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Internal Hernia as a Cause of Acute Abdomen in a Pediatric Patient
Vignesh Sankar1, Aiman Sajjad2, Francis Amador3
1Pediatric Surgery, Broward Health Medical Center/Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA.
Insights
A congenital mesenteric defect caused a life-threatening internal hernia in a pediatric patient. Prompt diagnosis and surgical repair were crucial for survival, highlighting the importance of early intervention in acute abdominal cases.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Emergency Medicine
Background:
- Acute abdomen in children presents diagnostic challenges due to diverse etiologies.
- Internal hernias are a rare but critical cause of bowel obstruction in pediatric populations.
Observation:
- A 2-year-old female presented with acute distress, abdominal guarding, and distension.
- CT scan revealed small bowel dilation without a clear cause of obstruction.
- Diagnostic laparotomy identified a strangulated internal hernia due to a congenital mesenteric defect.
Findings:
- Laparoscopic repair of the mesenteric defect was performed.
- 25 cm of necrotic small bowel was resected and an end-to-end anastomosis was created.
- Congenital mesenteric defects are the most common internal hernias in children, with high mortality if untreated.
Implications:
- This case underscores the necessity of a high index of suspicion for internal hernias in pediatric acute abdomen.
- Early diagnosis and surgical intervention are vital to prevent fatal outcomes.
- Multidisciplinary collaboration is essential for managing complex pediatric surgical emergencies.
Abstract:
An acute abdomen is a complex case with multiple possible etiologies and requires the help of many different disciplines. We present the case of a two-year-old female who presented to the emergency department in acute distress, pale in complexion, and continuously guarding her abdomen. Physical examination revealed a distended, rigid abdomen with tenderness to palpation of the abdomen in all four quadrants. A computed tomography scan illustrated markedly dilated loops of small bowel but unclear etiology of obstruction with no evidence of perforation. Stat diagnostic laparotomy showed a strangulated internal hernia secondary to a congenital mesenteric defect. The mesenteric defect was repaired laparoscopically, and 25 cm of necrotic bowel was resected with an end-to-end anastomosis. Internal hernias secondary to mesenteric defects are the most common forms of internal hernias in pediatric patients and present with a 100% mortality rate if left untreated. This case illustrates the importance of a high index of suspicion, thorough physical examination, prompt diagnosis, and treatment in preventing a fatal outcome in these patients.
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