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Emerg Med J. 2007 May; 24(5): 368.
PMCID: PMC2658497

Small bowel obstruction

Small bowel obstruction in children is uncommon; however, if improperly managed, it can lead to bowel ischaemia, necrosis, perforation and death. A 4‐year‐old boy presented with 4 days of vomiting, absolute constipation and diffuse abdominal pain. His abdomen was grossly distended, with subdued bowel sounds. An abdominal x ray showed several distended small bowel loops (fig 11).). Laparotomy showed an internal hernia caused by a mesodiverticular band that created a snare‐like opening through which a loop of bowel had herniated and become obstructed. Fortunately, the bowel was still viable, so the Meckel's diverticulum and the mesodiverticular band were resected and the hernia was reduced. Mortality for small bowel obstruction may reach 65% if >75% of the small bowel is necrotic at the time of laparotomy (http://www.emedicine.com/ped/topic1203.htm). In our case prompt treatment was given when the bowel was still viable, hence preventing any serious complications.

figure em37226.f1
Figure 1 Abdominal x ray of a 4‐year‐old boy showing several distended small bowel loops.

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