AN INTERESTING CASE OF

PEDIATRIC EPIGASTRIC

LUMP

History and clinical features

• A 10 yr old girl came with

complaints of

– Acute pain in epigastric region and

bilious vomiting since 2-4 days.

– O/E : Epigastric lump with localised

tenderness was noted.

– Temperature was slightly raised.

Erect plain X Ray AP View

Doppler on ultrasound

SMV

SMA

Upper GI study

Pylorus and

duodenal bulb

noted to the right

Direction of

barium flow

A NORMAL BARIUM STUDY

OUR PATIENT

NORMAL BARIUM STUDY LATERAL VIEW

OUR PATIENT BARIUM

STUDY LATERAL VIEW

“CORKSCREW

APPEARENCE”

Malrotation of Gut with

Midgut volvulus

Final diagnosis

Pedicle of the

volvulus

Superior mesenteric

artery noted along the

pedicle

Mesenteric

attachment

Segment of

intestine

alongwith the

volvulus

TAKE HOME MESSAGE

Upper

gastrointestinal

barium studies

are NOT obsolete

Dynamic USG for

demonstrating

the WHIRLPOOL

SIGN

Accurate

knowledge of

normal

appearances of

upper GI series

FINAL DIAGNOSIS