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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 5

Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 5

Michael P. D'Alessandro, M.D.,
Steven J. Fishman, M.D.,
Deborah E. Schofield, M.D.

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Five month old male with vomiting and abdominal distension.

Clinical History:
This patient was a 5 month old male with a 5 day history of recurrent vomiting and abdominal distension, who now presents with a 1 day history of bilious emesis and passing currant jelly stools.

Clinical Physical Exam:
The patient was lethargic, with a markedly distended, firm and tender abdomen. Peritoneal signs were present. The patient passed a currant jelly stool during the exam.

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Clinical Labs:

Clinical Differential Diagnosis:
Small bowel obstruction with Meckel diverticulum versus intussusception as the cause.

Imaging Findings:
Abdominal films showed a small bowel obstruction.

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Imaging Differential Diagnosis:
High grade mechanical small bowel obstruction, presumed intussusception.

Operative Findings:
Due to the prolonged nature of the bowel obstruction and the patient's serious condition and clinical peritonitis, an air enema to diagnosis and reduce the presumed intussusception was not attempted. The patient was taken emergently to the operating room. Via a right supraumbilical transverse incision, the abdomen was entered. Clear peritoneal fluid was seen. An ileocolic intussusception was encountered extending into the mid ascending colon. The bowel appeared pink and viable. The intussusception was reduced without great difficulty manually. No lead point was seen. A small Meckel diverticulum with a wide base was seen 1.5 feet from the ileocecal valve. No firm tissue was palpated within it and it was not involved in the intussusception. The diverticulum was not resected due to the patient's tenuous clinical condition and the dilated nature of the bowel loops.

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Pathological Findings:

Final Diagnosis:

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. A Meckel scan performed one week later did not demonstrate ectopic gastric mucosa within the known Meckel diverticulum.

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Similar Cases:
Case 9, Case 10


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