Enteritis Cystica Profunda Presenting as Ileoileal Intussusception in a Child: Report of a Case

We report the case of a 3-month-old male infant with small bowel intussusception caused by enteritis cystica profunda (ECP). The baby was admitted because he was refusing to feed, and was passing redcurrant jelly -like stools. A palpable mass was identified, and abdominal ultrasonography showed a mass with a lumen and lumen appearance. We performed laparotomy and resected the segment of bowel containing the mass. The resected segment had enteritis cystica profunda, which was considered to have precipitated the intussusception. A review of the English medical literature revealed only three other cases of children with similar symptoms in the last 30 years.     

Ileoileal Intussusception and Ileal Stricture Associated with Necrotizing Enterocolitis in a Premature Infant: Report of a Case

A 630-g male infant developed presumed necrotizing enterocolitis (NEC) after fungal enteritis that resulted in subsequent fungal septicemia associated with pneumoperitoneum on the 9th day of life. Urgent percutaneous Penrose drainage was required. During the operation on the 14th day, an ileoileal intussusception and an ileal stricture were found with perforations on each oral side of the lesions. The distinction between NEC and intussusception in premature infants when they coexist can be difficult, as these conditions share common symptoms. The relation between ischemic injury and dysmotility of the intestine is also discussed. The similarity of intrauterine fetal distress and NEC in premature infants, as seen in the present case of the intussusception associated with focal NEC, suggests that mesenteric and enteric vascular ischemia could be one trigger of intussusception in neonates. Received: March 12, 2001 / Accepted: July 17, 2001     

Ileoileal intussusception due to ileal ectopic pancreas with abundant fat tissue mimicking lipoma

A 26-year-old woman presented with symptoms of bowel obstruction. An emergent computed tomography (CT) scan was performed which showed ileoileal intussusceptions due to a fatty nodule. Exploratory laparotomy and removal of the involved small bowel was performed. The pathology showed the leading point of the intussusception to be ectopic pancreas with abundant fatty infiltration.     

Multiple sequential intussusceptions causing bowel obstruction in a preterm neonate

We present a case of multiple sequential intussusceptions in a preterm neonate that resulted in mechanical bowel obstruction. The differential diagnosis of abdominal obstruction in a neonate is extensive, requiring a thorough review of presentation and methodical workup to determine etiology (Teitelbaum DH. Obturation obstruction of the intestine. In: O'Neill JA, editor. Principles of pediatric surgery. St. Louis (MO): Mosby, 2003. p. 605-612). Rare causes must be considered in a patient with no obvious etiology on contrast studies and persistent symptoms. Intussusception, a common cause of obstruction and pain in older infants and children, can rarely occur in neonates and is unfortunately difficult to diagnose preoperatively (J Pediatr. 1955;47:87-94; Pediatr Surg Int. 1998;13:232-236; Ann Saudi Med. 2000; 20:310-312; Eur J Pediatr. 1999;158:830-832; J Paedatr Child Health. 2004;40:388-391; Radiology. 1977;125:463-466; J Perinat Med. 2004;32:190-194).     

Bladder outlet obstruction in a 5 years boy

We report a 5 years old boy with bladder outlet obstruction secondary to a fibroepithelial polyp of prostatic urethra. The micturating cystourethrogram showed a filling defect in the posterior urethra. Cystourethroscopy revealed a polyp in the prostatic urethra proximal to the verumontanum. Transurethral resection was done and histopathology confirmed fibroepithelial polyp of the urethra.     

Small bowel intussusception after blunt abdominal trauma in a 6-year-old boy: case report and review of 6 cases reported in the literature

Although intussusception is a well-known cause of acute abdomen in the pediatric population, traumatic intussusception is exceedingly rare and has been reported previously only 6 times in a preadolescent child. We present a case of ileoileal intussusception in a previously healthy 6-year-old boy after blunt trauma to the abdomen and review the English language literature on the subject.     

Mucosa-associated lymphoid tissue lymphoma of the ileum as the cause of an intestinal invagination

We herein report a case of a 14-year-old male with mucosa-associated lymphoid tissue (MALT) lymphoma of the ileum as the cause of an intestinal intussusception. The patient was referred to the hospital with abdominal pain and dyspeptic complaints and was operated on with a prediagnosis of acute abdomen. Abdominal exploration revealed an ileoileal intussusception induced by a 2-cm tumor. A segmental ileal resection was done at the operation. The histopathologic examination of the specimen revealed atypical lymphocytes starting from the mucosae infiltrating the muscular layer and the serosae. Based on these findings, the tumor was diagnosed as a high-grade MALT lymphoma. The patient recovered uneventfully after the surgery, and chemotherapy was started.     

