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Intersusseption - Coggle Diagram

- - - - Intestinal perforation (free intraperitoneal air)
      - Peritonitis
      - Persistent hypotension
      - Marked abdominal distension.
    - - Saline, pneumatic, or barium enema under fluoroscopy or US guidance.
      - Signs of successful reduction include a sudden flow of saline or air in the ileum with a honeycomb sign and disappearance of the target sign.
  - - - Radiographic reduction is contraindicated or has failed.
      - Peritonitis or pneumoperitoneum is detected.
      - A pathologic lead point is found.
    - - Identification of the sausage-shaped mass.
      - Start squeezing from the apex, avoiding pulling to prevent rupture.
      - Compression with a warm saline pack to reduce edema, aiding in reduction.
      - Bowel resection is required for irreducible and gangrenous intussusception.
      - If a lead point is found (e.g., Meckel's diverticulum or polyp), resection is recommended.
- - - - Meckel's diverticulum
      - Polyp
      - Appendix
      - Henoch-Schönlein purpura
      - Foreign body
      - Duplication of the bowel
      - Cystic fibrosis
      - Tumors (benign or malignant)
- - - - Abdominal X-ray findings include:
        
        Increased bowel gas shadow
        
        Absence of cecal gas
        
        Multiple air-fluid levels
      - A normal gas-filled colon nearly rules out intussusception.
    - - Before ultrasound became widely available, contrast enema was considered the gold standard for diagnosis or exclusion.
      - Characteristics "cobra head" sign on imaging.
    - - The characteristic finding is referred to as a "target" or "doughnut" lesion.
        
        Two rings of low echogenicity with an intervening hyperechoic ring.
      - Additional findings include:
        
        Enlarged mesenteric lymph nodes
        
        Free intraperitoneal fluid
        
        Pathologic lead points
        
        Absence of blood flow in the intussusception.
      - US can guide therapeutic reduction of intussusception.
    - - Not routinely used in evaluation but can confirm diagnosis and identify pathologic causes.
      - CT characteristic finding: target or doughnut sign.
      - MRI can provide similar information.
      - Useful in cases where ultrasound is inconclusive or when evaluating for complications such as malignancy.