History

• Age: 17 months

• History: Female infant with recent history of low grade fever. Presented to the ER on August 8th with increasing episodes of intermittent colicky abdominal pain. Not toxic appearing. Evaluated under fluoroscopy with air contrast enema.

Radiographic Images

Radiographic Images

Hospital Course

• Air contrast enema reduced the intussusception. Pt. was able to pass flatus, and quickly advanced to a regular diet.

• Discharged home August 9th without pain medication and instructions to follow up with PCP in 2 weeks.

• Diagnosis: Resolved intussusception following air contrast enema under fluoroscopy.

Radiographic Features• Intussusception

– Proximal segment of bowel passes into the lumen of a more distal segment, and propelled distally

– Proximal intussusceptum– Distal intussuscipiens– Barium, air, or water-soluble contrast enema is diagnostic and therapeutic

• Plain Films– Paucity of RLQ gas “Dance’s sign”– Left-side-down decubitus helpful in showing lack of air-filled cecum– No sign of SBO– Displacement of bowel loops from the right hypochondrium– Appendix if air-filled may be in an abnormal position– No free peritoneal air (Contraindication for air enema)

• Fluoroscopy– See the enema tip in the rectum– See the meniscus of soft tissue mass outlined in air-filled colon near the hepatic flexure =

best diagnostic clue– See soft tissue mass moving retrograde– See resolution of soft tissue mass and reflux of gas into small bowel consistent with

reduction

Differential Diagnosis

• RLQ sigmoid – misinterpreted as air in cecum and falsely exclude intussusception

• Appendicitis – similar symptoms, but patients are typically older

• Gastroenteritis – plain film shows multiple air fluid levels within mildly distended bowel loops/ air fluid levels in colon support gastroenteritis and make intussusception unlikely

• Ovarian pathology• Meckel diverticulum – may serve as a lead point,

cause GI bleeding, and/or abdominal pain

References

• Gore RM, Levine MS. Textbook of gastrointestinal radiology second edition. W.B. Saunders 2000, pp. 2121-2123.

• Donnelly LF, Kraus SJ, et al. Diagnostic imaging pediatrics. Amirsys 2005. pp. 4-74 to 4-77.

Randal Aschenbeck