Small bowel volvulus with large mesenteric defect in paediatric patient: An unusual presentation of acute abdomen

Abstract

Introduction: In children, internal herniation with small bowel strangulation due to the cause of a mesenteric defect is a rare cause of intestinal obstruction. So early diagnosis and early treatment in the pediatric emergency department are important factor for this disease. Aim: This case report, aim is to study the small bowel volvulus with large mesenteric defect in pediatrics patient, which is very rare. Methods and materials: A male child of 2 year and 8-month-old came to the emergency department of our institute with complains of abdominal pain, vomiting (bilious) and not passing stool for 2 days. On radiographic findings shows that, internal herniation is gaseous distension of the bowel loops in the upper abdominal area with a paucity of gas in the lower abdomen. Primarily patient vitally stabilized and plan for emergency operation. Exploratory laparotomy done and large mesenteric defect closed. Gangrenous segment resected and end ileostomy done with distal mucous fistula formation. Patient discharged successfully on 6th pod. Conclusion: Early diagnosis and treatment is very important in these patients. The most important step for this disease is early diagnosis of acute intestinal obstruction sign and symptoms like-tenderness, guarding and rigidity also vomiting and painful abdomen. So, it is very important that, Internal herniation should be considered in differential diagnoses of acute abdomen in the Pediatric Emergency Department.