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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 15

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

Case 15

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

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Six year old male who fell off his bike.

Clinical History:
The patient was a 6 year old male who was riding his bike and fell off it, hitting his abdomen on the handlebars. He went home, and subsequently developed diffuse lower abdominal pain, had 2 episodes of emesis, and then fell asleep. His parents called the Emergency Medical Service and he was taken to the hospital. The paramedics transporting him found him to be hemodynamically stable.

Clinical Physical Exam:
The abdomen was diffusely tender with guarding but was non distended.

Clinical Labs:
Hematocrit was 35.9.

Clinical Differential Diagnosis:
Solid organ injury after blunt abdominal trauma.

Imaging Findings:
Head CT, chest film, pelvis film and cervical spine exam on the day of admission were unremarkable. An abdominal CT from the day of admission was unremarkable and specifically showed no sign of free fluid in the pelvis. In light of a worsening abdominal exam, the patient had a repeat abdominal CT 24 hours later which showed new free fluid in the pelvis, but no free air or focally thickened bowel loops.

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Imaging Differential Diagnosis:
The development of free fluid in the pelvis 24 hours after the injury strongly suggests the presence of an underlying hollow viscus perforation or mesenteric injury.

Operative Findings:
An exploratory laparotomy was performed immediately after the second CT scan to search for a perforated viscus. An ileal perforation was discovered, and was repaired primarily.

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Pathological Findings:

Final Diagnosis:
Ileal Perforation secondary to handlebar injury

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.

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