCR.938124. None of them underwent a barium study. The CT scan has been used to evaluate patients with intestinal obstruction or an abdominal mass in whom intussusception is the final diagnosis. Retrograde jejunal intussusceptions, in which retrograde peristalsis determines the telescoping of a distal bowel segment into the adjacent proximal segment, are reported as postoperative complications of Roux-en-Y anastomoses [20]. Therefore, laparoscopic right hemicolectomy was chosen, and total resection without reduction is performed to avoid potential intraluminal seeding or venous tumor dissemination. No abdominal pain and distension developed after food intake. On postoperative day 4, the patient had bowel movements. This was based on a high incidence of underlying malignancy that could not be confirmed either preoperatively or intraoperatively. The https:// ensures that you are connecting to the Article (2) If necrosis of the intestine is found, the manual reduction is not recommended. Many cases in adults are caused by tumors. 1 A demonstrable etiology is found in 70% to 90% of cases in adult intussusceptions, and about 40% of them are caused by a primary or secondary malignant neoplasm. 75, no. During the operation, the colon proximate to the splenic flexure was dilated. Clipboard, Search History, and several other advanced features are temporarily unavailable. Intussusception is one of the common causes of intestinal obstruction in children but is uncommon in adults. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Coronal (e) and sagittal (f) reformatting better depict the site and the extent of intussusception. Postoperative-related factors are the second major cause of intussusception in adults, such as postoperative abdominal adhesion and intestinal ostomy. Etiologically, adult intussusception could be categorized into four groups: (1) tumor-related (13 cases, 52%); (2) postoperative (nine cases, 36%); (3 . On postoperative day 9, the LT was removed. 11291132, 1987. and Surgery I (K.T., T.H., T.K., H.K. They can be classified as duodenojejunal, jejunojejunal, or jejunoileal. Postoperative pathological result revealed moderately differentiated adenocarcinoma in the right colon with full-thickness invasion (magnification power: 40). So, a manual reduction was performed [8]. Gastrointestinal radiography revealed small bowel obstruction. The enhanced neoplastic mass, which acts as the lead point, is located in the rectum (arrow), at the tip of intussusceptum (b, c, d, and e). Unauthorized use of these marks is strictly prohibited. After resection of the lesion by removing the part of the descending colon proximate to the site of invasion and the entire transverse colon, the remainder of descending colon was brought close to the ascending colon, and side-to-side anastomosis was done using the stapler. Immunohistochemistry: Ki67 (about 60%, +), MLH1 (+), MSH2 (+), MSH6 (+), PMS2 (+), Her-2 (weak +). 20. The second appearance, the reniform pattern, appearing as a bilobed mass with central low attenuation and peripheral higher density, was thought to result from ischemic thickening of the intussusceptums bowel wall. Address correspondence and reprint requests to Dr. Kunio Takeuchi, Department of Surgery, Tone Chuo Hospital, 1855-1, Higashiharashin-machi, Numata-city, Gunma 378-0053, Japan. Disclaimer. Background: We are reporting a rare case of MUTYH-associated polyposis, a colorectal cancer hereditary syndrome, diagnosticated after an intussusception. Malignant tumors are the most common cause of intussusception caused by tumors (5073%) [5]. Ultrasonography (US) was used in four patients, and it made the diagnosis in three patients (Fig. In some cases, the enteroenteric intussusception is due to increased peristalsis of the intestinal loops caused by distal obstruction, such as a stenosis caused by a neoplasm of the colon (Figure 9). Colocolonic, when involving the large bowel. Intussusception occurs when a segment (intussusceptum) of gastrointestinal tract invaginates with its mesenteric fold into an adjacent segment (intussuscipiens). Colon Intussusception - an overview | ScienceDirect Topics How young people with cancer navigate dating, fertility and health Both patients presented with intermittent severe abdominal pain and weight loss, which is not usually a feature of cecal cancer without metastases. Intussusception in adults is an uncommon situation that represents 5% of the total incidents of intussusception and constitutes the cause for 1% of intestinal obstructions . Insertion of intestinal obstruction catheter, Reexamination of abdominal CT showed that the intestinal obstruction was