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Related Concept Videos

Assessment of the Rectum and Anus01:25

Assessment of the Rectum and Anus

Evaluating the rectum and anus plays a crucial role in conducting a thorough physical examination of the gastrointestinal system. Although it may be uncomfortable and often embarrassing for the patient, it holds immense diagnostic value, particularly in detecting gastrointestinal diseases and abnormalities. This guide will explain how to perform this assessment using inspection and palpation methods.
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Intestinal Obstruction II: Pathophysiology

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Appendicitis

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Complicated Rapunzel syndrome mimicking intussusception.

Sunita Singh1, Ashish Wakhlu, Anand Pandey

  • 1Department of Pediatric Surgery, CSMMU (Erstwhile King George's Medical University), Lucknow, Uttar Pradesh, India. drsunitasingh28@gmail.com

BMJ Case Reports
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PubMed
Summary

A rare case of pediatric trichobezoar caused an ileal perforation and intussusception in a 5-year-old girl. Surgical intervention and behavior therapy led to a successful recovery without recurrence.

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Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Radiology

Background:

  • Intussusception is a common surgical emergency in children.
  • Trichobezoars are rare gastric foreign bodies, often associated with psychological conditions.

Observation:

  • A 5-year-old girl presented with abdominal pain, distension, bilious vomiting, rectal bleeding, and an iliac fossa mass.
  • Clinical diagnosis of intussusception was made.
  • Exploratory laparotomy revealed a large trichobezoar causing distal ileal perforation and intussusception.

Findings:

  • The trichobezoar cast the stomach and extended through the duodenum, ileum, and ileocecal valve.
  • A large ileal perforation, obscured by the bezoar, was present.
  • Abdominal X-ray did not show pneumoperitoneum due to the perforation being covered by the bezoar.

Implications:

  • This case highlights the importance of considering rare causes like trichobezoars in pediatric intussusception.
  • Early surgical intervention and subsequent behavior therapy are crucial for favorable outcomes.
  • The absence of pneumoperitoneum on X-ray in cases of perforation covered by intraluminal contents can be misleading.