Paediatric Radiology


Case  16 :  
Pediatric Radiology
A 7-year-old boy presents with a right iliac fossa lump. X-ray abdomen (erect) showed acute small bowel obstruction. What is the diagnosis?
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Diagnosis

Ileo-colic intussusception

Discussion

Intussusception is an invagination of a segment of intestine into adjacent bowel. Intussusception may be ileocecal (most common), ileoileocolic, ileoileal or colocolic. Pathological lead points that may cause intussusception include Meckel's diverticulum, inflamed appendix and polyps. Clinical symptoms are characterized by colicky abdominal pain and the child's drawing the legs into the abdomen.

The initial management of intussusception has changed and new methods are being continuously investigated to avoid radiation exposure and barium peritonitis. Kim et al first described hydrostatic reduction under US guidance in 1982.

The absolute contraindications to hydrostatic reduction are: severe dehydration marked abdominal distension, and clinical features of peritonitis or demonstration of free intraperitoneal air on a plain abdominal radiograph. Relative contraindications are: History longer than 48 hours, extremes of age - patient less than three months of age or more than two years, dehydration more than five percent, small bowel obstruction on plain radiographs, US demonstration of a thick irregular rim of the target measuring more than 10 mm, absent Doppler signal on a color Doppler signifying non-viable bowel.

Dr. Sanjeev Mani, Mumbai