Presentation
Abdominal pain.
Patient Data
Intussusception in right lower abdomen containing mesenteric fat in the intussusceptum. The intussusception is ileolieal - the cecum is demonstrated lateral
Dilated loops of distal jejunum and ileum with air-fluid levels and gradual dilution of intraluminal contrast material. Transition point at pelvic distal ileum due to intussusception. Small amount of free pelvic intraperitoneal fluid.
Horseshoe kidney with parenchymal isthmus, without any calculi or dilation of the collecting systems.
Case Discussion
15 year-old boy complaining of worsening abdominal pain and no bowel movement for the past 3 days, vomits when he tries to eat.
Physical examination: Normal vital signs. Substantial periumbilical tenderness, right lower abdominal tenderness, ?rebound. Complete blood count: leukocytosis with neutrophilia, C-reactive protein not elevated.
Abdominal ultrasound demonstrated ileoileal intussusception in the right lower quadrant which was too prominent and contained too much mesentery to be dismissed as transient ileoileal intussusception. Moreover, pressure with the transducer over the intussusception elicited tenderness. The location was suggestive for a Meckel diverticulum as the lead point. A postcontrast CT study showed that the ileoileal intussusception was causing small bowel obstruction and confirmed the presence of a horseshoe kidney.
The boy underwent surgical release of the intussusception and excision of the culprit Meckel diverticulum.
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