14 year old MN diabetic who presented for hypoglycemia 10 days ago. Insulin dosage was decreased, but he has not been eating well. One episode of vomiting and having some diarrhea. Blood work unremarkable other than mild inc. in BUN and creat. Concern for hyperechoic/edematous mesentery with early loss of wall layering noted in multiple loops of small bowel and some mucosal fogging. I’m most worried about early lymphoma, but no lymphadenopathy and spleen size WNL. Impressions?
14 year old MN diabetic who presented for hypoglycemia 10 days ago. Insulin dosage was decreased, but he has not been eating well. One episode of vomiting and having some diarrhea. Blood work unremarkable other than mild inc. in BUN and creat. Concern for hyperechoic/edematous mesentery with early loss of wall layering noted in multiple loops of small bowel and some mucosal fogging. I’m most worried about early lymphoma, but no lymphadenopathy and spleen size WNL. Impressions?
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Ive seen complicated IBD do
Ive seen complicated IBD do this or spntaneous necrosis and normalize with tx or sx removal if need be so I would downplay neoplasia with the owner because often once they hear the Cancer word they often pull the tx plug and many of these are not neoplastic. often concurrent pancreatitis or even sepsis will play with glucose metabolism.
I like baytril metro or baytril clindamycin on these, pain manage and fluids of course and give it 48 hours and rescan. May clean up well despite the early loss of detail and neoplastic criteria that is emerging.