Presentation
Vomiting, abdominal pain.
Patient Data
Age: 10 months
Gender: Male
From the case:
Duplication cyst
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- nasogastric tube, tip in the stomach
- distended loops of bowel in the central abdomen with paucity of distal gas
- no pneumatosis intestinalis, portal venous gas or free gas
- lung bases clear
- no osseous abnormality
The overall appearances are most suggestive of a distal obstruction, favoring distal small bowel.
From the case:
Duplication cyst
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Abdominal ultrasound demonstrates:
- small volume free fluid
- modestly distended small bowel loops
- intussusception with dimensions ~2cm diameter suggesting it is small bowel rather than ileocolic
- a rounded cyst acting as a pathological lead point; there is no internal vascularity and a bowel wall signature, indicating an enteric duplication cyst
Case Discussion
At surgery, an ileoileal intussusception was reduced and a duplication cyst acting as pathological lead point was excised. The differential for this appearance includes a Meckel diverticulum.
Case contributed by Dr Tom Hess.