Tetra-layered sign of adult intussusception (new ultrasound approach)

Two-dimensional ultrasound is the principle method for the detection of intussusception. The aim of this study was to establish a pathognominic ultrasound criterion for diagnosing intestinal intussusception to facilitate a proper clinical decision. We have developed a new approach to diagnosing colonic intussuception based on the hypothesis that ultrasound image of the invaginated segment should reveal four border layers. We called this sign tetra-layered sign (TLS). In a prospective manner, all adult patients diagnosed with intussusception using the TLS approach in the period from July 1990 and July 2005 were included in this study. All patients underwent explorative laparotomy, and our preoperative diagnoses were compared with the surgical outcome. Thirty patients were diagnosed with intestinal intussusception using the TLS ultrasound sign. Surgery confirmed the preoperative diagnosis in all cases. Conventional ultrasound is very reliable in diagnosing intestinal intussusception in adult patients when utilizing the simple ultrasound applicable TLS. This facilitates the decision-making, improves the clinical outcome and reduces the associated costs.