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Abdominal pain in a female infant: suspected intussusception.

This 6-month old female with a past medical history of colic/ formula intolerance presented to the emergency department with a 2-day history of nausea, vomiting, decreased oral intake, irritability, and lethargy. The mother also related that the infant would intermittently cry and flex her legs and hips. After a few seconds, she would relax, then begin crying and posturing again. These episodes had been increasing in frequency over the past 24 hours. The remainder of the history was unremarkable. On presentation to our emergency department, the patient was alert but fussy and on abdominal examination was tender to palpation, greater on the right. There was voluntary guarding but there were no palpable masses, and there was no rebound tenderness. The remainder of the physical examination was within normal limits except for mild dehydration. The patient was suspected of having intussusception and because of this an ultrasound study was performed. No intussusception was identified but rather, an oval, solid mass, measuring 4 cm 2 cm with discrete round cystic areas was discovered in the pelvis (Fig. 1). What do you make of this? FIGURE 1. Ultrasound study of the abdomen/pelvis. Radiology in the ED