Enterocolic fistula - huge

Case contributed by Dr Jeremy Jones

Presentation

History of cerebral palsy with bilateral hip dislocation. Bilateral hip reconstruction performed with femoral and acetabular osteotomies. Bloody diahorea and aspirates.

Patient Data

Age: 9 years
Gender: Male
X-ray

Central gas-filled bowel. No obstruction.

Central bowel wall thickening, mural gas and portal venous gas.

Bilateral hip and acetabular reconstruction and abdominopelvic cast.

X-ray

Resolution of pneumatosis and portal venous gas. Persistent central distended gas-filled bowel.

Persistent fever despite broad spectrum antibiotics. Difficult to assess. Loose stool continues although no longer blood-stained. Plaster jacket precludes ultrasound. For CT.

CT

Bowel wall thickening and free fluid within the abdomen. No mural gas. No portal venous gas. No perforation.

On the coronal imaging, there is a huge defect in the transverse colon with connection to a loop of small bowel. Appearances of a huge enterocolic fistula.

Case Discussion

The enterocolic fistula was confirmed surgically and a large segment of small bowel needed to be resected along with a section of transverse colon.

The explanation for the imaging findings was post-operative NEC with portal venous gas and fistulation secondary to ischemia.

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