Radiological Case of the Month

A 3-MONTH-OLD boy with an unremarkable medical history was seen with an 18-hour history of nonbilious, nonbloody emesis of all feedings. The parents denied that the infant had any fever, diarrhea, or contacts with ill persons. Physical examination revealed that he was alert, afebrile, unusually fussy and agitated, and poorly consolable. His cry was high pitched. He seemed to have waves of sudden onset of severe pain that would rapidly resolve within minutes. His abdominal examination revealed diffusely diminished bowel sounds, mild firm distention and guarding, and mild diffuse tenderness to palpation. The testes were bilaterally descended and normal; no hernias or masses were appreciated on examination. An abdominal radiograph (Figure 1) was obtained to rule out bowel obstruction. He continued to have intermittent bouts of vomiting and severe pain. An upper gastrointestinal tract radiographic series with small-bowel follow-through was requested to investigate the possibility of midgut malrotation. Intussusception was