A 2-month-old female patient, born with a first pregnancy (31 weeks of gestational age and birth weight of 1450 g), presented with vomiting for 12 hours.
The patient had been hospitalized in neonatology since birth for 20 days due to hyperbilirubinemia and compatible with sepsis.
One month of age required a new hospitalization for 10 days due to an episode of sepsis caused by enteral focus, without germ identification.
As the child had frequent vomiting episodes since birth, a contrasted esophago-gastroduodenal series (GDS) had been performed three weeks prior to admission, which made it possible to diagnose three degree of reflux.
When vomiting worsened, the mother consulted in our institution, where she was hospitalized with a presumptive diagnosis of pyloric stenosis.
Upon admission, the patient was in a general condition afflicted with signs of voiding dysfunction (whitening of diuresis).
Umbilical hernia was cohercible and reducible with simple maneuvers.
The stools had normal characteristics.
The patient had a good feeding attitude, but vomited a few minutes after eating each food.
Pathogram, ionogram and EAB were normal.
Parenteral hydration was indicated and feeding was temporarily suspended.
During the first 24 h of hospitalization, the frequency of vomiting increased, which became bilious.
His general condition worsened, with distended abdomen, painful and tender to palpation, and intermittent crying.
A plain radiograph of the abdomen with radiopaque circular image of foot approximately 3 cm in diameter in the hypogastric region was performed, with intestine proximal to the dilated image and without distal air, compatible with coprolite.
Abdominal ultrasound showed distended intestinal loops with fluid content and increased peristalsis, without free fluid in the cavity; the rest was difficult to assess due to intense weather.
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With a diagnosis of obstructive surgical acute abdomen, the exploration was decided in the operating room.
Laparotomy was performed, finding an appendix with normal characteristics and intestinal dilation proximal to palpable concretion, 6 mm, located in the lumen of the small intestine at 10 cm from the ileocecal valve.
The concretion had hard-to-beat characteristics; as it was fixed to the intestinal mucosa, its mobilization was difi cult to remove it. When trying to remove it, there was tear of the serosa from the wall
The removed mass was whitish-colored, hard-to-beat consistency and firmly adhered to the ileal mucosa, which was separated with difficulty.
The patient had a favorable evolution and was discharged one week later.
