CASE REPORT Barlas Etensel Æ Sezen O ¨ zkısacık Æ Firuzan Do¨ger Mesut Yazıcı Æ Harun Gu¨rsoy Anomalous congenital band: a rare cause of intestinal obstruction and failure to thrive Accepted: 17 August 2005 / Published online: 20 October 2005 Ó Springer-Verlag 2005 Abstract Intestinal obstruction caused by an anomalous congenital band is very rare in adults and children. A 7- year-old boy was admitted with acute intestinal obstruction. His parents mentioned that the child always had mild abdominal distention and failure to thrive from his infancy. On his medical history, there were not any attacks of abdominal pain, fever and hospitalization. Laparotomy showed an ileal loop compressed by an anomalous band, which extended from the ileum to the sigmoid mesentery resembling a mesenteric remnant. The band was resected. Histologically, it was composed of loose connective tissue containing mature vessels. Keywords Congenital band Æ Intestinal obstruction Æ Ventral mesentery Æ Remnant Introduction In emergency departments, there are many cases of intestinal obstruction with different congenital or inflammatory origins [1–3]. One of the rarest causes of intestinal obstruction is an anomalous congenital band (ACB) that has no relationship with former intra- abdominal problems, such as past laparotomy or inflammatory diseases or peritonitis or embryogenic remnants [1, 2, 4]. We report a case of intestinal obstruction caused by a ACB, which extended from the sigmoid mesentery to the ileum, and caused chronic abdominal distention and failure to thrive from his in- fancy. Case A 7-year-old boy was admitted to the Emergency Department of Adnan Menderes University Hospital with a two-day history of abdominal pain and vomiting. His vomiting was bilious and he had no defecation for two days. On admission, he was 19 kg (10 Percentile) in weight and had moderate dehydration. His body tem- perature was 37.5°C, and his abdomen was distended with mild tenderness and muscular resistance. Neither hepatosplenomegaly nor mass was palpable. Bowel sounds were hypoactive. Rectal examination was nor- mal. He was the 3300 g product of an uncomplicated, term pregnancy of unrelated parents and born to a 25-year- old gravida 1 para 1 female. At delivery there was no evidence of polyhydramnios. Physical examination in the delivery room was normal. Meconium was passed within the first 24 h. He had good breast feeding and regular bowel movements. After his newborn period, a mild abdominal distention was observed by his parents. He had no associated vomiting. He was never referred to the hospital for evaluation of chronic mild abdominal distention and failure to thrive. There was no history of abdominal or inguinal surgery. He had no previous hospitalization. His parents never observed any attacks of bilious vomiting, fever and abdominal pain. Laboratory results revealed a WBC count of 12900/ mm 3 and hemoglobin of 12 g/dl. Electrolytes, total protein and albumin were all within the normal range, being at the lower limits. Plain films of the abdomen revealed an intestinal obstruction with multiple air-fluid levels. After an initial treatment with intravenous fluid and nasogastric suction, he was operated. At laparotomy, an anomalous band obstructing ileum extrinsically was found. Neither ischemic changes of the ileal loop nor evidence of acute or chronic intraperitoneal inflamma- tion were observed. The compressed ileal loop was easily mobilized out of the abdominal cavity and obstruction B. Etensel (&) Æ S. O ¨ zkısacık Æ M. Yazıcı Æ H. Gu¨rsoy Department of Pediatric Surgery, Adnan Menderes University, Tıp Faku¨ltesi, C¸ ocuk Cerrahisi Anabilim Dalı, 09100 Aydin, Turkey E-mail: betensel@adu.edu.tr Tel.: +90-256-2124078 Fax: +90-256-2146495 F. Do¨ger Department of Pathology, Adnan Menderes University, Tıp Faku¨ltesi, 09100 Aydin, Turkey Pediatr Surg Int (2005) 21: 1018–1020 DOI 10.1007/s00383-005-1563-x