Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Kalmar, PI; Petnehazy, T; Wießpeiner, U; Beer, M; Hauer, AC; Till, H; Riccabona, M.
Large, segmental, circular vascular malformation of the small intestine (in a female toddler with hematochezia): unusual presentation in a child.
BMC Pediatr. 2014; 14(5):55-55
Doi: 10.1186/1471-2431-14-55
(- Case Report)
[OPEN ACCESS]
Web of Science
PubMed
FullText
FullText_MUG
- Führende Autor*innen der Med Uni Graz
- Kalmar Peter
- Co-Autor*innen der Med Uni Graz
- Beer Meinrad
- Hauer Almuthe
- Riccabona Michael
- Till Holger
- Wießpeiner Ulrike Josefine
- Altmetrics:
- Dimensions Citations:
- Plum Analytics:
- Scite (citation analytics):
- Abstract:
- Failure to thrive and hematochezia in children may be alarm signs warranting endoscopy. In contrast, vascular malformations of the small intestine are uncommon in this age group. We report on a female toddler in whom various imaging techniques revealed an unusually large segmental vascular malformation of the ileum as the cause of the child's main clinical symptoms. A 19 months old girl presented with severe anemia (Hb 3 mmol/l), failure to thrive and chronic diarrhea. Diagnostics for intestinal blood loss and pathogens were negative. The child had duodenoscopy, also for histological diagnosis of celiac disease, with negative results. A dietary protocol was suggestive for inadequate iron intake and she was supplemented. After symptomless four-months the child presented again, now with mild abdominal pain and, for the first time, hematochezia. An orienting abdominal ultrasound (US) study showed a suspicious tumorous bowel condition. A subsequent detailed abdominal US supplemented by a saline enema during investigation (i.e., "hydrocolon", to improve outlining of the formation's localization) revealed a large circumferential cystiform vascular mass of the ileum causing segmental ileal obstruction.Complementing preoperative abdominal hydro-MRI, planned based on the findings of the US study, confirmed the suspected vascular malformation of the ileum and exquisitely outlined the extent, location and anatomy.The patient was successfully operated laparoscopically, the affected ileum segment with the mass was completely removed as proven by histology, and the child recovered well. The huge segmental vascular malformation of the distal ileum described here is an extreme rarity in young children. Although the reported child's presenting symptoms malabsorption and malnutrition could have been responsible for its severe anemia, this was obviously caused by blood losses from the ileal vascular malformation. It was due to incipient abdominal pain rather than hematochezia that abdominal US was performed and proved crucial for correctly diagnosing this rare malformation. Even in this extensive case detailed imaging work-up including adapted MRI added all information necessary for minimal invasive laparoscopic en bloc resection.
- Find related publications in this database (using NLM MeSH Indexing)
- Female -
- Gastrointestinal Hemorrhage - etiology
- Humans -
- Ileum - blood supply
- Infant -
- Vascular Malformations - complications
- Find related publications in this database (Keywords)
- Abdominal mass
- Bowel obstruction
- Gastrointestinal bleeding
- Children (Child, Pediatric)