Newborn with bilious vomiting

Surgical image of malrotation with midgut volvulus — Surgical image shows the midgut is dusky but not necrotic.

The diagnosis was malrotation with midgut volvulus.

Newborn with abdominal distension and failure to pass meconium

Surgical image of Hirschsprung disease — Surgical image shows a visible transition zone in the mid sigmoid colon with the forceps at the actual site of transition. The sigmoid colon (to the right) is dilated and had ganglion cells on biopsy. The rectum (to the left), descending into the pelvis, is not dilated and had no ganglion cells on biopsy.

The diagnosis was Hirschsprung disease.

Newborn with polyhydramnios on prenatal ultrasound and bilious vomiting after birth

Surgical image of jejunal stenosis due to jejunal web — Surgical image after the bowel has been incised shows a jejunal web within the bowel lumen.

The diagnosis was jejunal stenosis due to a jejunal web.

Newborn with vomiting

Surgical image of jejunal atresia — Surgical image shows a dilated stomach and duodenum (above) due to an atresia in the proximal jejunum. The remainder of the jejunum is spiraled around the ileocolic artery (apple peel atresia).

The diagnosis was jejunal atresia.

Newborn with vomiting

Surgical image of jejunal atresia — Surgical image obtained after resection and anastomosis of an atresia in the proximal jejunum (upper left) shows the jejunum spiraled around the ileocolic artery (apple peel atesia).

The diagnosis was jejunal atresia.

School ager with crampy abdominal pain and a fixed small bowel-small bowel intussusception

Surgical image of Non-Hodgkin lymphoma in the mesentery — Surgical image obtained after intussusception reduction and resection of the intussusception’s pathological lead point shows multiple large mesenteric lymph nodes.

The diagnosis was diffuse B-cell lymphoma (Non-Hodgkin lymphoma).

School ager with crampy abdominal pain and a non-transient small bowel-small bowel intussusception

Surgical image of small bowel - small bowel intussusception due to Non-Hodgkin lymphoma — Laparoscopic surgical image (above) shows the small bowel-small bowel intussusception. Surgical image of the small bowel after reduction of the intussusception (below) shows the serosa is pink-tan and intact with a 1.5 x 0.6 cm puckered, red, firm area that when opened in pathology revealed a 2.6 x 2.0 cm red-pink mass.

The diagnosis was diffuse B-cell lymphoma (Non-Hodgkin lymphoma) causing small bowel-small bowel intussusception.

School ager with abdominal pain and a non-transient small bowel-small bowel intussusception

Gross pathological image of small bowel - small bowel intussusception due to Burkitt lymphoma — Gross pathological images of the resected segment of intussuscepted small bowel shows on its serosal surface (above) a 2.0 x 1.2 cm irregular, tan-white centrally ulcerated and umbilicated firm area. The opened image of small bowel (below) reveals a 3.4 x 2.9 x 1.2 cm irregular, tan-white, smooth, firm mass which was sectioned to reveal smooth, tan-white, glistening, homogenous cut surfaces.

The diagnosis was Burkitt lymphoma causing small bowel-small bowel intussusception.

Newborn with emesis and bloody stools with an ileocolic intussusception which spontaneously perforated during reduction

Surgical image of ileocolic intussusception — Surgical image shows forceps in a 1.5 cm perforation in the mid point of the transverse colon. The ascending colon (on the right) is distended and is full of necrotic intussuscepted ileum up to the level of the hepatic flexure.

The diagnosis was ileocolic intussusception.

Infant with a large abdominal mass

Gross pathological image of inflammatory myofibroblastic tumor — Sectioned gross pathological image shows a tan to pink, firm, irregular solid mass measuring 14 x 13.5 x 8 cm. The mass was well encapsulated. No hemorrhagic necrosis or cystic degeneration was seen.

The diagnosis was inflammatory myofibroblastic tumor.

Infant with constipation

Surgical image of Hirschsprung disease — Surgical image shows a visible transition zone between the dilated sigmoid colon (in the upper middle being pinched between the two fingers) which contained ganglion cells and the narrowed rectum (in the lower middle) which was found to be aganglionic.

The diagnosis was Hirschsprung disease.

Toddler with constipation

Surgical image of Hirschsprung disease — Surgical image shows decompressed small bowel (on the left) and an extremely dilated sigmoid colon which contained ganglion cells (in the upper middle) with a transition zone near the end of the sigmoid colon (on the right) and a narrowed rectosigmoid colon and rectum (in the lower middle) which turned out to be aganglionic.

