Brian T. Kloss

Kloss, Brian T.

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CLINICAL IMAGES
Meckel’s diverticulum-induced ileocolonic intussusception
Brian T. Kloss
Received: 27 December 2009 /Accepted: 21 March 2010 /Published online: 14 May 2010
# Springer-Verlag London Ltd 2010
A previously healthy 8-year-old male complained of severe,
intermittent and stabbing abdominal pain that had waxed
and waned over the past 3 days. At the time of presentation,
the pain was right-sided, peri-umbilical and non-radiating.
He denied nausea, vomiting, hematochezia, melena or
urinary tract symptoms; he had however experienced
several recent episodes of brown diarrhea.
On physical exam, the child was afebrile with stable vital
signs and was in mild distress secondary to pain. The
abdomen was soft with hyperactive bowel sounds and non-
specific right lower abdominal quadrant tenderness. Obtu-
rator, psoas, Murphy’s and Rovsing’s signs were all
negative. On digital rectal exam, the rectal vault was empty
and stool tested guaiac negative. A CT of the abdomen and
pelvis was obtained and demonstrated the classic target sign
of intussusception in both the longitudinal and transverse
planes (Figs. 1 and 2). Exploratory laparotomy was
performed, the intussusception was located and reduced,
and a 1.5×1.5×1.5-cm Meckel’s diverticulum was identi-
fied as the lead point and excised.
The target sign is classic for intussusception on both
CT and ultrasound. Its appearance is attributed to the
different densities of tissue layers that are apposed to each
other by the telescoping bowel, and when the luminal
diameter is increased, intussusception must be considered
in the differential diagnosis [1]. Although most cases of
intussusception are idiopathic, there have been several
case reports of Meckel’s diverticulum serving as a lead
point [2–4].
References
1. Cox TD,WintersWD,Weinberger E (1996) CTof Intussusception in
the pediatric patient: diagnosis and pitfalls. Pediatr Radiol 26:26–32
2. Barron BJ, Robins DB, Lamki LM, Daniels W, Chopra L, Black
CT (1996) Intussusception secondary to Meckel’s diverticulum
detection with Tc-99m monoclonal antibodies to granulocytes
(Leukoscan). Clin Nucl Med 21(11):834–837
3. Steinwald PM, Trachiotis GD, Tannebaum IR (1996) Intussuscep-
tion in an adult secondary to an inverted Meckel’s diverticulum.
Am Surg 62(11):889–894, Review
4. Hurley LJ, Whalen TV, Glen L (1989) Intussusception secondary to
Meckel's diverticulum: A challenging diagnosis in adolescence.
Journal of Adolescent Health Care 10(1):51–53
Fig. 2 Target sign of intussusception on CT cross section
Fig. 1 Target sign of intussus-
ception on longitudinal CT
B. T. Kloss (*)
Department of Emergency Medicine, SUNY Upstate Medical
University, 550 East Genesee Street, Syracuse, NY 13202, USA
e-mail: klossb@upstate.edu
Int J Emerg Med (2010) 3:203
DOI 10.1007/s12245-010-0178-8


Meckel’s diverticulum-induced ileocolonic intussusception

Springer

CoxTD,WintersWD,WeinbergerE(1996)CTofIntussusceptionin the pediatric patient: diagnosis and pitfalls.

Intussusception in an adult secondary to an inverted Meckel’s diverticulum. Am Surg 62(11):889–894,

Intussusception secondary to Meckel's diverticulum: A challenging diagnosis in adolescence.

Intussusception secondary to Meckel’s diverticulum detection with Tc-99m monoclonal antibodies to granulocytes (Leukoscan).

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2926877

Meckel’s diverticulum-induced ileocolonic intussusception

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