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Age: 2

Sex: Female

Indication: Abdominal pain and distension

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Case #15


Findings

  • Dilated small bowel loops in the upper and left abdomen without distal gas
  • Small colonic stool burden
  • No abnormal intraabdominal mass effect or calcification
  • Widely spaced pubic symphysis
  • Streaky bibasilar pulmonary opacities


Diagnosis

  • Small bowel obstruction

Sample Report

Dilated small bowel loops in the upper and left abdomen without distal gas. Findings are concerning for a high-grade mid small bowel obstruction. Recommend surgery consultation.

Small colonic stool burden.

No abnormal intraabdominal mass effect or calcification.

Widely spaced pubic symphysis suggestive of a history of bladder exstrophy.

Streaky bibasilar pulmonary opacities, likely atelectasis.


Discussion

  • Small bowel obstruction in children beyond the neonatal period is uncommon, with some etiologies including intussusception, adhesions (in children with previous operations), and ingested foreign bodies
  • The etiology in this case was adhesions related to prior bladder exstrophy repair
  • CT can be helpful to identify the level and potential cause for obstruction, but is not always necessary and was not performed in this case
  • Bladder exstrophy results in a very typical “manta ray” appearance of the pelvis with a widely diastatic pubic symphysis



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