Case Summary
CT Scans and Pediatric Abdominal Conditions
This case discussed the practice preferences regarding the use of CT scans in diagnosing appendicitis and other abdominal conditions in children. The discussion emphasized the increased risk of leukemia associated with single CT scans of the abdomen. The team then proceeded to review a case of a 3-y-old boy presenting with abdominal pain, vomiting, and constipation, who had been transferred from up north. The boy was found to have iron deficiency and a large, heterogeneous density in the epigastric area, prompting an upper GI study to identify the loops.
Trichotillomania in Young Patient
The young patient had a bizarre, widened, and obstructed segment in the upper small bowel, which was identified on an upper gastrointestinal (GI) X-ray. This segment appeared to be attempting to bypass an obstruction. The team discussed the possibility of endoscopic removal of the obstructing material to relieve symptoms and improve nutritional status. This condition, known as trichotillomania, typically affects older patients, making this a unique and noteworthy case. The team agreed to share their experiences with similar cases to enhance understanding and management of this rare disorder.
Small Bowel Perforation Due to Bezoar
The case presentation discussed the patient's journey from initial presentation with abdominal pain and lethargy to the eventual discovery of a small bowel perforation. The perforation was found to be caused by a bezoar, a mass of indigestible material that formed in the stomach. The patient underwent emergency surgery to remove the bezoar and repair the perforations. Despite initial concerns, the patient recovered well and was discharged from the intensive care unit three days later. The team also discussed the importance of being aware of the potential for variable presentations of this condition and the need for careful management in similar cases.
Bezoar-Induced Obstruction and Inflammation
A case was reported of a patient who had undergone a contrast study and was still showing low-grade fevers despite being on antibiotics and antifungals. The patient was also struggling to eat, and had fluid collections throughout their abdomen, leading to a diagnosis of a bezoar, which was a mass of hair and food. The bezoar had caused an obstruction, leading to ulceration and a patchy inflammatory process. Details were discussed of the surgical specimens, highlighting the distinct line of perforations along the mesenteric insertion, and the thick blue exudate on the surface. Also noted was the presence of bacteria or fungus inside the muscle propria.
Synthetic Material Ingestion and CT Scans
Pathology reported on the child having ingested various synthetic materials, causing atypical and concerning symptoms. The team concluded that the symptoms were likely the result of pressure alteration, rather than chemical burn. However, the team was uncertain about the child's future, particularly regarding his need for ongoing support and care due to his delayed development and the severity of his condition. The team also compared the radiation exposure from a CT scan to that of an upper GI follow-through, finding the latter to be significantly less.
Patient Case Discussion