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Published on: March 5, 2018
Perforated appendicitis presenting as mechanical bowel obstruction in a pediatric patient: a rare diagnostic
Mohammed Al Blooshi1, Sadaf Binu Manaf2, Munir Ahmad1
1Department of Pediatric Surgery and Urology, Al Jalila Children's Specialty Hospital, 6th Street, Al Jaddaf, Dubai 300100, United Arab Emirates.
Insights
Perforated appendicitis causing small-bowel obstruction is rare in children. Early diagnosis with imaging and prompt surgery are crucial for preventing complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Perforated appendicitis is an uncommon cause of mechanical small-bowel obstruction in pediatric patients.
- It can present with symptoms mimicking common gastrointestinal illnesses, potentially delaying diagnosis and treatment.
Observation:
- A 3-year-old girl presented with prolonged vomiting, diarrhea, and fever, initially treated as gastroenteritis.
- Persistent symptoms and abdominal distension led to imaging, revealing dilated small-bowel loops and a periappendiceal abscess compressing the ileum.
Findings:
- Magnetic resonance imaging (MRI) was key in diagnosing the periappendiceal abscess and ileal compression.
- Surgical intervention (appendectomy, adhesiolysis, peritoneal lavage) was required due to perforated appendix and adhesions.
Implications:
- This case underscores the need to consider atypical appendicitis in children with persistent gastrointestinal issues.
- Early diagnosis using advanced imaging like MRI and timely surgical management are vital for favorable outcomes in pediatric small-bowel obstruction due to perforated appendicitis.
Abstract:
Perforated appendicitis causing mechanical small-bowel obstruction is rare in pediatric patients and can mimic common gastrointestinal illnesses, delaying definitive treatment. We report the case of a 3-year-old girl with 5 days of nonbilious vomiting, diarrhea, and high-grade fever, initially managed as gastroenteritis. Ongoing abdominal distension and failed conservative management prompted plain radiographs showing dilated small-bowel loops and air-fluid levels. Subsequent magnetic resonance imaging revealed a periappendiceal abscess compressing the distal ileum at a transition point. Urgent laparoscopy, converted to a minilaparotomy, confirmed a perforated appendix with dense adhesions tethering the ileum, necessitating appendectomy, adhesiolysis, and peritoneal lavage. The patient's postoperative recovery was uneventful, with normalization of inflammatory markers and restoration of bowel function. This case highlights the importance of considering atypical appendicitis in prolonged gastrointestinal symptoms, the utility of magnetic resonance imaging in diagnosis, and the need for prompt surgical intervention to prevent serious complications.
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