Pediatr Gastroenterol Hepatol Nutr.  2019 May;22(3):291-297. 10.5223/pghn.2019.22.3.291.

Rapidly Progressive Small Bowel Necrosis in a Previously Healthy Child without Proven Mechanical Obstruction

• Kim HH
• Kang H
• Park CH
• Kwon YJ
• Jung E
• Lim M

• KMID: 2444855
• DOI: http://doi.org/10.5223/pghn.2019.22.3.291

Abstract

Bowel ischemia is a life-threatening surgical emergency. We report a case of rapidly progressive bowel necrosis in a previously healthy child without proven mechanical small bowel obstruction. The definite diagnosis was established at the time of an exploratory operation. Of note, imaging studies and even a laparotomy did not reveal any evidence of acute appendicitis or mechanical obstruction such as intussusception or Meckel's diverticulum. During hospitalization, since we could not rule out surgical abdomen after inconclusive image findings, we closely followed the patient and repeated physical examinations carefully. Eventually surgical exploration was performed based on changes in clinical condition, which proved to be the right decision for the patient. We propose that in children with suspected strangulation of small bowel obstruction, especially when imaging findings do not provide a conclusive diagnosis, the timely exploratory surgical approach ought to be chosen based on carefully observed clinical findings and other evaluations.

Keyword

Small intestine; Mesenteric ischemia; General surgery; Child

MeSH Terms

Abdomen
Appendicitis
Child*
Diagnosis
Emergencies
Hospitalization
Humans
Intestine, Small
Intussusception
Ischemia
Laparotomy
Meckel Diverticulum
Mesenteric Ischemia
Necrosis*
Physical Examination

Figure

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  Fig. 1 Erect abdominal radiography, showing abnormal dilatation of small bowel loops with air-fluid levels suggestive of a possible small bowel obstruction.

• 

  Fig 2 (A) Axial and (B) coronal computed tomography, showing diffuse dilatation of large and small bowel loops (suggestive of paralytic ileus), mesenteric lymphadenitis and scanty ascites.

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  Fig. 3 Intraoperative findings, showing small intestinal necrosis at 30 cm superior from ileocecal valve.

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