Intussusception Small Intestine, Henoch-Schönlein Purpura vs. Intussusception Small Intestine, Gastrointestinal Duplication
Left picture: The diagnosis is a Henoch-Schönlein purpura with involvement of the intestine with edemas and bleedings of the wall, leading in this case to an ileoileal intussusception. Right picture: The cause of the present obstructive ileus is a duplication of the small intestine, which led to a compromise of the passage by accumulation of secretion in the duplication. Notice in the picture at the bottom in which the fixated resected intestinal segment is depicted, the antimesenteric site of the duplication which compresses the adjacent lumen of the small intestine. The connection of the duplication with the lumen of the small intestine - although insufficiently draining the secretions - explains the occurrence of repeated loss of blood through the anus because duplications frequently contain ectopic gastric mucosa. Intestinal obstructions are an important differential diagnosis of a surgical abdomen and, dependent on the individual case, also of an acute appendicitis. This is true for a complicated appendicitis at all ages and generally for an appendicitis in infancy and in toddlers.
Left picture: Acute abdominal emergency in a schoolchild with severe, colic-like abdominal pain, bilious vomiting and passage of blood from the anus. The belly is painful on palpation and from time to time high-pitched sounds can be auscultated. Besides the mentioned local abdominal findings the careful general examination reveals punctated bleedings at the inner side of the left foot. The operative findings at the bottom on the left side show an increasing dilatation of the small intestine from the top on the right side to the bottom on the left side with areas and points of hemorrhage. What diagnosis are you considering? Right picture: Schoolchild with bilious vomiting, abdominal pain and repeated loss of blood through the anus. Operative findings following opening of the abdominal cavity: In contrast to the segment of small intestine which is held with the thumb and the index finger on the left side, the segment which is localized proximally from it is very dilated. What pathology is present?