CT Case: 8 year old with Abdominal Pain

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CT Case 8 year old with Abdominal Pain

• Nick Hartman
• June 20, 2008

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Clinical Story

• 8 yo male s/p heart transplant as a neonate
• Presents today with colicky abdominal pain x 2
  days, with anorexia and bilious emesis
• VS T 36.3
• RR 28
• HR 116
• BP 113/78

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Abdominal exam

• Grossly distended
• Hyperactive bowel sounds
• Next step CT scan

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Diagnosis Intussusception

• Most common in children aged 6 mo-2 y
• Typically presents with abdominal pain, vomiting
  and bloody stools
• For patients above age 2, suspect anatomic
  abnormality Meckels, tumor, etc.
• Radiology findings of SBO, plus oval reniform
  mass, and intraluminal soft tissue structures
• Can often be reduced with barium enema, otherwise
  treat surgically

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Follow-Up

• Surgery was performed to reduce the
  intussusception and to remove the soft tissue
  mass found to be the cause
• Tissue pathology revealed lymphoproliferative
  disorder
• Pt discharged on hospital day 5 with resolved
  abdominal symptoms, eating normally

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References

• Gayer G, et al. Adult intussusception a CT
  diagnosis. The British Journal of Radiology
  2002 75 185-190.
• Wood BP. Intussusception, Child. E-medicine
  article, updated 2005. http//www.emedicine.com/RA
  DIO/topic366.htm