The diagnosis was Hirschsprung disease.

Newborn with abdominal distension and failure to pass meconium

Gross pathological image of Hirschsprung disease — Gross pathological image of the recto-sigmoid colon shows the dilated proximal portion of sigmoid colon which contained ganglion cells (on the left) separated by a transition zone from the narrowed distal portion of rectum (on the right) which turned out to be aganglionic.

The diagnosis was Hirschsprung disease.

Newborn with failure to pass meconium and bilious vomiting

Surgical image of Hirschsprung disease — Surgical image shows a transition zone in the terminal ileum with the proximal portion of the small bowel above the transition zone dilated (on the right) and the non dilated distal small bowel (on the left). The frozen biopsies showed no ganglion cells from the rectum all the way up to the terminal ileum.

The diagnosis was total colonic Hirschsprung disease.

Toddler with joint pain, abdominal pain, and a palpable rash

Clinical image of Henoch-Schonlein purpura — Clinical image shows the lower extremities to be covered with purple-colored palpable purpura.

The diagnosis was Henoch–Schonlein purpura.

Newborn post op from repair of an anterior abdominal wall defect

Surgical image of gastroschisis — Surgical image shows a prosthetic silo over loops of bowel not encased by a membranous sac that was created by sewing the silo to the fascia on either side of the incision. The silo was then wrapped in cotton gauze and sterile drapes. The patient underwent serial mesh tightening and on day of life eight underwent removal of the silo and final closure of the gastroschisis.

The diagnosis was gastroschisis.

Newborn with anterior abdominal wall defect

Clinical image of gastroschisis — Clinical image shows an anterior abdominal wall defect with stomach and small bowel exposed through an opening on the right side of the umbilicus. Note the absence of a peritoneal sac enclosing the abdominal contents.

The diagnosis was gastroschisis.

Newborn with anterior abdominal wall defect and dilated small bowel

Surgical image of gastroschisis — Surgical image shows an anterior abdominal wall defect with the small bowel protruding out of the abdomen, with no surrounding membranous sac. The small bowel loops are dilated. There was an atresia just distal to the cecum and the distal colon was small in caliber. A silo for the abdominal contents was constructed. A gastrostomy and cecostomy were also placed.

The diagnosis was gastroschisis and colonic atresia.

Newborn post op from repair of anterior abdominal wall defect

Surgical image of gastroschisis — Surgical image shows a silo over loops of bowel not encased by a membranous sac that is being sequentially reduced several days after the initial operation. The small intestine has been almost completely reduced into the abdomen.

The diagnosis was gastroschisis.

Teenager with crampy abdominal pain and vomiting

Surgical image of Crohn disease — Surgical image shows the terminal ileum, which is between the two forceps, to be thickened in nature, firm to palpation and to have mesenteric fat wrapped around it. The appendix is normal in appearance.

The diagnosis was Crohn disease.

A patriotic toddler with increasing stridor over time

Pathological image of an esophageal foreign body — Lateral radiograph of the airway (left) shows a radiopaque foreign body in the cervical esophagus which is associated with a large amount of retropharyngeal soft tissue swelling. Gross pathological image (right) shows a metal flag-shaped pin that was endoscopically retrieved from the patient’s esophagus.

The diagnosis was gastrointestinal foreign body which had been present for a long period of time.

Newborn with prenatal US showing polyhydramnios and a double bubble sign

Clinical image of duodenal atesia — Clinical image shows a massively distended abdomen.

The diagnosis was duodenal atresia.

Newborn with vomiting

Surgical image of duodenal stenosis — Surgical image shows a massively dilated second part of the duodenum in the center of the image. The decompressed proximal jejunum, being pinched between the thumb and forefinger, is seen to the left and inferior to the dilated duodenum.

The diagnosis was duodenal stenosis.

Preschooler with epigastric discomfort, especially when laying down to go to bed at night, who had a loop of bowel behind the sternum incidentally noted on a CXR

Surgical image of Morgagni hernia — Surgical image shows an anterior midline defect in the diaphragm, measuring 7 cm in width by 3 cm in depth. The transverse colon was herniated through this defect into the retrosternal space and had been reduced before this image was obtained.

The diagnosis was Morgagni hernia.

Newborn with respiratory distress

Gross pathological image of congenital diaphragmatic hernia — Gross pathological image shows portions of the intestine and spleen in the left hemithorax causing the heart to be displaced into the right hemithorax.

The diagnosis was left-sided congenital diaphragmatic hernia.