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Peritonitis mimicking mechanical duodenal obstruction in an infant

Department of Diagnostic Radiology, Stopford Medical School, Manchester M13 9PT

This excerpt was created in the absence of an abstract.

Bilious vomiting is a common symptom of systemic disease in infancy but it is also the cardinal symptom of mechanical duodenal obstruction. Paralytic or adynamic ileus in the adult may reproduce the radiological signs of duodenal obstruction, but such an event in childhood has not been described in the radiological literature. The case of an infant in whom bilious vomiting due to primary peritonitis led to the erroneous radiological diagnosis of mechanical obstruction of the duodenum with volvulus is described.

A nine-week-old boy presented with a 6-day history of swelling of the left leg and groin. There was no pyrexia and he was not systemically unwell, but dilated superficial veins were noted over the oedematous groin and lower abdominal wall. The clinical features and associated neutrophil leucocytosis led to a diagnosis of femoral venous thrombosis secondary to infection, although no causative organism was identified. Accordingly, intravenous antibiotic therapy was commenced. He remained quite well until 3 days later, when there was sudden clinical deterioration with bilious vomiting and abdominal distension. A "septic screen" including cerebrospinal fluid and urine culture again showed no new evidence of infection.

Received for publication February 1, 1986.