Dirk Schaper, P. Göbel (Klinik für Kinderchirurgie Krankenhaus St. Elisabeth und St. Barbara Halle-S.)  

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7 Years  

Male  

One week ago, stomach ache for the first time, partly crampy in nature, 3 times a day. There is an obvious connection to food ingestion. In the sense of primary symptoms, bloodwork was done on the 2nd of November; there, anemia noted. On the 5th of November, initial worsening of the patient's condition with lack of appetite, malaise, increased stomach aches and a repeating vomiting with acute onset.  

N/A  

<- view Ultrasound 1

Ultrasound 1: RUQ transverse: 42x30 mm in size, irregularly marked, non-echo-free mass with incomplete, gechogenic edge. Changes position on breathing in the area of the right colonic flexure.


<- view Ultrasound 2

Ultrasound 2: RUQ longitudinal: Same mass in power-mode. Homogenic vasculature, therefore not a cystic process.


<- view Ultrasound 3

Ultrasound 3: RUQ diagonal: Questionable localization of the mass (in the gut?) which has a stalk-like structure. At the lower edge one got the impression that there was a intussception "bulls-eye," which was not able to be completely visualized.


<- view Ultrasound 4

Ultrasound 4: RUQ diagonal: Visualization of the vessel's stalk and the branching within the mass.


<- view Ultrasound 5

Ultrasound 5: RUQ transverse, paramedian: Obvious lymph node swelling medial to the mass.


<- view OP-Situs 1

OP-Situs 1: Palpable tumor in the cecum.


<- view OP-Situs 2

OP-Situs 2: Ileocecal transition. Lymph node in the foreground, tweezers in the partly intusscepted ileum in the cecum.


<- view OP-Situs 3

OP-Situs 3: Intraoperative: Determination of the resection's edges.


<- view OP-Situs 4

OP-Situs 4: Specimen luxated out of the cecum.

Surgery / Histo  

Gastrointestinal inflammatory myofibroblastic tumor, intussusception, duplication, lymphoma.  

After extensive diagnostics (including CT, MRI), the ileocecal resection with end-to-end anastomosis is performed. After receiving histology, the child was transferred to the department of pediatric hematology and oncology.  

The sonographic categorization of the process in the lumen of the gut was difficult. Because of the connection to the gut and its partial intussusception, the categorization of which organ this belonged could be assumed. Intraoperatively, the sonographic findings of a partial intussusception were confirmed. A remarkable mobile cecum explains the localization of the tumor in a supine patient in the RUQ.  

N/A  

Mendelson, R.M., S.Fermoyle: Primary gastrointestinal Lymphomas: A radiological-pathological review. Part1: Stomach, oesophagus and colon
Australasian Radiology (2005) 49, 353-364

Zuti,S.,G.A.Rouse,M.de Lange:
Burkitt´s Lymphoma: A spectrum of sonographic findings
J Diag Med Sonograph (1993) 9(1) 19-23  

GI-Small intestine  

neoplastic