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Ileal perforation secondary to indomethacin administration

Payne KMP - MedPix (2005)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Ileal perforation secondary to indomethacin administration

History: A male infant was born at an estimated gestational age of 25 weeks. The patient was intubated and placed on a ventilator due to respiratory distress in the delivery room. On day of life 3, the patient was found to have a patent ductus arteriosus (PDA). Chest radiographs illustrated increased pulmonary vascular markings consistent with the clinical suspicion of a PDA. The patient was started on a course of indomethacin to pharmacologically close the PDA. One day after the last dose of indomethacin (day of life 6), the patient was noted to have bilious residuals from his orogastric feeding tube. An abdominal exam was benign. An upper gastrointestinal study was performed showing normal anatomy. Chest and abdominal radiographs were obtained showing no signs of perforation. On day of life 7, repeat radiographs were performed showing free air in the peritoneal cavity.

Findings: • Anteroposterior supine portable radiograph: • Abnormal lucency in the epigastric region due to anterior free air • Opaque stripe in right upper quadrant illustrating the falciform ligament (football sign) Left lateral decubitus portable abdominal radiograph: Lucency between the right liver edge and lateral right diaphragm Opaque stripe in area of falciform liagment

Ddx: Pneumoperitoneum secondary to: Pneumatosis cystoides intestinalis (secondary to necrotizing entercolitis) Complication of indomethacin treatment Complication of positive pressure ventilation Extension from pneumomediastinum Hirschsprung’s disease Older children – blunt abdominal trauma; perforated ulcer, Meckel’s diverticulum, or appendix

Dxhow: Pneumoperitoneum on abdominal radiograph, Ileal perforation found at surgery

Exam: Normal vital signs Benign abdominal exam No laboratory studies

No MeSH data available.


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Ileal perforation secondary to indomethacin administration

Payne KMP - MedPix (2005)

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1896&req=5

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Ileal perforation secondary to indomethacin administration

History: A male infant was born at an estimated gestational age of 25 weeks. The patient was intubated and placed on a ventilator due to respiratory distress in the delivery room. On day of life 3, the patient was found to have a patent ductus arteriosus (PDA). Chest radiographs illustrated increased pulmonary vascular markings consistent with the clinical suspicion of a PDA. The patient was started on a course of indomethacin to pharmacologically close the PDA. One day after the last dose of indomethacin (day of life 6), the patient was noted to have bilious residuals from his orogastric feeding tube. An abdominal exam was benign. An upper gastrointestinal study was performed showing normal anatomy. Chest and abdominal radiographs were obtained showing no signs of perforation. On day of life 7, repeat radiographs were performed showing free air in the peritoneal cavity.

Findings: • Anteroposterior supine portable radiograph: • Abnormal lucency in the epigastric region due to anterior free air • Opaque stripe in right upper quadrant illustrating the falciform ligament (football sign) Left lateral decubitus portable abdominal radiograph: Lucency between the right liver edge and lateral right diaphragm Opaque stripe in area of falciform liagment

Ddx: Pneumoperitoneum secondary to: Pneumatosis cystoides intestinalis (secondary to necrotizing entercolitis) Complication of indomethacin treatment Complication of positive pressure ventilation Extension from pneumomediastinum Hirschsprung’s disease Older children – blunt abdominal trauma; perforated ulcer, Meckel’s diverticulum, or appendix

Dxhow: Pneumoperitoneum on abdominal radiograph, Ileal perforation found at surgery

Exam: Normal vital signs Benign abdominal exam No laboratory studies

No MeSH data available.