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Updated: Jun 23, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Delayed diagnosis in a child with strangulated mesenteric hernia
Kenichi Tetsuhara1, Kazunobu Nakabayashi2, Mamoru Muraoka1
1Department of Critical Care Medicine Fukuoka Children's Hospital Fukuoka Japan.
Insights
Strangulated intestinal obstruction in children can be a life-threatening emergency. Early diagnosis is crucial to prevent severe complications and improve outcomes in pediatric shock cases.
Area of Science:
- Pediatric Surgery
- Emergency Medicine
- Critical Care
Background:
- Strangulated intestinal obstruction is a critical diagnosis in pediatric shock.
- Diagnostic challenges can lead to delays and errors in management.
- Prompt recognition is vital for patient survival.
Observation:
- A 3-month-old infant presented with shock, lactic acidosis, and altered mental status.
- Clinical signs included abdominal distension and acute kidney injury requiring renal replacement therapy.
- Delayed diagnosis (33.5 hours) due to diagnostic pitfalls occurred.
Findings:
- Contrast-enhanced CT revealed extensive intestinal ischemia.
- The infant was diagnosed with strangulated mesenteric hernia.
- Four specific pitfalls contributed to the diagnostic delay.
Implications:
- Highlights the importance of considering strangulated intestinal obstruction in pediatric shock.
- Emphasizes the need to identify and address diagnostic errors in intensive care settings.
- Underscores the critical role of timely diagnosis and intervention in pediatric surgical emergencies.
Background:
Strangulated intestinal obstruction is a life-threatening condition that should be considered as a differential diagnosis in children with shock. However, it has pitfalls in diagnosis and can lead to diagnostic errors.
Case Presentation:
A 3-month-old male patient presented with a pale complexion lasting 2 h and abnormal crying. He was in shock with lactic acidosis, altered mental status, and slight abdominal distension. He required volume resuscitation, vasoactive agents, and transfusion. On Day 2, he had marked abdominal distension and acute kidney injury, which required continuous kidney replacement therapy. Contrast-enhanced computed tomography revealed extensive intestinal ischemia. It took 33.5 h from his arrival to the computed tomography, leading to operative management. The small intestine had entered a mesenteric hiatus, leading to ischemia. He was diagnosed with strangulated mesenteric hernia.
Conclusion:
In this case, four pitfalls led to delayed diagnosis. Factors for diagnostic errors specific to strangulated intestinal obstruction and intensive care should be noted.
