Image of the Month—Diagnosis FREE

A 14-year-old boy was brought to the Department of Pediatic Surgery at Rabat University Children's Hospital with an 8-day history of abdominal cramping, pain, and bile-stained vomiting. During the past 6 months he had experienced episodes of abdominal distention, constipation, and bile-stained vomiting and 1 episode of hematemesis and rectal hemorrhage 3 days before his admission. He weighed 37 kg; although his abdomen was not distended, the upper abdomen was tender, with normal bowel sounds and no palpable mass. The results of laboratory examinations were all normal. An abdominal radiograph did identify an abnormally dilated loop of the small bowel. Investigations were performed, including esophagogastroduodenoscopy, which identified gastric ulcerations caused by vomiting. A small-bowel meal revealed mildly dilated small-bowel loops and a large lucent shadow in the upper abdomen (Figure 1). Abdominal ultrasonography and computed tomography revealed a well-encapsulated, unilocular, homogeneous mass, 12.4 × 6.8 × 11.0 cm, filling the lower abdomen up to the umbilicus and causing a volvulus of the small bowel. No other abnormalities were detected. At laparotomy, a mesenteric mass of the terminal ileum was identified approximately 20 cm proximal to the ileocecal valve. The mass extended to the antimesenteric border of the small bowel. The ileum segment was patent with signs of some edema and appeared to have formed a volvulus causing an intermittent obstruction. The mass was resected with the ileum segment (Figure 2). The patient made a good recovery and had no recurrence of his symptoms within 2 years of the operation.

A. Mesenteric lipoma

B. Abdominal cystic lymphangioma

C. Intestinal lymphoma

D. Lipoblastoma