Ultrasound Diagnosis of Hemangioma of the Small Bowel as a Cause of Recurrent Intussusception

Background: Intussusception is a common abdominal emergency in infancy and childhood, and the recurrence rate is reported to be up to 20%.The cause of intussusception is usually idiopathic; hemangioma of the small bowel is a rare cause of them.

Objective: We report a 4-month-old male infant with recurrent crying spells and bleeding in the diaper.The suspicion of intussusception was established based on clinical history and age of the child.

Methods: Case report

Results: A 4-month-old infant consulted in emergency service for recurrent crying spells followed by paleness an hypotonia. On physical examination he shows bleeding in the diaper with strands of blood. Personal history and the rest of the examination did not show significant findings and blood tests were normal. Abdominal ultrasounds showed a “donut-like” image compatible with intussusception and a hydrostatic reduction was carried out. The infant presented recurrent episodes in the following hours being reduced the intussusception up to three times. At the last ultrasound exam, a solid lesion in the small bowel was identified. Given these findings, it was decided to perform a laparotomy that showed an intussusception and a mass in the small bowel that was resected and confirmed as an intestinal hemangioma.

Conclusion: Intussusception is the process in which a portion of the intestine telescopes into itself. It is the most common cause of gastrointestinal obstruction in children, occurring most commonly between 3 and 12 months of age. The pathogenesis of intussusception is in approximately 90 % of cases idiopathic. Approximately 5–6 % of intussusceptions in children have pathologic lead points (PLP). The most common focal PLPs are (in decreasing order of incidence) Meckel’s diverticulum, duplication cyst, polyp, and lymphoma. Ultrasonography is essential not only in the diagnosis, but also it adds important elements in the therapeutic choice.