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2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February...
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Transcript of 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February...
2-year-old with Abdominal Pain Case MRN 6628633
Sarah Kurian, MS4Diagnostic RadiologyFebruary 2014
History 2 year old female with no significant past medical history who
presents with abdominal pain and non-bloody, non-bilious vomiting x 3 days.
Afebrile, normal WBC count Decreased urine output, last BM 4 days ago Admitted from ED for management of dehydration
KUB
History, continued Abdominal US to assess appendix – normal Surgery consulted - concern for malrotation vs. obstruction Surgery recommended further imaging Upper GI series with small bowel follow-through
KUB
Ultrasound
Target or donut — on transverse view
Lower GI with Fluoroscopy
Intussusception Ileocolic (90%) Mostly idiopathic
Thought to be 2/2 hypertrophied lymphoid tissue in the terminal ileum, induced by a preceding viral illness
Only 2–12% caused by an identifiable lead point Common lead points are Meckel's diverticulum, polyp, or
lymphoma ages 6 months to 2 years
Intussusception Classic triad of symptoms
Pain, vomiting, palpable abdominal mass Plain radiographs are diagnostic in 29–50% of cases Get at least 2 views including supine and prone or left
lateral decubitus views Force air into the cecum
Radiographic findings lack of air-filling of the
cecum on the supine film
Other findings:
Air crescent sign—gas around part of the intussusceptum (although rare, this is highly specific for the diagnosis)
Rim or Target sign—soft-tissue mass containing a faintly visible circle of fat density (the mesenteric fat)
Target or Rim Sign
Ultrasound 98.5–100% sensitive
and 88–100% specific
Able to identify anatomic lead points
Target or donut Crescent or donut—
the entrapped mesentery (often containing nodes) within the intussusception
Treatment Air or barium enema reduction under continuous
observation with fluoroscopy Contraindications = peritonitis, perforation Complication = bowel perforation
Surgery (if enema fails)
Recurrence – in 10% and is highest within the first 2 days following reduction
Back to our patient Returned with fevers 4 days after discharge Admitted + for Rhino-/Entero- virus Likely caused the intussusception in the first place!