SHM Converge Scientific Abstract ePoster Gallery-Vomiting and Lethargy in a Five Month Old Infant

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A five-month-old infant presented with non-bilious vomiting, lethargy, decreased oral intake, and reduced urine output. Although initially well-appearing with a soft, non-distended abdomen, abdominal imaging at the outside hospital showed dilated bowel loops concerning for obstruction. On transfer, ultrasound revealed an ileocolic intussusception with a suspected lead point. <br /><br />The child had a recent history of reflux and constipation, and had received his second rotavirus vaccine dose five days earlier. Because of the imaging findings and ongoing vomiting, pediatric surgery was consulted. Intraoperatively, the lesion was found to be an ileoileal intussusception caused by a Meckel’s diverticulum, which was resected. The bowel was dilated but viable. Surgeons also identified intestinal malrotation, prompting a Ladd procedure.<br /><br />Pathology showed Meckel’s diverticulum with heterotopic tissue, including pancreatic and gastric heterotopia, along with inflamed and hemorrhagic small bowel. The final diagnoses were Meckel’s diverticulum complicated by intussusception and intestinal malrotation.<br /><br />Postoperatively, the infant required temporary total parenteral nutrition while awaiting return of bowel function. He improved steadily, was transferred from the PICU to the floor on postoperative day 3, feeds were restarted on day 6, and he tolerated full oral feeds by day 8, at which point he was ready for discharge.<br /><br />This case highlights the importance of maintaining a high suspicion for abdominal emergencies in young infants, even when the abdominal exam is initially benign. It also illustrates the uncommon association between Meckel’s diverticulum and intestinal malrotation.

Asset Subtitle

Stephanie R. Moss

Meta Tag

Author List Stephanie R. Moss

Category Clinical Vignettes

Concept Intussusception

Concept Abdominal Emergency

Concept Bowel Obstruction

Concept Meckels Diverticulum

Concept Vomiting

Distinguished Non-Finalist

Presenter Organization The Cleveland Clinic Foundation

Presenting Author Stephanie R. Moss

Track Pediatric

Keywords

infant intussusception

Meckel diverticulum

intestinal malrotation

ileocolic intussusception

ileoileal intussusception

rotavirus vaccine

bowel obstruction

Ladd procedure

heterotopic tissue

pediatric surgery

Intussusception

Abdominal Emergency

Bowel Obstruction

Meckels Diverticulum

Vomiting