Fluoroscopy - Hydrostatic reduction
What are the classic history findings for pediatric intussusception?
Abdominal pain + non-bloody, nonbilious vomiting + currant jelly stool
What is the classic ultrasound appearance of intussusception?
Target shape of bowel-in-bowel appearance on transverse view
What is the Rule of Threes for hydrostatic reduction of intussusception?
3 timed attempts at reduction, each lasting 3 minutes, with the contrast media bag elevated to 3 feet above the table. Additional attempts are at the radiologist's discretion based on risk-benefit analysis.
What is the main risk mitigated by the Rule of Threes intussusception reduction?
Perforation of bowel
What is the most likely bowel location to perforate during the reduction of intussusception?
Rectum
Image one shows the initial flow of contrast media with the contrast bag elevated to 1 foot above the table. Notably, this flow ceases at the colon's splenic flexure, which, taken in the context of the ultrasound findings, is consistent with intussusception. The remaining images demonstrate the sequential hydrostatic reduction of the intussusceptum to, but not through, the ileocaecal valve with the contrast bag elevated to 3 feet above the table. The final image shows the presence of contrast media at the level of the caecum, with the filling of the appendix and an accompanying claw sign.