Acute abdomen in an infant

Abstract

A 10 month old boy was brought into the accident and emergency department with a six hour history of vomiting and irritability that began after his first feed of the day. The vomiting was stained green. During this period the child opened his bowels once and passed a large amount of diarrhoea with no specific characteristics. He continued to have wet nappies throughout the morning. He was also noted to have crying episodes that lasted approximately 20 minutes and involved the child bending his legs over his trunk. There was no history of fever, rashes, or preceding illness and he had not had a change in diet. The baby was breast fed until 9 months of age and had been weaned at five months. He had always been healthy and had normal development. On examination he was apyrexial, his peripheries were warm, well perfused, and he was not in obvious distress. During the examination the child became acutely irritable. He began to cry, bending his legs on to his trunk. On palpation of his abdomen his right iliac fossa was empty and a mass was noticed in the right upper quadrant. He also passed a small amount of red stool containing mucus. Testes and femoral pulses were present. The child was sent for an urgent abdominal ultrasound examination. Fig 1 Transverse sonogram of the abdomen. Fig 2 Longitudinal sonogram …