From the Research
The claw sign in intussusception is a highly specific ultrasound finding that represents trapped mesenteric fat and vessels, and its early recognition is crucial for prompt diagnosis and timely intervention to reduce morbidity and mortality. The claw sign appears as curved, echogenic lines extending from the periphery of the intussusceptum toward its center, creating a claw-like or finger-like projection on imaging 1. This sign helps differentiate intussusception from other causes of abdominal pain, particularly in children, where it is most commonly seen. When performing an ultrasound evaluation for suspected intussusception, the radiologist typically looks for the classic "target" or "doughnut" sign in transverse view and the "pseudokidney" sign in longitudinal view, with the claw sign providing additional diagnostic confidence.
Key Points
- The claw sign is highly specific for intussusception and helps differentiate it from other causes of abdominal pain in children.
- Early recognition of the claw sign is important for prompt diagnosis and timely intervention with air or hydrostatic enema reduction, potentially avoiding the need for surgical management and reducing complications such as bowel ischemia, necrosis, or perforation.
- Intussusception most commonly affects children between 3 months and 3 years of age and presents with intermittent abdominal pain, vomiting, and sometimes bloody stools.
- In adults, intussusception is rare and often associated with underlying malignancy, making surgical management the cornerstone of treatment 1.
- Contrast-enhanced computed tomography (CECT) of the abdomen is pivotal for accurately diagnosing intussusceptions and guiding appropriate management strategies.
Management
- Surgical management is the preferred treatment for adult intussusception, particularly in cases involving the colocolic type, where there is a significant risk of underlying malignancy 1.
- Attempts at reduction are generally avoided in adults due to the potential risk of tumor dissemination, which could adversely impact patient outcomes.
- In children, air or hydrostatic enema reduction is often attempted first, with surgical management reserved for cases where reduction is unsuccessful or contraindicated 2.