Segmental Dilatation of Small Intestine

Abstract

Segmental dilatation of the small bowel is a rare anomaly, the clinical features of which were intestinal obstruction, anemia due to blood loss, anemia due to malabsorption and intermittent intestinal obstruction [1]. A rare case of segmental dilatation of small bowel with the clinical picture of a blind loop syndrome is presented.A three-year-old Saudi male was admitted with the chief complaint of constipation alternating with passage of loose, yellowish, foul-smelling and occasionally mucinous stools starting at the age of four months. Before this, the child was perfectly well. There is a history of nonprojectile vomiting occurring on two occasions after excessive food intake. Despite a voracious appetite, there was poor weight gain, later weight loss, and failure to thrive. The patient was frequently hospitalized but his condition remained obscure. The parents observed transient improvement following intake of metronidazole. The boy was found in poor general condition. The weight (9.5 kg), height (80 cm), and head circumference (48 cm) were below the fifth percentile. The abdomen was nontender but distended, with visible intestinal loops and peristalsis. Hemoglobin was 10.8 g, MCV 89, and MCHC 33.A plain film of the abdomen was not conclusive. Barium meal revealed a dilated loop of small intestine located on the right side of the abdomen with evidence of delayed emptying. Barium enema showed the cecum and ascending colon placed on the left side of the abdomen. At laparotomy, there was segmental saccular dilatation of the small intestine measuring 40 cm in length. The segment was lying midway between the ligament of Treitz and the ileocecal valve, the distance from each being 60 cm (Figure). The mesentery of the dilated segment was very vascular, thickened and with many enlarged lymph nodes. Nonfixation of the cecum and ascending colon was confirmed. Resection of the dilated segment and an end-to-end anastomosis as well as appendectomy were performed. A change of the nonfixation state of the cecum and ascending colon was not attempted. The opened specimen showed no evidence of intrinsic obstruction. Mesojejunum, submucosa, and serosa showed fibrovascular proliferation, the blood vessels appearing elongated and ectatic. However, the mucosa was normal. The muscle coat was hypertrophic with normal ganglionation. The appendix was histologically normal. The postoperative recovery was uneventful. All symptoms have disappeared and the child is thriving well a year following the operation.Segmental dilatation of the small intestine has been referred to by various terms such as "giant Meckel's diverticulum", unusual anomaly of the small intestine, the bulbous bowel segment [2], segmental mega-ileum, and ileal dysgenesis [3], reflecting lack of clarity about the etiopathogenesis of this condition. Komi and Kohyama postulate that segmental dilatation may arise from prolonged obstruction of the bowel during fetal life because of external compression that may subsequently involute [4]. Against this phenomenon being an acqu...