Imaging description

Figure 37.1 depicts abdominal radiographs obtained in a 14-week-old boy with vomiting and abdominal pain. Figure 37.2 depicts one image from an ultrasound study, which confirmed the diagnosis of intussusception. The patient proceeded immediately to the fluoroscopically guided pneumatic enema reduction shown in Figure 37.3. During the course of this procedure, the diagnosis was confirmed, but just as it appeared that the intussusception was reduced, a popping noise was audible. Insufflation was stopped and the pressure on the sphygmomanometer released based on the appearance at fluoroscopy (Fig. 37.3). On inspection and palpation, the patient’s abdomen was massively distended and as hard as a board. A hypodermic needle was inserted into the peritoneal cavity percutaneously, and this was exchanged over a guidewire for a 6 French locking pigtail drainage catheter through which the pneumoperitoneum was aspirated (Fig. 37.4). The patient then went to the operating room where the surgeon noted that the intussusception had been reduced. There were several serosal tears in the small bowel and colon, and there was a 1 cm perforation in the sigmoid colon, which otherwise was normal. As no gross contamination of the peritoneal cavity was present and the patient appeared well, the perforation was repaired and the area irrigated. The patient did well postoperatively.