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Megacystis-Microcolon-Malrotation-Intestinal-Hypoperistalsis Syndrome (MMMIHS)

The MMMIHS is a rare cause of intestinal obstruction and consists of a massively dilated bladder,

Perforation of the GI tract is mostly iatrogenic. Both stomach and esophagus can incidentally be perforated by feeding tubes. The treatment with prosta-glandins in case of patients with a patent ductus of Botalli can also be complicated with a perforation of the GI tract. Rectal use of a thermometer is inci

Fig. 5.10a-c. MMMIHS: highly distended stomach on contrast study with slow passage of contrast. Very little peristaltic activity. a,b Note the unusual microcolon and distended bladder (catheter). Secondary hydronephrosis because of dilated bladder. c Dilated system can be seen on EU, with the atonic, large bladder with dilatation of the pyelocaliceal system

Fig. 5.10a-c. MMMIHS: highly distended stomach on contrast study with slow passage of contrast. Very little peristaltic activity. a,b Note the unusual microcolon and distended bladder (catheter). Secondary hydronephrosis because of dilated bladder. c Dilated system can be seen on EU, with the atonic, large bladder with dilatation of the pyelocaliceal system

Fig. 5.11a,b. Pneumo-peritoneum in an infant with ileal perforation. Free air outlining the GI tract. Note the visualized falciform ligament. a Supine film with "football sign"; b "cupula sign", free air under the cardiac silhouette

Fig. 5.11a,b. Pneumo-peritoneum in an infant with ileal perforation. Free air outlining the GI tract. Note the visualized falciform ligament. a Supine film with "football sign"; b "cupula sign", free air under the cardiac silhouette

dentally followed by rectal perforation (Devos and Meradji 2003).

Sepsis, obstructions and vascular accidents, especially necrotizing enterocolitis, are all non-iat-rogenic causes of enteral perforation.

A distended and painful abdomen with or without respiratory problems are clinical signs of perforation.

Perforation is most reliably demonstrated on abdominal plain films if taken in two directions. A supine film (Fig. 5.11) will demonstrate an abnormal lucency in the upper abdomen with gas outlining the right lobe of the liver, both sides of the wall of the stomach and bowel loops. The falciform ligament may be visible in the upper abdomen. In the newborn, a left-side down decubitus film will demonstrate free air between the liver and peritoneal wall, which is almost certainly impossible to confuse with intraluminal air. In case of an unstable neonate, a cross-table lateral view is preferred, but it can mask free air behind intraluminal air, unless the so-called 'triangle' sign (Fig. 5.12) is present.

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