Unenhanced CT findings of vascular compromise in association with intussusceptions in adults

The purpose of this study was to evaluate unenhanced CT findings for predicting the degree of vascular compromise in intussusception observed at surgery.

The imaging studies, clinical records, and surgical and pathologic findings in 25 patients with intussusception were reviewed retrospectively. We evaluated six CT findings based on the abnormalities of each component of intussusception. Presence or absence of these findings was compared with the degree of vascular compromise as observed on pathologic examination, such as edema, ischemia, or necrosis.

The hypodense layer was observed in 16 of 18 intussusceptions with various degrees of vascular compromise. A fluid collection surrounded by the returning wall, which was revealed to correspond to trapped peritoneal fluid, was observed in eight of nine intussusceptions with ischemia or necrosis. A gas collection surrounded by the returning wall was observed in two of four intussusceptions with necrosis. Free peritoneal fluid coexisted with a fluid collection surrounded by the returning wall in all the intussusceptions except one. Bowel obstruction was observed in six of nine intussusceptions with ischemia or necrosis. The maximum wall thickness was not related to the degree of vascular compromise.

The CT findings of a hypodense layer in the returning wall, fluid collection in the space surrounded by the returning wall, and gas collection in the space surrounded by the returning wall can be useful in predicting the degree of vascular compromise in intussusception.