Presentation
Episodic abdominal pain for several days. Now much more severe. Started to vomit over the last 24 hours. ? obstruction/appendicitis
Patient Data
Features of small bowel obstruction with central gas-filled distended loops. Complete absence of gas in the large bowel.
Impression of obstruction in the midline at the level of the pelvic brim
Ultrasound confirms small bowel obstruction with fluid-filled distended small bowel with associated bowel wall thickening.
The cause is an ileo-ileal intussusception in the midline.
Case Discussion
Ileo-ileal intussusceptions are not uncommon in pediatric ultrasound. However, they are usually self-limiting, resolve spontaneously during the ultrasound test and do not cause small bowel obstruction.
In this, case the intussusception is large and given it's location in the distal portion of the ileum, the suspicion was of a Meckel diverticulum. It would be unusual to have an idiopathic intussusception in this age-group.
The child was taken to theater and a small resection was performed with an end-to-end anastamosis.
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