Presentation on theme: "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."— Presentation transcript:
1HistoryAge: 17 monthsHistory: 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.
4Hospital CourseAir 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.
5Radiographic Features IntussusceptionProximal segment of bowel passes into the lumen of a more distal segment, and propelled distallyProximal intussusceptumDistal intussuscipiensBarium, air, or water-soluble contrast enema is diagnostic and therapeuticPlain FilmsPaucity of RLQ gas “Dance’s sign”Left-side-down decubitus helpful in showing lack of air-filled cecumNo sign of SBODisplacement of bowel loops from the right hypochondriumAppendix if air-filled may be in an abnormal positionNo free peritoneal air (Contraindication for air enema)FluoroscopySee the enema tip in the rectumSee the meniscus of soft tissue mass outlined in air-filled colon near the hepatic flexure = best diagnostic clueSee soft tissue mass moving retrogradeSee resolution of soft tissue mass and reflux of gas into small bowel consistent with reduction
6Differential Diagnosis RLQ sigmoid – misinterpreted as air in cecum and falsely exclude intussusceptionAppendicitis – similar symptoms, but patients are typically olderGastroenteritis – plain film shows multiple air fluid levels within mildly distended bowel loops/ air fluid levels in colon support gastroenteritis and make intussusception unlikelyOvarian pathologyMeckel diverticulum – may serve as a lead point, cause GI bleeding, and/or abdominal pain
7ReferencesGore RM, Levine MS. Textbook of gastrointestinal radiology second edition. W.B. Saunders 2000, ppDonnelly LF, Kraus SJ, et al. Diagnostic imaging pediatrics. Amirsys pp to 4-77.Randal Aschenbeck