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Findings: The abdominal plain films demonstrate a paucity of gas predominantly within the left abdomen and a focal dilated loop of bowel is seen in the right lower quadrant. Superior to this dilated bowel, there is a mass which has a target appearance of concentric bowel loops separated by fat of the mesentery.

On the other images, the air enema is demonstrated. The intussusception was first encountered in the transverse colon just proximal to the splenic flexure. After reduction, air is demonstrated within the colon as well as free reflux into the small bowel.

Diagnosis: Intussusception.

Discussion: Intussusception is an important acquired cause of intestinal obstruction in the child. The peak incidence occurs between 5-9 months of age and 90% occur before the second birthday.

With regard to location, approximately 90% of all intussusception are ileocolic, with the remaining 10% being either ileoileal of colocolic. The clinical symptoms include abdominal pain, vomiting, blood per rectum, palpable abdominal mass, fever, and "currant jelly" stools. Differential diagnosis considerations should include viral gastroenteritis, peritonitis caused by ruptured appendix or sepsis.

When intussusception is suspected on an abdominal radiograph, a diagnostic and therapeutic examination such as an air enema may be performed. Air should be instilled into the rectum under fluoroscopy while maintaining a maximum of 110 mm. of mercury. The intussusception is considered reduced after visualizing free reflux of air in the small bowel. A follow-up film should demonstrate air within the colon as well as the small bowel without evidence of free intraperitoneal air.

References:
Blickman JG. Pediatric radiology: the requisites. 1994. Mosby.

Brandt WE, Helms CA. Fundamentals of diagnostic radiology. 1994. Williams & Wilkins.

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