Answer for BIR CoW 01 Jun 2025
Gastroduodenal intussusception
Findings
CECT abdomen reveals a target-like soft tissue mass in the region of the pyloroduodenal junction, pyloric region of the stomach is seen telescoping into the proximal duodenum. A well-defined intraluminal soft tissue lesion is seen within the intussuscepted segment, serving as a lead point. The lesion shows moderate homogeneous enhancement. No evidence of bowel obstruction, ischemia, or perforation is seen.
IMPRESSION - gastroduodenal intussusception
FOLLOW UP Oesophagogastroduodenoscopy - Sessile polyp with in the background of gastritis Features consistent with hyper plastic polyp
Discussion
Presentations of gastroduodenal intussusception vary based on the degree of obstruction. Commonly reported symptoms include epigastric pain, vomiting, anemia, gastrointestinal bleeding, and abdominal distention patients can present with periodic and intermittent symptoms caused by intermittent prolapse of gastric lesion through the pylorus Preoperative diagnosis of gastroduodenal intussusception typically involves cross-sectional imaging and endoscopy Treatment of gastroduodenal intussusception is primarily surgical. IMAGING FINDINGS ABDOMINAL RADIOGRAPH ✓ Soft tissue mass ✓ Crescent sign/Meniscus sign: crescent of intraluminal colonic gas outlining the apex of the intussusceptum ✓ Target sign :concentric lucent rim surrounding a soft tissue mass - created by mesenteric fat ✓ Dilated gas filled bowel loops proximal to intussusception ABDOMINAL ULTRASOUND ❖The intussusceptum is usually found just deep to the anterior abdominal wall , most often on right side of the midline ❖ crescent-in-doughnut / target / bull’s eye” sign (on TRANSVERSE scan) concentric rings of alternating hypoechoic + hyperechoic layers with central hyperechoic portion (mesentery of intussusceptum) ❖ pseudokidney / sandwich / hay fork” sign (on LONGITUDINAL scan) = hypoechoic layers on each side of echogenic center of mesenteric fat CT • It appears as a complex soft tissue mass (sausage or target like appearance), consisting of the outer intussuscipiens and the central intussusceptum giving bowel with in bowel appearance • There is an eccentric area of fat density within the mass representing the intussuscepted mesenteric fat and the mesenteric vessels are often visible
REFERENCES
Behrooz, A., & Cleasby, M. Gastrogastric intussusception in adults:a case report with review of the literature. BJR|case reports, 0(0),20180006. https://doi.org/10.1259/bjrcr.20180006 Varghese S, Le V, Ali T. Large Fundic Gland Polyps in the Stomach.Gastroenterology & Hepatology. 2016;12(3):153–154.
Findings
CECT abdomen reveals a target-like soft tissue mass in the region of the pyloroduodenal junction, pyloric region of the stomach is seen telescoping into the proximal duodenum. A well-defined intraluminal soft tissue lesion is seen within the intussuscepted segment, serving as a lead point. The lesion shows moderate homogeneous enhancement. No evidence of bowel obstruction, ischemia, or perforation is seen.
IMPRESSION - gastroduodenal intussusception
FOLLOW UP Oesophagogastroduodenoscopy - Sessile polyp with in the background of gastritis Features consistent with hyper plastic polyp
Discussion
Presentations of gastroduodenal intussusception vary based on the degree of obstruction. Commonly reported symptoms include epigastric pain, vomiting, anemia, gastrointestinal bleeding, and abdominal distention patients can present with periodic and intermittent symptoms caused by intermittent prolapse of gastric lesion through the pylorus Preoperative diagnosis of gastroduodenal intussusception typically involves cross-sectional imaging and endoscopy Treatment of gastroduodenal intussusception is primarily surgical. IMAGING FINDINGS ABDOMINAL RADIOGRAPH ✓ Soft tissue mass ✓ Crescent sign/Meniscus sign: crescent of intraluminal colonic gas outlining the apex of the intussusceptum ✓ Target sign :concentric lucent rim surrounding a soft tissue mass - created by mesenteric fat ✓ Dilated gas filled bowel loops proximal to intussusception ABDOMINAL ULTRASOUND ❖The intussusceptum is usually found just deep to the anterior abdominal wall , most often on right side of the midline ❖ crescent-in-doughnut / target / bull’s eye” sign (on TRANSVERSE scan) concentric rings of alternating hypoechoic + hyperechoic layers with central hyperechoic portion (mesentery of intussusceptum) ❖ pseudokidney / sandwich / hay fork” sign (on LONGITUDINAL scan) = hypoechoic layers on each side of echogenic center of mesenteric fat CT • It appears as a complex soft tissue mass (sausage or target like appearance), consisting of the outer intussuscipiens and the central intussusceptum giving bowel with in bowel appearance • There is an eccentric area of fat density within the mass representing the intussuscepted mesenteric fat and the mesenteric vessels are often visible
REFERENCES
Behrooz, A., & Cleasby, M. Gastrogastric intussusception in adults:a case report with review of the literature. BJR|case reports, 0(0),20180006. https://doi.org/10.1259/bjrcr.20180006 Varghese S, Le V, Ali T. Large Fundic Gland Polyps in the Stomach.Gastroenterology & Hepatology. 2016;12(3):153–154.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!