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Age: 6

Sex: Male

Indication: Nausea, hematemesis

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Case #13


Findings

  • Massive colonic and rectal stool burden with fixed oblique lucencies in the mid abdomen
  • No evidence of free intraperitoneal air
  • No abnormal intraabdominal calcification
  • Incompletely imaged ventriculoperitoneal shunt catheter terminating in the right lower abdomen without evidence of discontinuity
  • Bilateral coxa valga with shallow acetabula


Diagnosis

  • Fecal impaction

Sample Report

Massive colonic and rectal stool burden concerning for fecal impaction. Fixed lucencies in the mid abdomen are favored to represent intracolonic air between the retracted formed stool and the distended colonic wall.

No evidence of free intraperitoneal air.

No abnormal intraabdominal calcification.

Incompletely imaged ventriculoperitoneal shunt catheter terminating in the right lower abdomen without evidence of discontinuity.

Bilateral coxa valga with shallow acetabula.


Discussion

  • Constipation is ubiquitous in children, but usually only this severe in children with neuromuscular disorders (evidenced by the hip abnormalities in this child)
  • Intraluminal gas around retracted formed stool can be a mimic for free intraperitoneal air, but will not migrate through the abdomen with different patient positions like free air should



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