155,289 Registered Members as of 07/24/2017.
Abdomen » Gastrointestinal
Intussusception due to Inverted Meckel Diverticulum
« Back to Listing
 
Author(s) :
Danilo Sirigu, MD
 
Presentation A 28 year-old woman presented with acute abdominal pain in the umbilical area radiating to the right lower quadrant. She was also experiencing vomiting and constipation. On physical examination there was abdominal tenderness, a palpable mass in the lower abdomen, rebound tenderness and increased bowel sounds.
 
 
 
Caption: Abdominal radiograph AP view
Description: Anteroposterior view abdominal radiograph showing multiple dilated loops of a small bowel with air-fluid levels
 
 
Caption: Right Lower Quadrant with 4 MHz transducer
Description: Transverse and londitudinal transabdominal ultrasound scans of the right lower quadrant with a 4 MHz convex linear probe shows typical multiple concentric rings sign on short axis
 
 
Caption: Right Lower Quadrant with 4 MHz transducer
Description: Additional sagittal scans of the right lower quadrant demonstrates the hyperechoic mass within the intestine
 
 
Caption: Longitudinal scans RLQ with 12 MhZ linear probe
Description: Longitudinal scans with a 12 MHz linear probe shows at the apex of the intussusception a bulbous mass with central hyperechogenicity from a core of mesenteric fat.
 
 
 
Caption: Gross Pathology Specimen
Description: The surgically resected specimen shows the invaginated Meckel diverticulum as a long polypoid projection from the mucosal surface of the bowel.
 
Differential Diagnosis
  • Appendicitis
    Hernias
    Gastroenteritis (primarily pediatrics)
    Any process causing abdominal pain or GI bleeding
 
Final Diagnosis Intuscusseption due to inversion of a Meckel diverticulum
 
Discussion

Meckel’s diverticulum is the most common congenital abnormality of the small intestine.  It is caused by an incomplete obliteration of the vitelline duct . Ectopic tissue, found in approximately 50 percent of cases, consists of gastric tissue in 60 to 85 percent of cases and pancreatic tissue in 5 to 16 percent

Meckel’s diverticulum may be silent or symptomatic when complicated by hemorrage, diverticulitis, umbilical fistulas and intestinal occlusion. Isolated inversion of the Meckel diverticulum with intuscusseption is a rare condition.  In  this case, the sonogram revealed a nonspecific hyperechoic mass at the apex of the intussusceptum.

For more information on intussuseption:

e-medicine
http://emedicine.medscape.com/article/802424-overview

http://emedicine.medscape.com/article/409870-overview

 
Case References
  1. Levy AD, Hobbs CM. From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic correlation. RadioGraphics 2004;24 : 565-587
  2. Daneman A, Myers M, Shuckett B e Coll: Sonographic appearances of inverted Meckel diverticulum with intussusception. Pediatr Radiol 27: 295-297,1997
  3. V.Miele – M.L.De Cicco-C.Andreoli – V.Buffa-L.Adami – V. David :Aspetti ecografici e TC nelle complicanze del diverticolo di Meckel ; La Radiologia Medica - Radiol Med 101: 230-234, 2001

 
Technical Details Case provided courtesy EchoMovies.  To view more video-based ultrasound cases please visit http://www.ecomovies.it/

 
Other contents by this AuthorOther Cases in This Category