1 - Serviço de Cirurgia Pediátrica, Hospital de Dona Estefânia, Centro Hospitalar Universitário Lisboa Central
- 8ª Reunião da EUSPP/ 23ª Congresso da SPCP
- Évora, 4 e 5 de Maio de 2023
Intestinal obstruction in the newborn is an emergency situation, caused by different conditions. Abdominal masses are one of them, possibly leading to volvulus, which late diagnosis results in high morbidity and mortality.
Clinical case: A 27 days-old was referred to our emergency room presenting with bile-stained vomits and no other symptoms. The patient had a prenatal diagnose on ultrasound (US) of an anechoic mass at the right side of the bladder; no other exams were performed. On admission, he was emaciated; the abdomen physical exam showed normal bowel sounds, no tenderness and no palpable masses; bilious nasogastric drainage. Blood gas sample with lactate 2.8 mmol/L and no other relevant alterations in laboratory tests. Abdominal x-ray showed distension of the transverse and left colon. Abdominal US revealed signs of mesenteric vessel torsion, suggesting intestinal volvulus, and a well delimited multiseptated cystic mass at the abdomino-pelvic transition, measuring 6x2 cm, suggesting lymphangioma/teratoid lesion. An exploratory laparotomy was made, detecting partial volvulus of the small intestine, without ischemia, with lymphatic congestion conditioned by a yellow multilobed structure at the mesenteric edge of the jejunum’s terminal loop. This intestinal segment was permeable with no apparent continuity with the structure. Malrotation was excluded. Segmental jejunal resection, including the mass, and end-to-end anastomosis were made. The anatomopathological report was compatible with lymphatic malformation (LM).
Discussion: Abdominopelvic LM can cause bowel obstruction and intestinal volvulus, being possibly detected during pregnancy US. Obstruction generally presentes as an acute abdomen with fast deterioration of the clinical status, with surgery being imperative.
Conclusion: In order to avoid morbi-mortality it is essential an early clinical suspicion and treatment.