Bowel obstruction secondary to an ectopic pancreas in the small bowels: About 2 cases

IntroductionEctopic pancreas is most commonly found in the jejunum and stomach. Most patients remain asymptomatic, and the diagnosis is usually made at autopsy or incidentally. We report here 2 cases of intestinal occlusion, secondary to an ectopic pancreatic tissue. Both cases were managed successfully by laparoscopy and laparotomy with subsequent segmental intestinal resection.Case presentationsCase 1 – An elderly patient presented to the ER because of intestinal occlusion. Paraclinical investigations were consistent with occlusion, with ileal suffering signs on CT-scan. After laparotomy and segmental intestinal resection were done, histopathalogy showed evidence of ectopic pancreas obstructing the intestinal lumen. Case 2 – A young man presented to the ER with acute onset of epigastric pain. signs of peritoneal irritation. Ct-scan showed evidence of small bowel intussusception. Exploratory laparoscopy was done, and confirmed the diagnosis. The intussusceptum was at the level of the proximal jejunum. The suffering intestinal part was exteriorized and then resected. Histopathology was consistent with an ectopic pancreas.DiscussionSymptomatic ectopic pancreas is extremely rare. Symptoms may include, bleeding, intestinal occlusion and intussusception. Few similar cases have been reported in the literature, and the current ones are to be added.ConclusionAs mentioned above, ectopic pancreatic tissue rarely causes symptoms. We presented 2 cases that presented 2 possible complications secondary to this pathology. Both cases were managed successfully.     

Turcot syndrome with colonic obstruction and small intestinal invagination: Report of a case

We report herein the case of a 16-year-old boy diagnosed as having turcot syndrome, otherwise known as glioma-polyposis syndrome. The patient was transferred from the Department of Neurosurgery where he was undergoing investigation of a brain tumor, to the Department of Medicine for investigation of gastrointestinal symptoms. The patient was diagnosed as having Turcot syndrome, and was then transferred to the Department of Surgery for treatment of an obstruction in the sigmoid colon and small intestinal invagination. A subtotal colectomy with side-to-end ileoproctostomy and release of the invaginations was carried out. Multiple polyps were found in the colon, two of which, including a large polyp that obstructed the colonic lumen, were confirmed histologically to be adenocarcinoma. The remaining polyps were adenomas. A biopsy of the brain tumor confirmed a diagnosis of astrocytoma (WHO grade II). This case report describes the characteristic features of Turcot syndrome presented by this patient.     

Case of gonadoblastoma in a 9-year-old boy without physical abnormalities

BACKGROUND: A 9-year-old boy was admitted to Jikei University Hospital complaining of gradual enlarging of the left scrotal contents. METHODS/RESULTS: Physical examination was significant for bilateral descended testicles. No abnormalities were detected in the testicles or along the spermatic cords. Scrotal ultrasound showed that hyperechoic shadows were recognized in the central area of the left testicle. Subsequent testicular biopsy and histopathological examination showed intratubular malignant germ cells in the testicular tubules. One week later, left orchiectomy was performed. CONCLUSIONS: Histopathological evaluation revealed gonadoblastoma. Gonadoblastoma, a rare gonadal neoplasm, is composed of germ cells and sex cord derivatives and usually occurs in phenotypically female patients with gonadal dysgenesis. To date, only three cases of gonadoblastoma have been reported in anatomically normal male patients with scrotal testicles. We report on a case of gonadoblastoma unaccompanied by a germ cell tumor in a physically normal male.     

Jejunal obstruction as initial presentation of polyarteritis nodosa in a 13-month-old boy

Systemic polyarteritis nodosa (PAN) is a rare disease in childhood affecting small and midsized arteries. The typical presentation in children is of isolated 1- or 2-organ involvement, and the diagnosis is often based on the histopathology. We report a case of pediatric PAN whose presenting symptom was jejunal obstruction owing to ischemic necrosis of the small bowel. The postoperative recovery was uneventful, and the patient responded well to steroid therapy. There are only a few cases of PAN with intestinal involvement described in the literature, some of them fatal. The diagnosis of PAN should be considered in children with acute intestinal obstruction with no obvious etiology, as early recognition and treatment may reduce its high mortality.     

Vermian hematoma in a four-year-old child.

An unusual case of a vermian hematoma from the rupture of an angioma in a four-year-old child is presented. The lesion was treated successfully with complete recovery.