Infant with bilious vomiting

Surgical image of malrotation with midgut volvulus — Surgical image shows spiraling of the bowel around the midgut mesentery (superiorly). The small bowel (peripherally) is dusky in color.

The diagnosis was malrotation with midgut volvulus.

Infant with bilious vomiting

Surgical image of malrotation with midgut volvulus — Surgical image shows spiraling of the bowel around the midgut mesentery (right superiorly). The small bowel (peripherally) is dusky in color.

The diagnosis was malrotation with midgut volvulus.

Infant with bilious vomiting

Surgical image of malrotation with midgut volvulus — Surgical image shows spiraling of the bowel around the midgut mesentery in the center of the image. The small bowel (inferiorly) is dusky in color.

The diagnosis was malrotation with midgut volvulus.

Infant with bilious vomiting

Surgical image of malrotation with midgut volvulus — Surgical image shows spiraling of the bowel around the midgut mesentery in the center of the image. The small bowel is not dusky in color.

The diagnosis was malrotation with midgut volvulus.

Newborn with bilious vomiting

Surgical image of malrotation with midgut volvulus — Surgical image shows spiraling of the bowel around the midgut mesentery in the center of the image. The small bowel (to the left) is dusky in color.

The diagnosis was malrotation with midgut volvulus.

Newborn with bilious vomiting

Surgical image of malrotation with midgut volvulus — Surgical image shows the midgut (superiorly) to be dusky in color.

The diagnosis was malrotation with midgut volvulus.

Newborn with bilious vomiting

Surgical image of malrotation with midgut volvulus — Surgical image shows spiraling of the bowel around the midgut mesentery in the center of the image.

The diagnosis was malrotation with midgut volvulus.

Newborn with bilious vomiting

Surgical image of malrotation with midgut volvulus — Surgical image shows the entire midgut being twisted around a single narrow mesentery in the center of the image.

The diagnosis was malrotation with midgut volvulus.

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 atresia).

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.