A 6-month-old male infant presented in surgical emergency with history of bilious vomiting for 25 days and non passage of stool for a week. There was no history of abdominal distension. The patient on presentation could not tolerate feeds rather he was reluctant to take the feeds. The baby was investigated in another hospital where upper gastrointestinal contrast study showed obstruction in proximal jejunum (Fig. 1). CT scan of abdomen revealed a rounded intra-luminal mass obstructing the bowel lumen (Fig. 2). Patient had also developed jaundice Liver function tests showed, total bilirubin 3.2mg/dl, direct 1.2mg/dl, alkaline phosphatase 220IU/lit with SGPT and SGOT were within normal limits. Abdominal radiograph showed signs of sub acute intestinal obstruction.
Figure 1: GIT contrast study showing obstruction and filling defect in the proximal jejunum.
Figure 2: CT scan showing a hypo-dense intraluminal bowel mass.
Surgery was planned for sub acute obstruction intestinal obstruction. On exploration, the proximal jejunum was distended, edematous and thickened, having putty like material on palpation, being stuck and could not be moved. Enterotomy was performed which showed edematous and swollen bowel mucosa. Jelly balls formed thick sludge and caused obstruction. The jelly like material was removed from the jejunum (Fig. 3). Enterotomy was closed transversely as after retrieval of jelly material the bowel was looking healthy and not compromised. Post operatively the parents were enquired about crystal jelly balls and mother admitted that the boy from neighbors gave the baby two jelly balls and he swallowed one of them.
The patient developed burst abdomen on 6th postoperative day and was re-operated. At exploration anastomotic leak was found. The anastomosis was revised and abdomen closed by retention sutures. The patient developed septicemia, and succumbed after 2 days of second operation.
Figure 3: The retrieved crystal jelly material from small bowel.