Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology
The patient was an 11 year old female status post appendectomy 3 months ago. The patient presented with a two day history of crampy abdominal pain and a six hour history of vomiting. The patient denied fever and diarrhea. The patient has a past medical history remarkable for insulin-dependent diabetes mellitus which is poorly controlled and rheumatoid arthritis.
Clinical Physical Exam:
The abdomen was soft without rebound or guarding but with right sided tenderness.
The white count was 10.2, with 56% polys and 35% lymphs.
Clinical Differential Diagnosis:
Gastroenteritis, small bowel obstruction due to adhesions
An abdominal film from the day of admission was unremarkable. A repeat abdominal film from the second hospital day showed interval development of a complete small bowel obstruction, and this was confirmed on an upper GI exam the same day.
Images 3 and 4
Imaging Differential Diagnosis:
Partial distal small bowel obstruction.
In light of the patient's worsening abdominal symptoms and the upper GI findings, the patient was taken to the operating room the next day for an exploratory laparotomy via a small peri-umbilical midline incision. A small amount of serosanguinous fluid was seen in the abdominal cavity. The small bowel was dilated proximally. A volvulus was noted at the level of the terminal ileum, caused by adhesions from the cecum to the small bowel, forming a closed loop obstruction that was causing some bowel wall congestion. The patient underwent lysis of adhesions and had the volvulus corrected.
Small Bowel Obstruction
Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.
Case 9, Case 55
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