An 8 week old was admitted late at night with inconsolable crying and a couple of episodes of vomiting. Observations were unremarkable and examination did not reveal any obvious abdominal masses.
The paediatric surgical SpR wasn’t convinced this was intussusception. The PEM SpR performed an abdominal POCUS examination showing the following.
Question: What does this show?
This shows the classic ‘target’/’doughnut’ sign of intussusception with oedematous loops of bowel, along with notable free fluid around the inferior pole of the liver. Remember – this is where free fluid is most likely to be seen in most supine patients.
The surgical SpR reviewed this US and agreed this was definitely intussusception and arranged for the patient to be taken to theatre urgently for a gas enema. In this way, POCUS rapidly changed the trajectory of care for this patient and without bedside POCUS, arranging an overnight US would have taken considerably longer.
For a further in depth review of POCUS for Intussusception, visit US of the Week #015 or see the ACEP page at https://www.acep.org/how-we-serve/sections/emergency-ultrasound/news/september-2018/pediatric-emergency-ultrasound-deep-dive-on-pocus-for-intussusception/.
- Hom J, Kaplan C, Fowler S, Messina C, Chandran L, Kunkov S. Evidence-Based Diagnostic Test Accuracy of History, Physical Examination, and Imaging for Intussusception: A Systematic Review and Meta-analysis. Pediatr Emerg Care. 2020 Sep 15. doi: 10.1097/PEC.0000000000002224. Epub ahead of print. PMID: 32941364.
- Bellman, L, Singh M. Pediatric Emergency Ultrasound: Deep Dive on POCUS for Intussusception. ACEP