Ruptured Appendicitis Within an Intussusception on Point-of-Care Ultrasound

This case describes a 21-month-old girl who was transferred to our pediatric emergency department with daily fevers for 9 days and concern for intussusception on an ultrasound obtained at the outside hospital. Her examination was notable for diffuse tenderness to palpation with no rebound or guarding. Point-of-care-ultrasound (POCUS) revealed a noncompressible, target-shaped structure in the right midabdomen, which appeared to contain a dilated loop of bowel surrounded by a hypoechoic fluid collection. This was confirmed by radiology-performed ultrasound and computed tomography scan, which showed an ileocolic intussusception containing a dilated echogenic loop of bowel consistent with perforated acute appendicitis and associated abscess with surrounding inflammatory changes. To our knowledge, this is the first reported case of perforated appendicitis within an intussusception identified on POCUS in a pediatric patient. This case demonstrates the utility of POCUS in facilitating the recognition of an atypical diagnosis of a perforated appendicitis contained within an intussusception and helping to guide further evaluation and management.