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Question

Consider the following radiological signs :
1. Claw sign in barium enema
2. Apple core sign in barium enema
3. Multiple fluid levels with absent caecal gas in plain skiagram of abdomen
4. Single large fluid and air level in plain skiagram of abdomen

Which of the above signs is/are suggestive of ileocolic intussusception?

The correct answer is
1 and 3 only

Identifying Radiological Signs of Ileocolic Intussusception

The question asks to identify the radiological signs suggestive of ileocolic intussusception from the given options.

Key Radiological Findings

Let's analyze each sign:

  • 1. Claw sign in barium enema: This sign is characteristic of intussusception. During a barium enema, the barium column may show a smooth, curved filling defect, resembling a claw, as it surrounds the intussuscepted bowel (the intussusceptum). This is a key indicator.
  • 3. Multiple fluid levels with absent caecal gas in plain skiagram of abdomen: This finding on a plain abdominal X-ray (skiagram) suggests small bowel obstruction. In ileocolic intussusception, the intussusception acts as an obstruction. If the obstruction is significant and ileocecal junction is involved, characteristic signs like multiple air-fluid levels in the small bowel proximal to the obstruction and potentially absent gas in the cecum can be observed.

Signs Not Typically Suggestive of Intussusception

  • 2. Apple core sign in barium enema: This sign is typically associated with annular carcinoma (cancer) of the colon, specifically seen as a circumferential narrowing with mucosal irregularity. It is not a sign of intussusception.
  • 4. Single large fluid and air level in plain skiagram of abdomen: While a single large fluid and air level can indicate bowel obstruction, it is less specific and often seen in conditions like ileus or other types of bowel obstruction rather than being specifically suggestive of intussusception compared to sign 3.

Conclusion

Based on the analysis, the 'Claw sign' on barium enema (1) and the signs of obstruction like multiple fluid levels with absent caecal gas on plain skiagram (3) are suggestive of ileocolic intussusception.

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Important Questions from Intestines

  1. An eight month old male child is brought to the emergency with recurrent episodes of screaming and drawing up of legs. The child appears to be listless in between the attacks. Local examination of abdomen reveals feeling of emptiness in the right iliac fossa and blood stained mucus is found on the finger on per rectal examination. The most probable clinical diagnosis in this child is
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    3. Caecal perforation is a well recog- nized complication of this condi- tion 

    4. Intravenous Neostigmine is used for the treatment of this condition 

    Select the correct answer using the code given below :

  3. In familial adenomatous polyposis, which of the following all are true ? 

    1. Presence of $>100$ colorectal polyps 

    2. Positive family history 

    3. Autosomal Recessive inheritance 

    4. Genetic mutation on Chromo- some 5 

    Select the correct answer using the code given below :

  4. Among the extra intestinal manifesta- tions of Crohn's disease which one of the following is related to the disease activity?
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    3. Typhoid ulcers are placed trans- versely to the long axis of the gut 

    4. Terminal ileum is the most common site for enteric perfora- tion 

    Select the correct answer using the code given below :

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