We now proceed to the diagnostics of intussusception.

Intussusception is often suspected based as said earlier on examination, including observation of Dance
sign (Dance sign consists of evaluating right lower quadrant of the abdomen for retraction, which can be
an indication of intussusception).

A digital rectal examination is helpful, as a finger may feel the intussusceptum.

A definite diagnosis requires confirmation by imaging modalities.

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One imaging modality is the plain radiograph

It is not sensitive or specific test. • Normal in early stages 25%. • later can have absence of gas in right
lower quadrant (RLQ) and RUQ, as well as RUQ soft tissue mass; with obstruction, will have air- fluid
levels, paucity of distal gas. Findings could show the following:

 Soft tissue mass surrounded by a crescent of gas

 Evidence of distal small bowel obstruction

 Absence of or decreased gas in the colon

 Pneumoperitoneum

 May be normal 

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Radio graph Image

1. The target sign is a rounded soft tissue mass representing the intussusception, with concentric
lucencies due to the presence of mesenteric fat within the mass

2. The meniscus sign is a crescent of gas within the colonic lumen outlining the apex of the
intussusception 

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Radio graph Image

4. Nonspecific signs of intussusception on AXR that may suggest or support the diagnosis include soft
tissue density and absence of gas in the right lower quadrant 

5. and signs of small bowel obstruction

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Radio graph Image

 An abdominal radiograph demonstrates a soft tissue mass in the  right side of the abdomen 
(black arrows) with several air-containing and minimally dilated loops  of small bowel (white
arrow). In a patient with crampy abdominal pain, this is highly suggestive of  an 
intussusception. 

The mass may be seen on plain abdominal x-ray but is more easily demonstrated on air or contrast
enema.

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When the findings suggests intussusception, ultrasound is typically performed.

 Ultrasound is the test of choice for diagnosis of intussusception. The appearance of target sign
or doughnut sign usually around 3 cm in diameter, confirms the diagnosis.

 The image seen on transverse sonography or computed tomography is a doughnut shape,

created by the hyperechoic central core of bowel and mesentery surrounded by the hypoechoic
outer edematous bowel.

Transverse: target or doughnut sign, with hypoechoic rim (edematous bowel wall) surrounding
hyperechoic central area (intussusceptum and associated mesenteric fat)

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 In longitudinal imaging, intussusception may resemble a sandwich.

This is the sandwich, trident, or hayfork sign, with layering of hypoechoic bowel wall and hyperechoic
mesentery

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• Oblique: pseudokidney sign, with hypoechoic bowel wall mimicking the renal cortex and hyperechoic
mesentery mimicking the renal fat

• Doppler may help determine viability of the tissue

• In adults, may be less useful, as often cannot identify the pathologic lead point and is most useful
when an abdominal mass is palpated

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CT scan is sometimes used to make a diagnosis, especially when the Ultrasound imaging remains
doubtful. However, in young children, obtaining a CT scan often requires the use of anesthesia and there
is also the risk of intravenous contrast and radiation exposure.