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Int J Emerg Med. 2010 September; 3(3): 203.
Published online 2010 May 14. doi:  10.1007/s12245-010-0178-8
PMCID: PMC2926877

Meckel’s diverticulum-induced ileocolonic intussusception

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. Obturator, 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 and2).2). Exploratory laparotomy was performed, the intussusception was located and reduced, and a 1.5 × 1.5 × 1.5-cm Meckel’s diverticulum was identified as the lead point and excised.

Fig. 1
Target sign of intussusception on longitudinal CT
Fig. 2
Target sign of intussusception on CT cross section

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 [24].

References

1. Cox TD, Winters WD, Weinberger E. CT of intussusception in the pediatric patient: diagnosis and pitfalls. Pediatr Radiol. 1996;26:26–32. doi: 10.1007/BF01403699. [PubMed] [Cross Ref]
2. Barron BJ, Robins DB, Lamki LM, Daniels W, Chopra L, Black CT. Intussusception secondary to Meckel’s diverticulum detection with Tc-99m monoclonal antibodies to granulocytes (Leukoscan) Clin Nucl Med. 1996;21(11):834–837. doi: 10.1097/00003072-199611000-00002. [PubMed] [Cross Ref]
3. Steinwald PM, Trachiotis GD, Tannebaum IR. Intussusception in an adult secondary to an inverted Meckel’s diverticulum. Am Surg. 1996;62(11):889–894. [PubMed]
4. Hurley LJ, Whalen TV, Glen L. Intussusception secondary to Meckel's diverticulum: A challenging diagnosis in adolescence. Moore Journal of Adolescent Health Care. 1989;10(1):51–53. doi: 10.1016/0197-0070(89)90048-X. [PubMed] [Cross Ref]

Articles from International Journal of Emergency Medicine are provided here courtesy of Springer-Verlag