Rapidly Progressive Small Bowel Necrosis in a Previously Healthy Child without Proven Mechanical Obstruction
10.5223/pghn.2019.22.3.291
- Author:
Hyun Hee KIM
1
;
Hyungoo KANG
;
Chul Hee PARK
;
Yu Jin KWON
;
Euna JUNG
;
Misun LIM
Author Information
1. Department of Pediatrics, Seoul Medical Center, Seoul, Korea. pedms1004@gmail.com
- Publication Type:Case Report
- Keywords:
Small intestine;
Mesenteric ischemia;
General surgery;
Child
- MeSH:
Abdomen;
Appendicitis;
Child;
Diagnosis;
Emergencies;
Hospitalization;
Humans;
Intestine, Small;
Intussusception;
Ischemia;
Laparotomy;
Meckel Diverticulum;
Mesenteric Ischemia;
Necrosis;
Physical Examination
- From:Pediatric Gastroenterology, Hepatology & Nutrition
2019;22(3):291-297
- CountryRepublic of Korea
- Language:English
-
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.
