Question:
An 18-month-old male infant presents with recurrent episodes of colicky abdominal pain and crying, drawing up his legs during the attacks. Between episodes, he appears relatively well. Ultrasound of the abdomen shows a pseudo-kidney sign in the longitudinal axis. What is the most likely diagnosis?
An 18-month-old male infant presents with recurrent episodes of colicky abdominal pain and crying, drawing up his legs during the attacks. Between episodes, he appears relatively well. Ultrasound of the abdomen shows a pseudo-kidney sign in the longitudinal axis. What is the most likely diagnosis?
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Ultrasound signs of Intussusception: "Target sign" (transverse view) and "Pseudo-kidney sign" (longitudinal view).
Clinical triad: Colicky pain, palpable sausage-shaped mass, and red currant jelly stools (a late sign).
Clinical triad: Colicky pain, palpable sausage-shaped mass, and red currant jelly stools (a late sign).
Updated On: Sep 3, 2026
- Pyloric stenosis
- Intussusception
- Meckel’s diverticulum
- Acute appendicitis
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The Correct Option is B
Solution and Explanation
Concept:
The clinical scenario presents the classic symptomatic triad and radiological hallmark of a specific pediatric acute abdomen.
The clinician must correlate the intermittent colicky pain, postural changes (drawing up legs), and the ultrasound "pseudo-kidney sign" to the correct pathology.
Explanation:
• Intussusception occurs when a proximal segment of bowel (the intussusceptum) telescopes into the lumen of the adjacent distal segment (the intussuscipiens), most commonly at the ileocecal junction.
• This telescoping causes intermittent bowel obstruction and venous congestion, producing classic episodes of severe, colicky abdominal pain where the child cries and pulls their knees to their chest.
• A key clinical feature is that between these severe spasms, the infant often appears completely normal and playful.
• Ultrasound is the imaging modality of choice for diagnosis.
• On ultrasound, the telescoped bowel loops create concentric rings in the transverse axis (the "target" or "doughnut" sign) and layered hypoechoic and hyperechoic bands in the longitudinal axis (the "pseudo-kidney" sign).
• Pyloric stenosis presents much earlier (3-6 weeks) with non-bilious projectile vomiting and an "olive" mass, not a pseudo-kidney sign.
• Meckel's diverticulum classically presents with painless lower GI bleeding, while appendicitis typically causes continuous, worsening pain rather than intermittent colicky attacks with normal intervals.
Final Answer:
The combination of intermittent colicky pain, leg drawing, and a pseudo-kidney sign on ultrasound is highly diagnostic of intussusception.
The clinical scenario presents the classic symptomatic triad and radiological hallmark of a specific pediatric acute abdomen.
The clinician must correlate the intermittent colicky pain, postural changes (drawing up legs), and the ultrasound "pseudo-kidney sign" to the correct pathology.
Explanation:
• Intussusception occurs when a proximal segment of bowel (the intussusceptum) telescopes into the lumen of the adjacent distal segment (the intussuscipiens), most commonly at the ileocecal junction.
• This telescoping causes intermittent bowel obstruction and venous congestion, producing classic episodes of severe, colicky abdominal pain where the child cries and pulls their knees to their chest.
• A key clinical feature is that between these severe spasms, the infant often appears completely normal and playful.
• Ultrasound is the imaging modality of choice for diagnosis.
• On ultrasound, the telescoped bowel loops create concentric rings in the transverse axis (the "target" or "doughnut" sign) and layered hypoechoic and hyperechoic bands in the longitudinal axis (the "pseudo-kidney" sign).
• Pyloric stenosis presents much earlier (3-6 weeks) with non-bilious projectile vomiting and an "olive" mass, not a pseudo-kidney sign.
• Meckel's diverticulum classically presents with painless lower GI bleeding, while appendicitis typically causes continuous, worsening pain rather than intermittent colicky attacks with normal intervals.
Final Answer:
The combination of intermittent colicky pain, leg drawing, and a pseudo-kidney sign on ultrasound is highly diagnostic of intussusception.
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