Mysterious Terminal Ileum Narrowing in a 13-year-old Girl.

1. Sudarshawn Damodharan, DO* 2. Istvan Danko, MD, PhD* 3. Hau D. Le, MD† 1. *Department of Pediatrics, 2. †Department of Surgery, American Family Children’s Hospital–University of Wisconsin, Madison, WI A 13-year-old premenarchal, obese girl with a past medical history significant for anxiety presented to the emergency department with multiple episodes of nonbloody, nonbilious emesis. She also reported having worsening nausea over the past week along with constant and diffuse abdominal discomfort for the past few months. Her parents had given over-the-counter omeprazole and antacids with no relief. Review of systems was negative for weight loss, diarrhea, hematochezia, fatigue, or decreased appetite. Vitals obtained were within normal limits. She was afebrile. On physical examination, the patient appeared anxious. A complete physical examination showed no evidence of abdominal distention, tenderness, hepatomegaly, or splenomegaly upon palpation. Her blood work was significant for leukocytosis with white blood cell count of 12.9 × 103 /μ L, elevated inflammatory markers with a c-reactive protein of 5 mg/L, and erythrocyte sedimentation rate of 39 mm/hour. Her complete metabolic panel was unremarkable. A computed tomography scan of the abdomen showed a large amount of heterogeneous material within the stomach, a high-grade small bowel obstruction (SBO), and fecal material in the terminal ileum (TI) along with wall narrowing and thickening of the TI without a focal lesion. The patient was admitted to pediatric general surgery service for management of her SBO. Given the findings of bowel wall thickening of the TI and elevated inflammatory …