1. 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.

2. Radiographic Images

3. Radiographic Images

4. 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.

5. 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

6. 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

7. References
Gore RM, Levine MS. Textbook of gastrointestinal radiology second edition. W.B. Saunders 2000, pp
Donnelly LF, Kraus SJ, et al. Diagnostic imaging pediatrics. Amirsys pp to 4-77.
Randal Aschenbeck