Clinical History: A 2-year-old child presented with intermittent abdominal pain, vomiting, and episodes of crying with drawing up of the legs. Parents reported possible passage of blood-stained stool (currant jelly stool). Ultrasound examination was requested to evaluate for suspected intestinal obstruction or intussusception.
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| Fig-1. Transverse ultrasound image of the abdomen demonstrates the classic "target sign" (also known as the doughnut sign), characterized by multiple concentric echogenic and hypoechoic rings. This appearance represents telescoping of one bowel segment into another, consistent with intestinal intussusception. |
Key diagnostic ultrasound signs:
a- Target sign / doughnut sign in transverse section
b- Pseudokidney sign in longitudinal section
c- Concentric bowel wall layers
d- Mesenteric fat and vessels dragged inside bowel lumen
Why Intussusception?
Target Sign Appearance:
The most characteristic ultrasound feature is the
target or doughnut sign, formed by concentric rings of
invaginated bowel segments.
Telescoping of Bowel:
One segment of intestine (intussusceptum) slides into the adjacent
segment (intussuscipiens), producing layered bowel wall appearance.
Pseudokidney Sign:
On longitudinal imaging, the intussuscepted bowel resembles
a kidney-shaped mass due to bowel wall edema and mesenteric fat.
Mesenteric Fat Within Lesion:
Mesenteric fat and vessels may be seen within the intussusception,
confirming telescoping bowel loops.
Clinical Correlation:
Children often present with intermittent abdominal pain,
vomiting, and occasionally currant jelly stool.
| Condition | Key Ultrasound Features |
|---|---|
| Intussusception |
✔ Target / doughnut sign ✔ Pseudokidney appearance ✔ Concentric bowel layers ✔ Mesenteric fat within lesion |
| Bowel mass |
✖ Solid mass without concentric rings ✖ No telescoping pattern |
| Appendicitis |
✖ Non-compressible tubular structure ✖ Blind ending bowel loop |
| Enteritis |
✖ Diffuse bowel wall thickening ✖ No concentric telescoping bowel loops |
Possible conditions that may mimic intussusception on imaging include:
• Small bowel mass
• Enlarged lymph nodes
• Bowel wall edema from enteritis
• Meckel's diverticulum acting as lead point
Findings:
A well-defined bowel-within-bowel configuration is visualized in the
right abdomen demonstrating the classic target sign on transverse
scan and pseudokidney sign on longitudinal scan. Mesenteric fat
and vessels are noted within the lesion. These findings are consistent
with intestinal intussusception.
Conclusion:
Ultrasound findings are highly suggestive of
ileocolic intussusception.
Recommendation:
Urgent pediatric surgical consultation is advised.
Air or contrast enema reduction under fluoroscopic guidance
may be considered as the first-line treatment.
End of Case Study
You have reached the end of this Intussusception – Ultrasound Case Study (Target Sign).
Content is intended for educational, training, and clinical reference only.
Declaration:
I, R. K. Mouj, declare that the material presented in this case study titled
“Intussusception – Target Sign on Ultrasound” has been prepared solely
for educational and academic purposes.
The imaging findings, measurements, and interpretations are intended for
learning and demonstration only.
Definitive diagnosis requires clinical correlation, surgical evaluation,
and appropriate specialist consultation.
Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Domain: Diagnostic Sonography & Pediatric Radiology
Platform: SonoAcademy
Supervisor / Guide: Department Radiologist
Department: Radiology
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