Computed Tomography Target Sign: A Case of Mistaken Intussusception

Abstract

A 57-year-old male presented with a complete small bowel obstruction. Computed tomography confirmed an obvious transition point in the distal ileum, as well as an adjacent small bowel target sign. At exploratory laparotomy, the CT target sign had been caused by an obstructing phytobezoar cast ejected from a Meckel's diverticulum. Keywords Meckel's diverticulum . Target sign A previously healthy 57-year-old male presented with a complete small bowel obstruction. His vomiting was nonbilious in nature. Physical exam revealed significant abdominal tenderness and distention. Computed tomography (CT) confirmed a small bowel obstruction with an obvious transition point in the distal ileum. This finding was also associated with an adjacent small bowel target sign (Fig. 1). At exploratory laparotomy, a large phytobezoar was noted to be obstructing the ileocecal valve. It was consistent in size and shape with the intra-luminal dimensions of the meckel's diverticulum (Fig. 2). In spite of our suspected diagnosis, no intussusception was present. After reducing the phytobezoar back into the diverticulum, a small bowel resection with a functional end to end stapled anastamosis was performed.

Rare Idiopathic Adult Intussusception: A Case Report

“…Some of the vaguer characteristics, such as bowel thickening, air within the bowel, mesenteric fat, and vessels, can be seen in other pathologies, such as intramural hematomas, internal hernias, volvulus, or bowel ischemia [6,12]. There has also been a case reported in which the classic target sign found on CT imaging was thought to be an intussusception, but exploratory laparotomy demonstrated a large phytobezoar that was noted to be obstructing the ileocecal valve instead [13]. CT scans are also limited by less accessibility, static and single-plane exploration, radiation, and oral and IV contrast, which could further delay the study and, thus, the proper diagnosis [6].…”