Small Intestine Perforation, Blunt Abdominal Injury vs. Obstructive Ileus due to Adhesions
Left picture: This child has sustained a blunt abdominal trauma as part of a battered child syndrome. The diagnosis is a free intestinal perforation; according to the findings on revision, the perforation is localized in the jejunum on the antimesenteric side, and is visible in the picture at the bottom on the left side. Right picture: The reason for the described clinical presentation is not a constipation; rather, an obstructive ileus due to postoperative adhesions is present which could have been suspected not only from the clinical presentation, but also by a precise history with former abdominal surgery. Compare that with the picture at the bottom on the right side showing an adhesion running over the mesentery and covering two intestinal loops with already compromised blood supply. Besides a complete history, a precise clinical examination is important; in this case, a barely visible scar following appendectomy was present in the right lower belly.
Left picture: Surgical abdomen in a schoolchild. The lateral plain x-ray of the abdomen in supine position - the child was unable to stand due to pain and the local findings - displays an abdomen void of air, and two large air-fluid levels. Right picture: Schoolchild with sudden onset of vomiting and abdominal colics around the navel and in the right lower abdomen. In addition, a hardly visible scar was present in the right lower abdomen. The plain abdominal x-ray performed between the colics in upright position shows two isolated air-fluid levels in the midline, and a marked coprostasis in the left colon.