School ager female with abdominal pain and an abdominal mass

Surgical image of ovarian dysgerminoma causing ovarian torsion — Surgical image (above) shows a mass arising from the left ovary. Surgical image (below) shows the left adnexal pedicle to be twisted in the center of the image. The mass and the left ovary and the fallopian tube were found to be torsed.

The diagnosis was ovarian dysgerminoma causing ovarian torsion.

Preschooler with a palpable midline abdominal mass

Surgical image of rhabdomyosarcoma of the bladder — Surgical image shows the mass (between the surgeon’s fingers) to be extraperitoneal in location, originating from the left posterior aspect of the dome of the bladder. The mass did not appear to invade any normal structures except where it originated in the bladder, which is along the inferior edge of the image.

The diagnosis was rhabdomyosarcoma of the bladder.

Female infant with a right ovarian cyst on prenatal ultrasound and an incidental abdominal calcification noted on a CXR

Surgical image of ovarian torsion — Surgical image shows a large circular and soft mass that was adherent to, but not invading, the hepatic flexure, omentum, and distal ileum and which was no longer connected to any pelvic structures. There was no ovarian tissue in the right adnexa. The left ovary was normal.

The diagnosis was ovarian torsion that most likely occured in-utero.

Toddler with a right-sided abdominal mass

Gross pathological image of neuroblastoma — Gross pathological image with the aorta in the midline cut open shows a large mass arising from the right adrenal gland, which displaces the right kidney inferiorly and which crosses the midline and encases the aorta.

The diagnosis was neuroblastoma of the right adrenal gland.

Teenager with bloody diarrhea

Pathological image of colonic pseudopolyps in ulcerative colitis — Pathological image of the colon shows colonic pseudopolyps.

The diagnosis was ulcerative colitis.

School ager with appendectomy 3 months ago, now with abdominal pain and vomiting

Surgical image of small bowel obstruction due to abdominal adhesions — Surgical image shows dilated and congested loops of small intestine in the upper right corner and normal sized decompressed loops of small bowel adjacent to them. A volvulus was noted at the level of the terminal ileum, caused by adhesions from the cecum to the small bowel, forming a closed loop obstruction that was causing bowel wall congestion.

The diagnosis was small bowel obstruction due to abdominal adhesions.

School ager who fell off his bike and has abdominal pain

Surgical image of small bowel perforation — Surgical image shows an ileal perforation with the forceps placed through the perforation.

The diagnosis was small bowel perforation secondary to bowel trauma

Premature newborn with abdominal distension and clinical deterioration

Surgical image of necrotizing enterocolitis — Surgical image shows the bowel was white and necrotic throughout its entire length from the duodenum to the colon. There was no salvageable bowel.

The diagnosis was total necrosis of the intestines due to necrotizing enterocolitis.

Toddler with an abdominal mass in the right upper quadrant

Surgical image of mesenchymal hamartoma — Surgical image shows a massive tumor in the left medial segment of the liver after it has been delivered. The left lateral segment of the liver and the right lobe of the liver appeared normal and this was confirmed by intraoperative ultrasound. The patient underwent a left medial segment hepatectomy.

Newborn infant of a diabetic mother who has failed to pass meconium

Clinical image of meconium plug — Clinical image shows a contiguous plug of meconium that was expelled by the patient after a water-soluble contrast enema.

Infant with non-bilious and bilious vomiting

Surgical image of Meckel's diverticulum — Surgical image shows shows multiple dilated loops of small bowel in the background with a sharp transition point seen in the center of the image in the terminal ileum where on its anti-mesenteric border a diverticulum is seen with an omphalomesenteric duct remnant coming off it. This remnant had been attached to the under surface of the umbilicus, serving as a fulcrum for a small bowel volvulus, resulting in a small bowel obstruction.

The diagnosis was Meckel’s diverticulum causing a small bowel volvulus and a small bowel obstruction.

Newborn with vomiting and a double bubble sign on prenatal ultrasound

Surgical image of jejunal stenosis — Surgical image shows the two retractors outlining a markedly dilated duodenum in the center of the image. The proximal jejunum is markedly stenotic where it joins to the duodenum at the duodenal-jejunal junction in the center of the image. The more distal jejunum is normal in caliber.

