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Special Feature |

Pathological Case of the Month FREE

Atilano G. Lacson, MD; Richard Harmel, MD; Marianne R. Neal, MD; Paul Welty, MD
[+] Author Affiliations

From the Departments of Pathology and Laboratory Medicine (Dr Lacson), Surgery (Dr Harmel), Radiology (Dr Neal), and Pediatrics (Dr Welty), All Children's Hospital, St Petersburg, Fla.

Section Editor: Enid Gilbert-barness, MD

Arch Pediatr Adolesc Med. 2000;154(2):203. doi:10.1001/archpedi.154.2.203.
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A 5-MONTH-OLD male infant had presented with chronic nonbilious emesis at age 3 weeks and was briefly hospitalized owing to dehydration from emesis and constipation for 4 days, the latter relieved by barium enema. An abdominal x-ray film showed distended bowel loops. Two months later, emesis recurred with diarrhea and a low-grade fever. A stool sample was positive for rotavirus. Soy-based formula was administered. At 3 months of age, symptoms recurred with abdominal pain. Distended bowel loops were noted on abdominal x-ray film. He responded to volume resuscitation and broad spectrum antibiotics. At 5½ months of age, he had recurrent dehydration and foul-smelling stools. His white blood cell count was 50 × 109/L with a shift to the left.

A repeated barium enema showed an "apple core" deformity (Figure 1). An extrinsically obstructed segment was resected from the splenic flexure. The specimen was 3.5 cm in diameter and 7.0 cm long. Mucosal hyperemia of the dilated segment and polypoid hyperplasia near the obstructed region was seen. The opened bowel and histologic sections are shown in Figures Figure 2,Figure 3, and Figure 4. The postoperative course was uneventful, and he was discharged 7 days postoperatively. He was asymptomatic at follow-up 6 months later.




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