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Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology
The patient was a 13 year old male diagnosed with Crohn disease of the terminal ileum at age 8. He had been managed as a medical outpatient since, without hospitalizations or radiologic procedures since diagnosis. Over the last year he has had several episodes of abdominal pain and vomiting. He presented now with 3 days of intermittent, crampy abdominal pain and vomiting. The patient had no recent memory of foreign body ingestion.
Clinical Physical Exam:
Diffuse abdominal pain upon palpation.
Clinical Differential Diagnosis:
Distal small bowel obstruction, due to Crohn disease of the terminal ileum.
An abdominal film from the day of admission showed a high grade small bowel obstruction. An upper GI exam from the fourth hospital day showed an inflamed and narrowed terminal ileum due to Crohn disease.
Images 2 and 3
Imaging Differential Diagnosis:
On the sixth hospital day the patient went to the operating room for elective resection of the terminal ileum. Explored through a midline incision, the terminal ileum was found to be thickened in nature, firm to palpation and to have mesenteric fat wrapped around it. The penny was palpable just proximal to the stricture. The patient had an ileocecectomy with primary ileocolostomy. The penny was returned to the patient.
Examination of the surgical specimen revealed the terminal ileum was ulcerated with pseudopolyp formation at the stricture and had transmural inflammation with granuloma formation and ulceration.
Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.
Case 9, Case 24
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