Unique capsule endoscopic appearance of segmental intestinal dilatation in a child (original) (raw)

A child with lower gastrointestinal bleeding – aetiology and diagnostic procedure

Pediatria polska, 2022

Introduction: Lower gastrointestinal bleeding (LGIB) is not a rare clinical problem in children. The aetiology of LGIB varies according to age. Likewise, experiences in different countries reflect the disparities in the frequency of various causes of LGIB in children. Although some cases can be diagnosed clinically, choosing the appropriate diagnostic methods in children is challenging. The aim of the study was to determine the aetiology of LGIB in children and analyse the diagnostic procedures needed to make a diagnosis. Material and methods: The medical records of children with chronic LGIB admitted to the Paediatric Gastroenterology Department were reviewed. The diagnoses and diagnostic procedures were analysed according to age groups (< 5 with subgroups < 2 and 2-5, 5-10, and > 10 years old). Results: 227 patients were enrolled in the study. The most important causes of LGIB among all patients were constipation associated with anal fissures (36.6%) and inflammatory bowel disease (IBD) (33.5%). According to age groups, the main causes of LGIB were: up to 5 years old-constipation (39.62%) and food allergy (28.3%), in the youngest age subgroup up to 2 years old-food allergy (52.38%), between 5 and 10 years old-constipation (44%) and ulcerative colitis (14%), over 10 years old-IBD ulcerative colitis (36.29%), Crohn's disease (13.71%), and constipation (32.26%). Patients with IBD were more likely to have anaemia and weight loss. The level of faecal calprotectin was significantly elevated in children with IBD and colorectal polyps. Conclusions: Constipation is a common cause of LGIB in all age groups of children. Food allergy should be considered in infants and young children, but it is rarely seen in children over 5 years old. In children older than 5 years old, diagnostics for IBD should be carried out, especially in patients with weight loss, high levels of faecal calprotectin, and anaemia. Colorectal polyps and Meckel's diverticulum are less common causes of LGIB.

Segmental dilatation of the ileum accompanying hypoproteinemia

Journal of Pediatric Surgery, 2008

Purpose: Segmental intestinal dilatation (SID) is a rare pathologic finding, which causes intestinal obstruction in newborn period and gastrointestinal bleeding, anemia, abdominal pain, malabsorption, and growth failure in older children. We present a case of SID causing hypoproteinemia. Patient: A 10-year-old girl presented with recurrent abdominal distension since she was 8.5 months old. She was diagnosed to have protein-losing intestinal lymphangiectasia. Result of physical examination was normal except moderate growth retardation. Her blood workup showed depletion in total protein, albumin, and globulin levels. Gastrointestinal series revealed a dilated segment of small intestine, and Tc 99m -pertechnetate scintigraphy detected ectopic activity in abdomen. The patient was taken to operation with the presumptive diagnosis of intestinal duplication. A dilated segment of ileum was encountered, and segmental resection and anastomosis were performed. Results: Patient was discharged on the postoperative fourth day and remains well. Histopathologic examination of the specimen revealed SID. Discussion: Segmental intestinal dilatation is an uncommon congenital anomaly. Most of the cases were operated on in newborn period because of intestinal obstruction, and their diagnoses were made perioperatively; the others were diagnosed in older ages during the investigation of nonspecific symptoms. The index patient is the second case of SID having hypoproteinemia in the literature. Gastrointestinal series suggested the diagnosis, and segmental resection and anastomosis were the adequate treatments.

Not gastroschisis or omphalocele or anything in between: a novel congenital abdominal wall defect

Pediatric Surgery International, 2017

signs of mild dehydration, and had a diffuse desquamating rash extending across the torso and extremities. The abdominal mass appeared to be a segment of bowel not covered by a membrane protruding through her umbilicus (Fig. 1). The abdomen was otherwise mildly distended but non-tender. IV Ceftriaxone and Flagyl were given with a fluid bolus to initiate care. She was taken to the operating room for a laparotomy, and a peri-umbilical incision was made revealing a mass extruding from the antimesenteric border of the transverse colon through the umbilicus (Fig. 2). The defect was located in the midline through the umbilicus, and there was no peritoneal covering. It did not involve the urachal remnant or any other umbilical remnant. The cecum was examined carefully and was normally located, and a normal appendix was seen. The small bowel was partially obstructed, but all the bowels appeared pink and healthy appearing. Given the findings, the mass was resected in continuity with a short segment of colon, and due to the clinical status of the baby, an end colostomy and mucus fistula were created. No pathology review was available for this case; however, on gross examination, the resected tissue did not appear to have a lumen and there was no visible luminal communication with the transverse colon. The abdomen was closed and the baby extubated without issue. Feeds were resumed after the return of bowel function from the ostomy and she was kept on broad spectrum antibiotics for the rash and suspected toxic shock syndrome (Fig. 3). She recovered well and was discharged home within a week. She gained appropriate weight and returned at 9 months of age for an ostomy takedown and primary anastomosis, which was uneventful. She was discharged home after that admission and at 1 year post-operative follow-up was gaining weight and thriving.