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Duodenal Obstruction Caused by Acute Appendicitis with Intestinal Malrotation in a Child.

Biçer Ş, Çelik A - Am J Case Rep (2015)

Bottom Line: The caecum was in the right upper quadrant, and an inflamed appendix was located in the subhepatic region.After the appendectomy, the cecum was mobilized and fixed in the right lower quadrant.In children with intestinal malrotation, acute appendicitis can present as duodenal obstruction without abdominal pain, and standard imaging methods can miss the correct diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Erzincan University, Medical School, Erzincan, Turkey.

ABSTRACT

Background: In patients with intestinal malrotation, the diagnosis of acute appendicitis can be difficult due to atypical presentation. Duodenal obstruction caused by acute appendicitis with the presence of malrotation has rarely been reported in children.

Case report: We report the case of a 14-year-old male patient with bilious vomiting and abdominal distension. A diagnosis could not be made by computed tomography, ultrasonography, or endoscopy. We observed a dilated stomach and malrotation in laparotomy. The caecum was in the right upper quadrant, and an inflamed appendix was located in the subhepatic region. After the appendectomy, the cecum was mobilized and fixed in the right lower quadrant.

Conclusions: In children with intestinal malrotation, acute appendicitis can present as duodenal obstruction without abdominal pain, and standard imaging methods can miss the correct diagnosis.

No MeSH data available.


Related in: MedlinePlus

The appearance of the dilated stomach extending to the pelvic region in UGI radiography.
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f1-amjcaserep-16-574: The appearance of the dilated stomach extending to the pelvic region in UGI radiography.

Mentions: In an abdomen CT scan, the 1st and 2nd parts of the duodenum and stomach were slightly dilated, and we observed wall thickening in the pylorus segment and passage to distal. In upper gastrointestinal (UGI) radiography, a dilated stomach extending to the pelvic region was observed (Figure 1). In the first 20 min, there was no passage to the small intestine. Within 2 h, half of the contrast substance had passed to distal. Based on endoscopy, the passage was open for 100 cm. After pre-operative resuscitation, the patient was operated on. We accessed the abdomen via an upper median incision. In the exploration, it was seen that the stomach was dilated and that there was malrotation. The cecum was mobile and located in the right upper quadrant. The appendix was located at the subhepatic region (Figure 2); it was inflamed but not perforated. An appendectomy was performed and the cecum was mobilized and fixed in the right lower quadrant. Liquid was added from a nasogastric catheter and the passage of the contents to the small intestine was observed. We determined that the passage was open and the surgery was concluded. After the surgery, the patient, who was stopped enteral feeding, was given total parenteral nutrition for 15 days. The nasogastric drainage amount decreased gradually. UGI radiography of the patient, who could tolerate oral nutrition on the post-operative 15th day, was obtained. Although the stomach was dilated, it was seen that the passage was normal. The pathology report noted acute appendicitis, and the patient was discharged on the 20th day after the operation. Gastric dilatation improved in a follow-up X-ray examination 2 months later.


Duodenal Obstruction Caused by Acute Appendicitis with Intestinal Malrotation in a Child.

Biçer Ş, Çelik A - Am J Case Rep (2015)

The appearance of the dilated stomach extending to the pelvic region in UGI radiography.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554333&req=5

f1-amjcaserep-16-574: The appearance of the dilated stomach extending to the pelvic region in UGI radiography.
Mentions: In an abdomen CT scan, the 1st and 2nd parts of the duodenum and stomach were slightly dilated, and we observed wall thickening in the pylorus segment and passage to distal. In upper gastrointestinal (UGI) radiography, a dilated stomach extending to the pelvic region was observed (Figure 1). In the first 20 min, there was no passage to the small intestine. Within 2 h, half of the contrast substance had passed to distal. Based on endoscopy, the passage was open for 100 cm. After pre-operative resuscitation, the patient was operated on. We accessed the abdomen via an upper median incision. In the exploration, it was seen that the stomach was dilated and that there was malrotation. The cecum was mobile and located in the right upper quadrant. The appendix was located at the subhepatic region (Figure 2); it was inflamed but not perforated. An appendectomy was performed and the cecum was mobilized and fixed in the right lower quadrant. Liquid was added from a nasogastric catheter and the passage of the contents to the small intestine was observed. We determined that the passage was open and the surgery was concluded. After the surgery, the patient, who was stopped enteral feeding, was given total parenteral nutrition for 15 days. The nasogastric drainage amount decreased gradually. UGI radiography of the patient, who could tolerate oral nutrition on the post-operative 15th day, was obtained. Although the stomach was dilated, it was seen that the passage was normal. The pathology report noted acute appendicitis, and the patient was discharged on the 20th day after the operation. Gastric dilatation improved in a follow-up X-ray examination 2 months later.

Bottom Line: The caecum was in the right upper quadrant, and an inflamed appendix was located in the subhepatic region.After the appendectomy, the cecum was mobilized and fixed in the right lower quadrant.In children with intestinal malrotation, acute appendicitis can present as duodenal obstruction without abdominal pain, and standard imaging methods can miss the correct diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Erzincan University, Medical School, Erzincan, Turkey.

ABSTRACT

Background: In patients with intestinal malrotation, the diagnosis of acute appendicitis can be difficult due to atypical presentation. Duodenal obstruction caused by acute appendicitis with the presence of malrotation has rarely been reported in children.

Case report: We report the case of a 14-year-old male patient with bilious vomiting and abdominal distension. A diagnosis could not be made by computed tomography, ultrasonography, or endoscopy. We observed a dilated stomach and malrotation in laparotomy. The caecum was in the right upper quadrant, and an inflamed appendix was located in the subhepatic region. After the appendectomy, the cecum was mobilized and fixed in the right lower quadrant.

Conclusions: In children with intestinal malrotation, acute appendicitis can present as duodenal obstruction without abdominal pain, and standard imaging methods can miss the correct diagnosis.

No MeSH data available.


Related in: MedlinePlus