not significantly relieved. Bethesda, MD 20894, Web Policies A review of 25 adult patients with intussusception is reported. Ileocecal intussusception of small-bowel lymphoma: diagnosis by colonoscopy. Adults with bowel intussusception caused by malignant tumors are fairly uncommon. The diagnosis of intussusception in adults is difficult as a result of the nonspecific signs and symptoms. Adult intussusception represents 5% of all cases of intussusception and accounts for only 1%-5% of intestinal obstructions in adults ( 1, 2 ). Although most authors agree that surgical resection is mandatory, the extent of resection and whether the intussusception should be reduced before resection is controversial. Most surgeons believe that laparotomy is necessary for the treatment of adult intussusception because of the high incidence of underlying malignancy colon intussusception, and the inability to differentiate benign or malignant in enteric intussusceptions (6). Pneumatosis coli and colonic intussusception. 1 In the same year, adults 65 years or older accounted for approximately 54% of new colorectal cancer diagnoses and 68% of colorectal cancer-related mortality in the United States. As a library, NLM provides access to scientific literature. Cold Versus Hot Snare Polypectomy for Colorectal Polyps: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials, Risk of Gastrointestinal Infections After Initiating Vedolizumab and Anti-TNF Agents for Ulcerative Colitis, Peroral Endoscopic Myotomy Is Safe and Highly Effective Treatment for Advanced Achalasia With Sigmoid Esophagus. In this case, a biopsy through enteroscopy confirmed that it was moderately differentiated adenocarcinoma. ; Sekihara, Masao M.D. 8). Here, we presented a case of a 64-year-old woman whose intussusception was secondary to ascending colon cancer, which was diagnosed by abdominal computed tomography (CT) scan and colonoscopy. No abdominal pain or bloating developed after food intake. The site is secure. to maintaining your privacy and will not share your personal information without Plain abdominal radiography and abdominal CT upon admission showed intestinal obstruction. The tube could even be withdrawn by a section of length each day until it is completely removed. doi:https://doi.org/10.1016/j.jpedsurg.2020.02.034. Enteroenteric (ileoileal) intussusception. The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author/s. According to the BMJ Best Practice, Intussusception occurs when one part of the intestine slides into the next section.. and transmitted securely. About 70-90% of intussusceptions in adults have a lead point, which is a well-defined pathological abnormality. QH and YS collected the information and images. Clinical Communications: Adults - The Journal of Emergency Medicine 2). The clinical courses after surgery in all seven patients were uneventful. Computed tomographic (CT) scans can reveal unsuspected intussusception. The .gov means its official. The average age of the patients was 65.1 years, with a range of 22 to 92 years. This largely prevents patients from unnecessary suffering. BMC Cancer. Omori H, Asahi H, Inoue Y, Irinoda T, Takahashi M, Saito K. Intussusception in adults: a 21-year experience in the university-affiliated emergency center and indication for nonoperative reduction. 26. It is composed of a central intussusceptum and outer intussuscipiens, separated by mesenteric fat, which appears as a low-attenuation layer. Early diagnosis of intussusception in adults is difficult, and it might be misdiagnosed in an emergency easily. Gas-fluid levels in the dilated proximal loops are signs of small bowel obstruction. Patients with intussusceptions caused by intestinal intubations, agonal intussusceptions, rectal or stomal prolapses, and jejunogastric intussusceptions after gastroenterostomies were excluded from this study. This is a rare entity and it is more prevalent in children and less common in adults. Successful treatment of adult cecorectal intussusception caused by The patient passed flatus and had bowel movements later. Br J Radiol 1990; 63:25762. Some error has occurred while processing your request. Am J Roentgenol 2001; 176:116771. She was followed up for 1 year, and there was no recurrence. Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. Idiopathic intussusception occurs less often than those of the small bowel, accounting for approximately 10% of intussusceptions [5]. Actually, intussusception often appears as a complex soft-tissue mass on MDCT images. Ultrasound scan (a) shows a heterogeneous target-like mass located in right flank.
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