Pediatric Colonic Perforation

  • Etiology: Hirschsprung disease is most common cause of colonic perforation in first year of life, intussusception, blunt trauma, colonoscopy
  • Imaging: Pneumoperitoneum
  • DDX:
  • Complications: Perirectal abscess in cases of rectal trauma
  • Treatment:
  • Clinical: Rare in blunt trauma

Radiology Cases of Colonic Perforation

Radiology Cases of Colonic Perforation Due to Trauma

Radiograph of Chance fracture
AP (left) and lateral (right) radiographs of the lumbar spine show a three column fracture of the L3 vertebral body.

Radiology of Cases of Colonic Perforation Due to Intussusception Reduction

AXR of pneumoperitoneum
Supine AXR obtained during an intussusception reduction shows air outlining both the inner and outer walls of the small bowel (Rigler’s sign).
Air enema of intussusception reduction
AXR scout image (above left) shows a non-obstructive bowel gas pattern. AP image from the start of an air enema begun after manual reduction of the mass into the rectum (above right), shows the tip of the rectal catheter in contact with the mass in the rectum. AP image from later in the study (below left) shows the mass now in the transverse colon near the splenic flexure. Despite multiple attempts the intussusception could not be reduced further and the exam was ended when air was seen outlining the liver and both sides of the wall of the small bowel (Rigler’s sign)(below right). In the operating room the intussusception was reduced manually and a site of perforation could not be found.