An unusual cause of small bowel obstruction in a child: ingested rhubarb.

Small bowel obstruction is rarely caused by bezoars concretions formed from undigested foreign material in the gastrointestinal tract. An important cause of bezoars is phytobezoars, formed from vegetables or fruits. A four-year-old boy presented to our emergency department with symptoms of acute intestinal obstruction. Upright plain abdominal radiography revealed multiple air fluid levels. Ultrasound showed no abnormalities, and because of worsening symptoms computed tomography of abdomen was performed. It showed intraluminal obstruction of the terminal ileum. Exploratory laparotomy revealed a phytobezoar consisting of undigested rhubarb. The mass was milked through the large bowel and out the anus. Although rare in humans, bezoars are a well-documented cause of small bowel obstruction and should be considered when intraluminal bowel obstruction occurs. Bezoars causing small bowel obstruction may require surgical treatment.

Treatment of airway obstruction by metallic stents in infants and children.

OBJECTIVE: The internal metallic stent is a relatively new and controversial method for the treatment of airway collapse in infants and children. The study examined the outcomes of this treatment in a large group of patients and defined clear indications for airway stenting. METHODS: A retrospective review was conducted of 32 patients in whom 42 stents were inserted. The patients were divided into three groups with respect to the stented segment: group A, trachea (n = 14); group B, bronchi (n = 16); and group C, trachea and bronchi (n = 2). RESULTS: In 30 cases, there was immediate improvement of respiratory obstruction, and 23 patients could be weaned, at least temporarily, from ventilation. Excessive granulation developed after the stenting in 26 patients. In 6 patients, all in group A, the granulation and inflammatory reaction generated severe airway obstruction, necessitating thoracotomy in 2 cases. One patient died of airway obstruction, and another died during the attempt to remove the stent; both were in group A. Stents placed for 2 to 72 months (mean 8.7 months) have now been removed in 11 patients. Six children are alive and well with stents in place, 2 from group A and 4 from group B. Fifteen patients died during the follow-up period; in 13 cases, death was related to the associated disease. CONCLUSION: The use of metallic stents, especially in the trachea, is associated with a high rate of complications. Granulation tissue, which often develops after stenting, is a major concern. Removal of the stents is arduous and carries a high risk of complications. The use of stents should be restricted to the limited situations in which conventional initial therapy has failed.

Mass at the splenic hilum: a clue to torsion of a wandering spleen located in a normal left upper quadrant position.

Wandering spleen is an extremely rare condition in which the spleen is lacking its normal ligamentous attachments and therefore can move to an ectopic position in the abdomen or pelvis. Wandering spleen predisposes the patient to life-threatening complications due to torsion of the spleen's vascular pedicle, with resulting splenic infarction, portal hypertension, and bleeding. Because of the nonspecific symptoms, imaging plays an important role. To our knowledge, only a few case reports describing wandering spleen in the pediatric population have been published, including 2 cases in infancy. We report a case of splenic torsion in an infant with a preoperative diagnosis made on the basis of color and power Doppler sonography. The diagnosis was confirmed by contrast-enhanced helical computed tomography (CT) and proved at surgery. On sonography, a diffusely hypoechoic spleen and a mass at the splenic hilum representing the torsed splenic pedicle were shown. The splenic hilar mass correlates with the CT "whirl" sign indicative of torsion.