Toddler with abdominal pain

US of transient small bowel intussusception
Transverse greyscale US (upper left) of the left lower quadrant of the abdomen shows a soft tissue mass demonstrating a target sign measuring less than 2 cm in diameter which on transverse color doppler US (upper right) shows normal vascularity. Sagittal greyscale US of the area shows a pseudokidney sign (below). A repeat US 15 minutes later showed the mass was gone.

The diagnosis was transient small bowel-small bowel intussusception.

School ager with abdominal pain

CT of Meckel's diverticulum causing small bowel obstructin
Axial (above), coronal (lower left) and sagittal (lower right) CT with contrast of the abdomen shows multiple dilated loops of small bowel and a soft tissue mass in the right upper quadrant just beneath the gall bladder that shows the target sign on the sagittal image and the pseudokidney sign on the transverse and coronal images. The soft tissue mass was still present on an US performed 1 hour later.

The diagnosis was small bowel obstruction due to an ileal-ileal intussusception caused by Burkitt lymphoma.

Toddler with colicky abdominal pain

US of intussusception
XR supine (upper left) shows a non-obstructive bowel gas pattern but suggests a soft tissue mass in the right lower quadrant. Transverse US of the right lower quadrant (upper middle) shows a soft tissue mass with a target sign measuring 3 cm in diameter while the longitudinal US (upper right) shows a pseudokidney sign. AP spot image from an air enema (bottom) shows a soft tissue mass being encountered in the cecum.

The diagnosis was ileocolic intussusception which was successfully reduced.

School ager with nausea and vomiting

CT of small bowel obstruction due to Meckel's diverticulum
AXR supine (upper left) and coronal CT with contrast of the abdomen (lower left) show multiple dilated loops of small bowel with thin walls throughout the abdomen. The lower axial CT (upper right) shows a small cystic structure in the midline with a thicker wall than the surrounding dilated bowel which is also seen on the midline sagittal CT (lower right) just beneath the umbilicus.

The diagnosis was distal small bowel obstruction due to Meckel’s diverticulum.

Infant with abdominal pain and currant jelly stools and peritonitis

AXR of small bowel obstruction due to intussusception
AXR supine (left) shows decompressed loops of bowel (presumed jejunum) in the left upper quadrant and multiple dilated loops of bowel (presumed ileum) in the right lower quadrant. AXR upright (right) shows multiple air-fluid levels.

The diagnosis was distal small bowel obstruction with the patient going directly to the operating room due to the peritonitis where an ileocolic intussusception was encountered and reduced.

Infant who had congenital diaphragmatic hernia repair months ago, now with vomiting

SBFT of small bowel obstruction due to abdominal adhesions
AXR supine (left) shows several dilated loops of bowel in the left upper quadrant. Upper GI and small bowel follow through delayed image (right) shows contrast filling several dilated loops of jejunum with no contrast passing distally into the colon.

The diagnosis was proximal small bowel obstruction. In the operating room, the obstruction was found to be due to abdominal adhesions in the proximal jejunum.

Toddler with long-standing vomiting after eating

Upper GI of aspiration due to gastroesophageal reflux
Upper GI exam shows a markedly distended stomach with marked gastroesophageal reflux rising to the level of the oropharynx and entering into the trachea clearly outlining the trachea to the right of the esophagus on the AP image (left) and anterior to the esophagus on the lateral image (right).

The diagnosis was aspiration secondary to gastroesophageal reflux due to gastric outlet obstruction.

School ager with protein calorie malnutrition who has just rapidly eaten the equivalent of 3 large meals

AXR of gastric distension
AXR AP taken immediately after ingesting 3 large meals shows an extremely distended stomach along with a moderate amount of stool throughout the colon. An AXR obtained the next day showed the stomach to be completely empty, thus ruling out gastric motility problems.

The diagnosis was acute gastric distension from overeating, mimicing a bezoar or gastroparesis.