Virtual Pediatric Hospital(tm) : A digital library of pediatric information

Home | About | FAQ | Reviews | Search

Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 24

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

Case 24

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

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Eleven year old female who had an appendectomy 3 months ago and now has abdominal pain and vomiting.

Clinical History:
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.

Clinical Labs:
The white count was 10.2, with 56% polys and 35% lymphs.

Clinical Differential Diagnosis:
Gastroenteritis, small bowel obstruction due to adhesions

Imaging Findings:
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.

icon gifImage 1

icon gifImage 2

icon gifImages 3 and 4

Imaging Differential Diagnosis:
Partial distal small bowel obstruction.

Operative Findings:
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.

icon gifImage 5

Pathological Findings:

Final Diagnosis:
Small Bowel Obstruction

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

Similar Cases:
Case 9, Case 55


Title Page

Additional pediatric resources: | Facebook iconTwitter iconRSS icon |

Follow us on Twitter @pedseducationTwitter icon and @pedsimagingTwitter icon and Facebook @pedsimagingFacebook icon and Instagram @pedsimagingInstagram icon

About Us | FAQ | Reviews | Contact Us | Search

Virtual Pediatric Hospital is curated by Donna M. D'Alessandro, M.D. and by Michael P. D'Alessandro, M.D.

Please send us comments by filling out our Comment Form.

All contents copyright © 1992-2016 Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D. and the authors. All rights reserved.

"Virtual Pediatric Hospital", the Virtual Pediatric Hospital logo, and "A digital library of pediatric information" are all Trademarks of Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D.

Virtual Pediatric Hospital is funded in whole by Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D. Advertising is not accepted.

Your personal information remains confidential and is not sold, leased, or given to any third party be they reliable or not.

The information contained in Virtual Pediatric Hospital is not a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.