A 13-YEAR-OLD girl entered the pediatric emergency department complaining of increasing abdominal pain. Her illness started 4 days earlier with cramping in the left iliac fossa. The cramps increased in duration and frequency. She had had no bowel movements in the last 8 days and no results from enemas.
On clinical examination, the girl was in no acute distress but was markedly overweight: 83.5 kg with a height of 155 cm. Her obesity made the clinical examination of the abdomen difficult. Palpation of the left lower quadrant was not painful but a mass could be felt. Peristaltic activity was normal. Results of rectal examination were normal and results of a radiograph of the abdomen were normal. In an attempt to visualize the colon and loosen impacted stool, a water-soluble contrast enema was performed using diatrizoate meglumine (Figure 1). Later sigmoidoscopy results were judged to be normal and showed neither obstruction
Robberecht E, Smets A, Van Winckel M, Delens F. Radiological Case of the Month. Arch Pediatr Adolesc Med. 1996;150(9):993–994. doi:10.1001/archpedi.1996.02170340107020