Bezzina Atef, Lahmar Lilia, Moalla Salma, Douira-Khomsi Wièm *
Department of Paediatric radiology, Béchir Hamza Children’s Hospital, Tunis, Tunisia
* Correspondence: Khomsiwiem@yahoo.fr
Clinical History:
A 5-days-old boy born at term was admitted to our hospital after 3 days of alimentary and later biliary vomiting. There was no failure of passaging air and stool. The pregnancy had been normal and the Apgar Score at birth was 9/10. The meconium had passed within the first 24 hours. The abdomen was soft without distension on palpation. A plain abdominal film was obtained at admission as well as abdominal ultrasound.
Video 1-4: Abdominal ultrasound, axial plane
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CORRECT ANSWER EXPLAINED BELOW | |
Correct answer to Q1 is: Incomplete obstruction of the 2nd segment of duodenum |
CORRECT ANSWER EXPLAINED BELOW | |
Correct answer to Q1 is: Incomplete obstruction of the 2nd segment of duodenum |
The mesenteric vessels are wellpositioned and there is air in the bowel loops in the upper left quadrant indicating an incomplete obstruction in the 2nd segment of duodenum. Gastroenteritis would not cause dilatation of the stomach especially not after excessive vomiting. There is no stenosis or enlargement of the stomach wall at the level of the pylorus. As the fluid and air filled structure is identified as the stomach, caecal volvulus is not likely.
CORRECT ANSWER EXPLAINED BELOW | |
Correct answer to Q2 is: Small bowel follow through.Additional Images:Discussion:In a small bowel follow through examination the baby drinks water soluble oral contrast and fluoroscopy images are obtained consequtively. This examination shows dilated stomach and proximal duodenum, but slight, delayed passage. There is no stenosis at the level of the pylorus. The proximal jejunal bowel loops are located in the correct anatomical position (upper left quadrant). The examination indicates a partial obstruction (a web) in the 2nd part of the duodenum. The patient underwent surgery which confirmed the finding of a duodenal web. Ultrasound is a non-invasive examination, which is readily available also in the acute setting. It is often a supplement to plain abdominal film in the acute pediatric setting. It is helpful to determine the level of obstruction and may indicate the cause. ConclusionVomiting in neonates or small infants may indicate obstruction. Conflicts of interest“The authors declare no conflict of interest.” References
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CORRECT ANSWER EXPLAINED BELOW | |
Correct answer to Q2 is: Small bowel follow through.Additional Images:Discussion:In a small bowel follow through examination the baby drinks water soluble oral contrast and fluoroscopy images are obtained consequtively. This examination shows dilated stomach and proximal duodenum, but slight, delayed passage. There is no stenosis at the level of the pylorus. The proximal jejunal bowel loops are located in the correct anatomical position (upper left quadrant). The examination indicates a partial obstruction (a web) in the 2nd part of the duodenum. The patient underwent surgery which confirmed the finding of a duodenal web. Ultrasound is a non-invasive examination, which is readily available also in the acute setting. It is often a supplement to plain abdominal film in the acute pediatric setting. It is helpful to determine the level of obstruction and may indicate the cause. ConclusionVomiting in neonates or small infants may indicate obstruction. Conflicts of interest“The authors declare no conflict of interest.” References
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