Clinical Presentation

A 60-year-old man presents to the emergency department with the recent onset of progressive, severe abdominal pain.

(A) Barium enema shows abrupt obstruction of the barium column (arrows). A long filling defect (arrowheads) invaginates into the lumen. (B) Continued filling pushes the barium column to the level of the cecum (arrows). The long filling defect (arrowheads) appears to originate from the ileocecal level. (C) Postevacuation image shows contrast throughout the colon and entering the distal small bowel.

Differential Diagnosis

• Intussusception with a lead point: This is the most likely diagnosis, given the verification of intussusception by successful reduction barium enema and considering the age of the patient. This patient should undergo colonoscopy to determine the type of lead point.

• Intussusception without a lead point: Intussusception sans a lead point is much less common in adult patients.