Question

A baby presented with abdominal pain. On examination, a mass is palpated in the right lumbar region. A barium enema is done, and the image is given below. What is the likely diagnosis?

• A. Intussusception
• B. Volvulus
• C. Duodenal atresia
• D. Intestinal obstruction

Answer 1

The Correct Option is A

The clinical presentation is crucial in arriving at the diagnosis. A baby presenting with abdominal pain and a palpable mass in the right lumbar region suggests an intestinal issue. The use of a barium enema helps visualize intestinal anomalies.

Let's evaluate the options:

• Intussusception: This condition usually occurs in infants and presents with abdominal pain, a palpable abdominal mass (often described as "sausage-shaped"), and sometimes bloody stools known as "currant jelly." A barium enema is not only diagnostic but can also be therapeutic for intussusception. The classic "coiled spring" or "target" sign seen in imaging like a barium enema supports this diagnosis.
• Volvulus: This involves twisting of the intestine that can cause obstruction and ischemia. While volvulus can present with a palpable mass, the imaging signs differ, typically showing a "bird beak" appearance rather than target signs.
• Duodenal atresia: This is a congenital obstruction of the duodenum. It presents early in life with bilious vomiting and a classic "double bubble" sign on imaging, not with a palpable abdominal mass.
• Intestinal obstruction: This is a broad term that can encompass various specific diagnoses, including intussusception. However, the lack of more specific signs in the vignette reduces its likelihood compared to other specific conditions.

Based on the clinical presentation and imaging findings typically diagnostic with a barium enema, the most likely diagnosis is Intussusception.