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Age: 2

Sex: Male

Indication: Abdominal pain, constipation

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Case #3


Findings

  • Focal paucity of bowel gas in the right hemiabdomen along the liver margin
  • Overall nonobstructive bowel gas pattern
  • Small colonic and rectal stool burden
  • No evidence of free intraperitoneal air
  • No acute findings in the chest


Diagnosis

  • Intussusception

Sample Report

Focal paucity of bowel gas in the right hemiabdomen along the liver margin, which is nonspecific. Consider ultrasound for further evaluation if there is clinical concern for intussusception.

Overall nonobstructive bowel gas pattern with a small colonic and rectal stool burden.

No evidence of free intraperitoneal air.

No abnormal intraabdominal mass effect or calcifications.

No acute findings in the chest.


Discussion

  • Radiographs have poor sensitivity for intussusception relative to ultrasound
  • Radiographic signs to look for include:
    • Soft tissue mass in the right hemiabdomen, which can have a targetoid appearance
    • Distal small bowel obstruction
    • Crescent of gas outlining the intussusceptum in the proximal colon
  • Helpful terminology:
    • Intussusceptum: bowel segment that telescopes into another bowel loop (on the inside of the target)
    • Intussuscipiens: bowel segment that receives the intussusceptum (on the outside of the target)
  • First line treatment is air enema


Images

Red arrows: abnormal soft tissue density in the right hemiabdomen along the liver margin. Red arrows: targetoid appearance of intussusception confirmed on subsequent ultrasound.

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