Abstract:
Case-1: Wandering spleen is a rare clinical entity characterized by splenic hypermobility resulting from laxity or maldevelopment of the suspensary ligaments. Diagnosis is quite difficult, especially in children because of the lack of symptoms and signs until splenic torsion has occured. An array of investigations is possible but US with color Doppler,and CT with intravenous (I.V) contrast are frequently being used to diagnose wandering spleen with or without torsion . I present a case of 5 years old child with torsion and gangrene of wandering spleen to high light the importance of prompt diagnosis and management.
Case-2: Segmental dilatation of the intestine in pediatric age group is a rare entity with a few cases described in literature. Although segmental dilatation can involve the gastrointestinal tract anywhere from duodenum to distal colon, ileum is the most commonly affected site. Patients usually present with partial intestinal obstruction which may delay surgical decision. Our case was an 18-month-old girl, who presented with partial intestinal obstruction, provisionally diagnosed as a case of Hirschsprung’s disease. Diagnostic evaluation with contrast study gave a clue of small intestinal obstruction with a dilated segment.
Case-3: Spigelian hernias are normally acquired conditions, only a few congenital cases have been reported in infants in the literature. The diagnosis of a Spigelian hernia is elusive and requires a high index of suspicion. Many patients, however, present with a hernia-related complication, i,e incarceration due to small size of the hernia orifice. Our case is a 27 days old female baby who presented with irritability and bilious vomiting. X.Ray abdomen and US were inconclusive. Exploratory laparotomy was diagnostic for incarcerated Spigelian hernia.
Conclusion: While dealing with a child with acute abdomen rare causes should also be kept in mind to avoid undue delay in the management and high morbidity and mortality.
Audience Take Away
- Paediatric surgeons, paediatricians and GPs will be more careful while evaluating a child with acute abdomen
- Paediatric morbidity and mortality will be decreased if acute abdomen in children is investigated thoroughly
- Further research can be initiated on unusual causes of pain abdomen in children
