CASE 13802 Published on 08.07.2016

Teaching Case

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Barbara Bonnesen

Hellerup, Denmark;
Email:d010796@dadlnet.dk

Patient

12 months, male

Categories

Area of Interest Abdomen, Gastrointestinal tract, Stomach (incl. Oesophagus) ; Imaging Technique Conventional radiography ;

Procedure Contrast agent-oral ; Special Focus Congenital ;

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Clinical History

Twin born by caesarean section at gestational age 37+0. Was -35% weight at birth and given gavage due to low blood sugar. Problems with daily vomiting of full meals 2 - 30 min after ingestion. Poor development, did not meet developmental milestones.

Differential Diagnosis List

Innate stomach invagination/intussusception

Stenosis

Malrotation

Innate malformation

Imaging Findings

Radiography of the abdomen after ingestion of per oral contrast shows contrast in the fundus and antrum of the stomach, but a void in the area of the corpus of the stomach. Upon closer examination the outline of the stomach seems normal, however, the luminal space is reduce to almost nothing due to invagination.

Discussion

Gastrointestinal invagination/intussusception is a frequent cause of bowel obstruction in young infants [1, 2], and can be treated safely and efficiently using laparoscopy [3]. The disease involves the telescoping of the bowel into itself, usually including both the large and small bowel. The typical age of presentation is between 4 and 10 months. There have been rare reported cases of infants under 2 months of age with intussusception. In most infants, the intussusception involves the ileum invaginating through the ileocaecal valve into the caecum. [4, 5]

Invagination/intussusception of the stomach and oesophagus was first reported in a child in 2004 [6], and invaginations/intussusceptions in this section of the gastrointestinal tract are probably rare. In this child symptoms have been present since birth, and the condition may have been consistent throughout.

References

[1] Charles T, Penninga L, Reurings JC and Berry MC. (2015) Intussusception in Children: A Clinical Review. Acta Chir Belg 115(5):327-33 (PMID: 26559998)

[2] Sklar CM, Chan E and Nasr A. (2014) Laparoscopic versus open reduction of intussusception in children: a retrospective review and meta-analysis. J Laparoendosc Adv Surg Tech A 24(7):518-22 (PMID: 24987845)

[3] Apelt N, Featherstone N and Giuliani S (2013) Laparoscopic treatment of intussusception in children: a systematic review. J Pediatr Surg 48(8):1789-93 (PMID: 23932624)

[4] Shah S (2013) An update on common gastrointestinal emergencies. Emerg Med Clin North Am 31(3):775-93 (PMID: 23915603)

[5] Jiang J, Jiang B, Parashar U, Nguyen T, Bines J and Patel MM (2013) Childhood intussusception: a literature review. PLoS One 22;8(7):e68482 (PMID: 23894308)

[6] Lukish JR, Eichelberger MR, Henry L, Mohan P and Markle B. (2004) Gastroesophageal intussusception: a new cause of acute esophageal obstruction in children. J Pediatr Surg 39(7):1125-7 (PMID: 15213914)

Case information