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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 9

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

Case 9

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

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Seven month old female with non bilious and bilious vomiting.

Clinical History:
The patient was a 7 month old female with a 4 day history of non bilious and bilious vomiting.

Clinical Physical Exam:
The abdomen was soft but markedly distended and there was evidence of tenderness throughout.

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Small bowel obstruction due to intussusception or Meckel diverticulum

Imaging Findings:
Abdominal films obtained on the day of admission showed a small bowel obstruction. An ultrasound exam performed on the day of admission showed the small bowel obstruction and a small amount of free fluid. A water soluble enema performed on the day of admission did not demonstrate an intussusception. An upper GI from the day of admission showed the duodenal jejunal junction to be malpositioned to the right of the spine.

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Imaging Differential Diagnosis:
Misplacement of the duodenal jejunal junction could be due to displacement from the multiple dilated small bowel loops or a malrotation.

Operative Findings:
On the second hospital day the abdomen was explored via a supraumbilical transverse incision in order to investigate the cause of the small bowel obstruction. A small amount of straw colored peritoneal fluid was encountered. Multiple dilated loops of small bowel were seen and there was a sharp transition point where a Meckel diverticulum was seen with an omphalomesenteric duct remnant coming off it extending up to the umbilicus. There had been volvulus of the small bowel around the omphalomesenteric duct remnant. This band and the Meckel diverticulum was resected. The ligament of Treitz was in the normal position.

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Pathological Findings:
None

Final Diagnosis:
Meckel Diverticulum causing Small Bowel Obstruction

Follow-up and Prognosis:
The patient's post operative course was complicated 3 months later by a bout of small bowel obstruction which required an exploratory laparotomy and a lysis of adhesions.

Similar Cases:
Case 5, Case 10

References:

Title Page


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