The diagnosis was jejunal stenosis.

Teenager with abdominal pain and vomiting with a narrowed terminal ileum

Gross pathological image of Chron's disease — Gross pathological image of the terminal ileum shows markedly thickened intestinal wall and adherent pericolonic fat (“fat-wrapping”).

The diagnosis was Crohn’s disease.

Newborn with vomiting and a palpable abdominal mass

Surgical image of duodenal duplication — Surgical image shows a cystic mass attached to the inner surface of the C-loop of the duodenum from just distal to the pylorus to slightly proximal to the region of the ampulla of Vater. The distal antrum is visible in the upper left corner of the incision and the gall bladder is visible in the right corner of the incision between the liver and the mass.

The diagnosis was duodenal duplication.

Newborn with failure to pass a nasogastric tube

Pathologic image of esophageal atresia — Pathological image taken from the posterior aspect of the specimen shows a dilated proximal esophageal pouch superiorly that abruptly transitions to a more narrow in diameter distal esophageal segment.

The diagnosis was esophageal atresia.

Newborn with failure to pass meconium

Surgical image of colonic atresia — Surgical images show numerous loops of small bowel which are dilated, thickened and inflamed along with an extremely dilated ascending colon which is at the lower part of the left image and to the left side of the right image. An area of atresia was identified at approximately the hepatic flexure. The downstream colon (not shown) had the appearance of a microcolon. On the right image, the forceps are on the dilated appendix.

The diagnosis was colonic atresia near the level of the hepatic flexure.

Infant with 5 days of vomiting and abdominal distension who now has peritoneal signs and currant jelly stools

Surgical image of ileocolic intussusception — Surgical image shows an ileocolic intussusception extending into the mid ascending colon with a dusky terminal ileum (to the right) intussuscepting into the cecum (to the left). Note that the appendix (in the middle of the image) is intussuscepted with the ileum. The intussusception was reduced without great difficulty manually. No lead point was seen.

Newborn with a cystic abdominal mass on prenatal US

Surgical image of ileal duplication — Surgical images show the round mass arising from the mesenteric border of the ileum.

The diagnosis was ileal duplication.

Infant with respiratory distress, anemia, and an abdominal mass

Surgical image of inflammatory myofibroblastic tumor — Surgical image shows a mass with a large number of collateral blood vessels that was intimately associated to the terminal ileum and cecum with the appendix draped across the mass.

The diagnosis was inflammatory myofibroblastic tumor.

Infant with vomiting and a palpable olive

Surgical image of hypertrophic pyloric stenosis — Surgical image shows delivery of the pylorus which is thickened, firm and blanched as opposed to its normal small, soft and pink consistency.

The diagnosis was hypertrophic pyloric stenosis.

Newborn with polyhydramnios and a double bubble sign on prenatal US

Surgical image of duodenal atresia — Surgical image shows a massive fluid filled stomach (on the left) and duodenal bulb (on the right) which was found to contain over 400 cc of fluid.

The diagnosis was duodenal atresia.

Newborn with failure to pass meconium

Surgical image of ileal atresia — Surgical image shows a massively dilated distal ileum (to the left of the image) than then dramatically narrows in the center of the image.

The diagnosis was ileal atresia.

Teenager with paraplegia who uses an appendicovesicostomy for self-catheterization who now has abdominal distension and no stool for one week

Surgical image of cecal volvulus — Surgical image shows an extremely distended cecum twisted around the pateint’s appendicovesicostomy tract. The distal ileum was also extremely dilated.

The diagnosis was cecal volvulus.

Young adult with recurrent pulmonary infections

Gross pathological image of bronchial atresia — Gross pathological image of a sectioned right middle lobe shows a dilated mucous filled airway (in white) distal to a focal area of an atretic bronchus.

The diagnosis was bronchial atresia.

Teenager with a chronic cough

Gross pathological image of bronchiectasis in cystic fibrosis — Gross pathological image of a sectioned lung shows marked dilation of the airways in the middle and lower lung with many of the dilated airways containing mucous within them.

The diagnosis was bronchietasis in cystic fibrosis.