Scroll down for radiographs:
Right lateral thorax
Right lateral abdomen
Left lateral abdomen
Ventro dorsal abdomen
The pulmonary parenchyma is unremarkable. The cardiac silhouette and pulmonary vasculature are within normal limits. The trachea and mainstem bronchi are normal. There is no evidence of thoracic lymphadenopathy or pleural effusion. The included skeletal structures are within normal limits.
In the mid right abdomen there is a segment of intestine that appears to be transverse and descending colon which is distended and contains heterogeneous soft tissue which a formed appearance like cloth or foreign material (image below, red arrows). In the ventrodorsal image, this segment of intestine is confluent with the descending colon and there is a smoothly marginated convex intraluminal soft tissue margin contrasted by gas (image below, green arrow). The cecum is not identified. In the cranial abdomen there is a segment of intestine that may represent transverse colon which contains a small (1cmx0.8cm) rectangular mineral foreign body (suspect rock, blue arrow). There is mild to moderate gas distension of the small intestine in the cranial abdomen (green circle). The stomach is moderately fluid distended. The abdominal serosal detail is appropriate for the patients age. The liver, spleen, kidneys, and urinary bladder are unremarkable. Incidentally, the transverse processes of L7 are slightly transitional and appear to extend laterally to articulate with the ilial wings.
Colonic foreign material and possible intussusception. The appearance of the colon is concerning for possible obstruction secondary to foreign material. An ileo caeco-colic intussusception is considered possible.
The radiographic findings likely explain the haematochezia and lethargy. Given the degree of distension and slightly bunched appearance of the foreign material, mechanical ileus is considered likely and surgical explore should be considered. If available, abdominal ultrasound could be performed to further assess the integrity of the intestinal tract and presence of intussusception.
This patient underwent an exporatory laparotomy and an ileo caeco-colic intussusception was found. A resection and anastamosis was performed and the patient recovered well.