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CASE VIDEO
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 124

Visible Intestinal Peristalsis in a Child


Department of Pediatrics, Kamala Raja Hospital, GRMC, Gwalior, Madhya Pradesh, India

Date of Submission22-Mar-2022
Date of Decision03-May-2022
Date of Acceptance03-May-2022
Date of Web Publication30-May-2022

Correspondence Address:
Dr. Borra Ranganath
Department of Pediatrics, Kamala Raja Hospital, GRMC, Gwalior, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipcares.ipcares_82_22

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How to cite this article:
Ranganath B, Ambey R. Visible Intestinal Peristalsis in a Child. Indian Pediatr Case Rep 2022;2:124

How to cite this URL:
Ranganath B, Ambey R. Visible Intestinal Peristalsis in a Child. Indian Pediatr Case Rep [serial online] 2022 [cited 2022 Aug 11];2:124. Available from: http://www.ipcares.org/text.asp?2022/2/2/124/346265

A 4-year-old boy presented with recurrent episodes of vomiting for 4 weeks, each nonbilious and projectile in nature. He also had decreased intake of food but no diarrhea, abdominal pain, or distention. There was a significant history of pica. Examination revealed moderate acute malnutrition and pallor. Abdominal inspection revealed visible intestinal peristalsis in the right hypochondriac and epigastric region [Video 1][Additional file 1]. Ultrasonography showed a dirty shadow in the stomach. Barium follow-through showed inhomogeneous filling defects at 3, 6, and 9 h suggestive of a bezoar [Figure 1]. The family was advised surgery but left against medical advice.
Figure 1: Barium follow-through at 9 h showing inhomogeneous filling defects, indicative of bezoars

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Visible peristalsis are waves of movement across the abdomen that often originate from the left upper quadrant and move to the right lower quadrant direction. They are typically a sign of gastric outlet or intestinal obstruction.[1] Intestinal obstruction may not always present with typical manifestations. Visible intestinal peristalsis may be overlooked by the parents and clinician. In young infants, a common cause is hypertrophic pyloric stenosis. Beyond this, the usual underlying pathology are mechanical causes of obstruction resulting from hernia, diverticular disease, tumors, adhesions, strictures, intussusception, volvulus, or foreign body (swallowed material, bezoar, and parasite). Nonmechanical causes of obstruction such as paralytic ileus or Ogilvie's syndrome (acute colonic pseudo-obstruction) will not manifest with this sign, as gut motility is reduced, and there is no anatomical obstruction. Untreated bezoars may lead to gastric perforation.[2] They are common among children with pica.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shimizu T, Tokuda Y. Visible intestinal peristalsis. BMJ Case Rep 2013;2013. doi:10.1136/bcr-2013-201748.  Back to cited text no. 1
    
2.
Mehta MH, Patel RV. Intussusception and intestinal perforations caused by multiple trichobezoars. J Pediatr Surg 1992;27:1234-5.  Back to cited text no. 2
    
3.
Lalith S, Gopalakrishnan KL, Ilangovan G, et al. Rapunzel Syndrome. J Clin Diagn Res 2017;11:D01-2.  Back to cited text no. 3
    


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