Intra-abdominal pneumatosis because of gastric outlet obstruction

Posted By Paggie Kim
Intra-abdominal pneumatosis because of gastric outlet obstruction

A 9 week-old healthy full term infant was brought to emergency care with a history of intermittent vomiting after feeding and a 1.5 lb. (~10%) weight loss noted in the past week. On physical examination, the infant’s abdomen was distended and tender to palpation. Abdominal sonography showed gastric distention with air and portal and splenic venous gas (Fig 1 & 2). The infant developed bradycardia (heart rate of 50 beats/minute) and bradypnea requiring resuscitation with oxygen administered by mask. His serum potassium level was 2.3 mMol/L (normal in our laboratory is 3.5 - 5.0 mMol/L); Chloride level was 45 mMol/L (normal in our laboratory is 98 - 109 mMol/L) and serum CO2 of 45 mMol/L (Normal in our laboratory is 23 - 33 mMol/L). Subsequent abdominal radiographs, after the patient had vomited and also was treated with a nasogastric tube for suction, showed clearing of most the pneumatosis previously present in the liver and spleen (Fig 3 & 4); abdominal examination was positive for a “pyloric olive”, and confirmed by grey scale ultrasound (Fig 5 & 6). The pyloric stenosis was treated surgically with resolution of the infant’s symptoms and recovery of his ability to tolerate feedings with formula. He has been maintaining his weight after the surgery.

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  • Paggie Kim 2015-06-19 22:39:03

    Hi Dr. Talanow,



    We are very interested in submitting this case to JRCR because there was great radiographic and sonographic findings of hypertrophic pyloric stenosis with foci of air in the portal veins and splenic veins. We often think of necrotizing enteritis when we see portal venous gas but gastric outlet syndrome is also a ddx. This is the first case of hypertrophic pyloric stenosis with air in the splenic veins in our institution that demonstrated on an ultrasound study. There are 3 similar cases reported in the literature with findings on the radiographs. To our knowledge, there is none reported the literature with the findings on ultrasound. We believe that this is a great learning case. It also highlight the ultrasound findings of portal and splenic venous air. We hope to have the opportunity to publish this case in JRCR. Thank you so much.



    Sincerely,



    Paggie Kim

    Reply

  • Roland Talanow 2015-06-06 22:46:41

    Thank you for showing this case. If interested in submitting to JRCR, what makes this case special/report worthy? Thank you.

    Reply