Radiological Case of the Month FREE

A 9-YEAR-OLD girl presented with a 2-week history of considerable abdominal distress. She had been experiencing intermittent, sharp abdominal pain associated with nonbilious vomiting; the initial episode of pain was accompanied by a loose bowel movement and a low-grade fever. The patient's condition had been evaluated for similar symptoms on 2 prior occasions; on 1 occasion she required intravenous hydration. Her most recent visit occurred 3 days before this presentation. Then abdominal radiographs were reported to show considerable fecal retention and enemas were prescribed. Despite 16 enemas in the past 13 days, the abdominal distress continued, often waking her at night.

Physical examination revealed an epigastric mass to the left of the midline that, when palpated, reproduced her symptoms. An abdominal radiograph showed distention of her small and large bowel, but no obstruction or notable fecal retention. The patient was admitted to the hospital for intravenous hydration and further evaluation. The next day, radiographic studies of the abdomen (Figure 1) and an upper gastrointestinal series were obtained (Figure 2). Figure 3 indicates the cause of the abdominal distress.