Subserosal haematoma of the ileum.

N.C., a white male infant, born June 18, 1958, was admitted to hospital on May 18, 1959, when 11 months old, with a five days' history of being irritable and apparently suffering from severe colicky abdominal pain for the previous 24 hours. On the day of admission his bowels had not moved and he vomited several times. He looked pale and ill and a mass could be felt in the right hypochondrium. There was no significant abdominal distension and the bowel sounds were within normal limits. A saline enema was given which showed a small amount of mucus but no blood. A diagnosis of intussusception was made, and after resuscitation with intravenous therapy the same evening laparotomy was performed, which showed no evidence of intussusception, but instead a large subserosal haematoma, involving approximately 7 cm. of ileum, 30 cm. from the ileo-caecal junction, and which formed the tumour that had been felt clinically (Figs. 1 and 2). In the middle of the haematoma there was a hard yellow small tumour; the mesenteric glands were slightly enlarged and some were blueish in colour. Resection of the diseased segment with end-to-end anastomosis was performed, and the appendix was removed. The child remained ill for a few days but recovered and was discharged home on the seventh postoperative day, when he was taking feeds well and gaining weight. When last seen, two months after operation, he was thriving and no further appointment was considered necessary. The appendix, as expected, showed no macroor microscopic abnormality; the mesenteric gland showed, on microscopic examination, only sinus catarrh. The resected gut, on macroscopic examination, showed 'a segment of intestine 9 cm. long, half way along which there was a haemorrhage over an area of 4 cm., which had lifted the serosa from the rest of the wall. On the outer aspect, also half way, there was a small diverticulum 1 cm. long, which, however, did not appear to communicate with the lumen of the small bowel. Opposite, the mucosa had a small erosion'. Microscopical examination (Figs. 3, 4 and 5) showed that 'considerable haemorrhage had occurred in the serous, muscular and mucous coats. The mucosa, however, was viable and the maximal zone of damage was towards the serosa. Numerous large capillaries were present in the coats. The lining of the diverticulum formed by glandular epithelium suggesting ileal mucosa was partly destroyed, but it had a well-formed muscular coat': it was considered to be probably a duplication. The main diagnosis was that of haemangioma of the ileum.