In children, failure to thrive and hematochezia may be warning signals that require endoscopy. However, in this age group, vascular abnormalities of the small intestine are uncommon. Various imaging modalities indicated an exceptionally significant segmental vascular abnormality of the ileum as the origin of the child’s main clinical symptoms in a female toddler. Severe anemia (Hb 3 mmol/l), failure to thrive, and chronic diarrhea were all present in a 19-month-old female. Intestinal blood loss and pathogens tests came back negative. The Child received a duodenoscopy based on histology, revealing that he did not have celiac disease. Researchers gave the child supplementation after a food protocol told the child was deficient in iron. The youngster presented again after a symptom-free four months, this time with slight abdomen pain. For hematochezia the first time, suspicious tumorous bowel disease was discovered during orienting abdominal ultrasonography (US) study. A following comprehensive abdominal US, augmented by a saline enema to increase delineation of the formation’s location (i.e., “hydrocodone”), revealed a massive circumferential cystiform vascular mass of the ileum producing segmental ileal blockage.
Preoperative abdominal hydro-MRI validated the suspected vascular abnormality of the ileum and delicately delineated the extent, location, and architecture, as expected based on the findings of the US study. The patient underwent a successful laparoscopic procedure, during which the afflicted ileum segment containing the mass was totally removed, as evidenced by histology, and the youngster recovered well.
The enormous segmental vascular abnormality of the distal ileum documented in the study is extremely rare in young children. Although the extreme anemia in the described infant could have been caused by malabsorption and starvation, it was caused by blood losses due to the ileal vascular abnormality. Stomach US was performed due to incipient abdominal pain rather than hematochezia, and it was critical to detect this unusual abnormality in this complex instance correctly. A thorough imaging examination, including an adapted MRI, provided all of the information needed for a minimally invasive laparoscopic en bloc resection.
Reference:bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-14-55
