Monday, April 23, 2012

Bowel Obstruction in Children: Differential Diagnosis #4

Intestinal obstruction is a common concern in the pediatric population. While neonates often have congenital causes of obstruction such as Hirschsprung's disease or meconium ileus, older children above the age of infancy are more likely to have acquired causes. They may also have late presentations of the entities found in neonates. An easy way to remember the common causes of bowel obstruction in children is the mnemonic where you take (AIM)^2 or AAIIMM:

IIncarcerated inguinal hernia
MMeckel's diverticulum Rule of 2s for Meckel's: 
2% of the population
2 feet from the ileocecal valve
2 inches long
2 types of ectopic tissue (gastric and pancreatic)
2 years old at presentation.
2 times more common in boys
MMalrotation / midgut volvulusCorkscrew appearance

Midgut Volvulus
Midgut Volvulus
Source: Radiopaedia

The mnemonic comes from Donald R. Kirks, MD as described in Lane Donnelly's Pediatric Imaging: The Fundamentals.