Ileus bij kinderen zonder eerdere buikoperaties
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Klinische les
05-10-2015
Daan van Poll, Sjoerd A. de Beer, Justin R. de Jong en Hugo A. Heij

Mechanical ileus in children with no prior history of abdominal surgery

This supplementary information is presented as submitted by the corresponding author. It has not been copy-edited by NTvG.

Introduction

Mechanical ileus in children with no prior abdominal history caused and not including intussusception and incarcerated inguinal hernia are rare problems that can lead to disastrous outcomes if no adequate and swift action is undertaken.

Case description

We present two cases of children with ileus and no prior medical history. The causes were congenital in both cases and necessitated emergency-procedures. The first case is of a 6-year old boy who presented with acute abdominal pain and vomiting caused by a persistent omphalomesenteric duct. Strangulation was seen on abdominal ultrasound. Emergency-laparotomy was performed with resection of the omphalomesenteric duct. Recovery was uneventful.

The other case is of a 9-year old boy who presented after his intercontinental flight had to perform a stopover because of increasing abdominal pain, bilious vomiting and a deterioration of his general clinical condition. After analysis on the first-aid department including plain abdominal X-ray and abdominal ultrasound it was clear that either an infectious or mechanical abdominal problem was the cause of the clinical deterioration in this patient. An emergency-laparotomy was performed revealing malrotation with volvulus. Ischemia necessitated partial ileum resection leaving 150 centimeters of small intestine in situ. Recovery was prolonged with 9 days admission on the Intensive Care but eventually led to full oral feeds and discharge at day 12.

Conclusion

Children with no prior abdominal history and no signs of incarcerated inguinal hernia or intussusception who present with complaints that may be caused by mechanical obstruction should be managed with a surgical viewpoint and without delay. Congenital causes including malrotation with midgut volvulus and persistent omphalomesenteric duct should always be considered as potential causes.