PMC4898003_01
4-year-old boy with small bowel polyps. Frontal, supine radiograph of the abdomen demonstrates a large soft tissue mass in the central abdomen, displacing bowel loops peripherally. The stomach is moderately distended.
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Frontal radiograph of the abdomen (Fig. 1) demonstrated a mid abdominal soft tissue mass which displaced bowel loops to the periphery, a distended stomach, and a relative paucity of gas distally.
4-year-old boy with small bowel polyps. Contrast enhanced axial CT images demonstrate the jejunojejunal intussusception. The intussusceptum (arrow head) is contained within the intussuscipiens (*). Intussuscepted mesenteric fat can also be identified (arrow).
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A small bowel obstruction was suspected and an abdominal/pelvic contrast enhanced computed tomography (CT) scan (Fig. 2) was performed.
4-year-old boy with small bowel polyps. Upon entering the peritoneal cavity, some distended loops of jejunum were identified (arrowhead). More normal appearing bowel is also identified (*). Note the difference not only in size, but also the color.
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On entering the peritoneal cavity, very large, distended loops of small bowel were encountered (Fig. 3).
4-year-old boy with small bowel polyps. Intraoperative view of the intussusception with normal appearing bowel (*) distally, intussusceptum which includes mesenteric fat (arrow), and dilated intussuscipiens (arrow head).
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There was proximal jejunal to jejunal intussusception (Figure 4) with lead point about 12 cm distal to the ligament of treitz.
4-year-old boy with small bowel polyps. Gross, resected jejunal specimen with three hemorrhagic polyps (*) which served as the lead points. Note the clear demarcation between the hemorrhagic and normal mucosa (arrows).
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There were three polyps noted on the antimesenteric border of the jejunum that acted as a lead point (Fig. 5). After complete reduction, there was a clear transition zone between the proximal 10 cm of the jejunum and the next 50 cm, where there was hemorrhagic-appearing mucosa (Figure 5).
4-year-old boy with small bowel polyps. Low power (6A) and high power (6B) H&E photos of hamartomatous polyp with hemorrhagic necrosis. Note the band of smooth muscle running through the polyp (*). Images courtesy of Dr. Kathleen Patterson.
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Pathological evaluation revealed hemorrhagic hamartomatous polyps (Fig. 6).
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