Anorexia nervosa is a condition with a wide range of presenting signs and symptoms. Our report describes an adolescent suffering from restrictive anorexia nervosa (no purging) who presented with a Body Mass Index (BMI) of 9,73 kg/m² and asymptomatic spontaneous subcutaneous emphysema, pneumomediastinum, pneumoperitoneum and pneumatosis intestinalis. History revealed fatigue, lower limbs weakness, jaw pain and swollen neck over the last few weeks but no abdominal complaints. She was successfully managed with supportive care and progressive enteral nutrition leading to a favourable outcome with significant weight gain (BMI of 12,1 kg/m²at discharge). Her clinical course was complicated by refeeding syndrome and Rotavirus gastro-enteritis leading to a pre-shock state. We hypothesize that her clinical presentation was attributable to severe chronic undernourishment. Previous reports support the theory that severe undernourishment can lead to altered interstitial wall composition, which could result in migration of air through weakened alveolar or intestinal wall. This case is of interest given that spontaneous pneumoperitoneum and pneumatosis intestinalis have rarely been described in association with anorexia nervosa, especially in an asymptomatic patient. In addition, her favorable outcome suggests that these patients can effectively be managed with conservative care. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Massé-bouillé Guy-anne, Taddeo Danielle, Jamoulle Olivier, Frappier Jean-yves, Wilkins Jean, Miron Marie-claude

Keywords: anorexia nervosa, pneumatosis intestinalis, pneumoperitoneum

Traumatic lesions to the sternum are uncommon, especially in the pediatric population. Sternal fractures require significant force to occur due to the greater thorax elasticity in children compared to adults. Sternal segment dislocation is extremely rare with only 13 cases reported in the literature. We report a case of traumatic sternal segment dislocation in a 3-year-old girl. After falling on a pole, a 3-year-old girl presented chest pain increased by Valsalva and low-grade fever for few days. Her parents brought her to the hospital when she experienced a painful thoracic crisis with the development of a presternal lump. Ultrasonography showed an acoustic shadowing calcified mass representing the first sternal segment being dislocated and rotated at almost 90 degrees. CT showed dislocation with horizontal alignment of the first sternal segment and an undisplaced fracture line in the middle of this segment. There was soft tissue swelling but no repercussion on mediastinal structures. A bone scintigraphy was ordered to exclude any infectious process surimposed and was normal. Conservative management was elected. X-rays 2 months later showed partial remodeling of the sternum. Ten months after the initial trauma, patient remained asymptomatic. CT showed partial osteolysis of the first sternal segment compatible with osteonecrosis. The main cause of sternal dislocation is direct trauma to chest wall. The sternal body is composed of 4 segments which begin to ossify early in childhood. The manubrium is rigidly attached to both the first ribs and clavicles, providing relative elasticity of other sternal segments. The first sternal segment is the most common dislocated segment. Patient usually presents with limited chest pain and anterior chest wall deformation. The diagnosis of sternal segment dislocation is based on history and physical exam. Imaging studies are useful to confirm the diagnosis. The sternal segment may be minimally dislocated initially, but can continue its rotation for about 2 weeks. Fragment gain stability at 90 degrees rotation. According to the review of the 13 published cases, both operative and conservative treatments show similar outcome. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Murray Nicolas, Rypens Françoise, Trudel Jean-sébastien, Cantin Marie-andrée, Miron Marie-claude

Keywords: Pediatric, Sternal segment dislocation, Sernal fracture