Case presentation2008-03-21R1

Case F/14moC/C: bloody diarrhea, irritability, and poor oral intake

IntussusceptionTelescoping of bowel segment

Idiopathic in almost case

M/C location: Ileocolic type

Clinical symptoms: acute abdominal pain currant-jelly stools palpable abdominal mass Only 30%68%

PLAIN RADIOGRAPHY Soft-tissue mass in RUQGasless abdomenTarget sign Meniscus sign

Exclusion sign: Cecum filled with gas or feces in the normal location

Ultra Sonography sensitivity: 98%100% specificity: 88%100% Target sign Crescent-in-doughnut sign Sandwich sign Hayfork sign

CT bowel-within-bowel: pathognomonic

Management algorithm

Air Enema Excellent results Easy, quick, clean Less x-ray exposure

Limiting procedure timeHigher perforation Only intraluminal content visualization Less control of residual ileoileal intu.

Criteria for complete air reductionCopious reflux of air into small bowel Disappearance of soft-tissue massPr. Limit: 120 mmHg Average initial pr. :56.5 mmHgAverage maximum pr. :97.8 mmHg

ReferanceGloria del-Pozo, MD, Jos C. Albillos, MD et al. Intussusception in Children: Current Concepts in Diagnosis and Enema Reduction; Radiographics. 1999;19:299-319 William E. Shiels II, Constans K. Maves et al. Air Enema for Diagnosis and Reduction of Intussusception: Clinical Experience and Pressure Correlates; Radiology 1991; 181:169-172 : ; 2000;43:765-769