GI Tract Emergencies in Pediatrics

Int. Thorsang Chayovan 17.06.2013

IMAGINGS of

Outline: GI Tract Emergencies in Pediatrics

• Overview

• Anatomy and normal radiologic findings

• Features of intestinal obstruction in plain abdominal radiographs

• The diseases: GI obstruction emergencies

GI Tract Emergencies in Pediatrics

• Chief complaints

– Abdominal pain

– Vomiting

– Abdominal distension

– Hematochezia

• Causes

Obstructions

Non-obstructions

Obstructions

Non-obstructions

• Pneumoperitoneum

• Necrotizing enterocolitis

• Acute appendicitis

• Acute pancreatitis

GI Tract Emergencies in Pediatrics

• Investigations

– Plain abdominal radiographs: supine and upright

– In bowel obstructions >> contrast examinations

– Ultrasonography

– CT

• Gastrointestinal obstructions

– Common in children coming to ED

– Imaging

• High VS low

• Complete VS partial

Anatomy and normal radiologic findings

Neonates

Older childrens

Proportional dilatation

Normal rectal gas

Same height of air fluid levels in the same loop in bowel ileus

Relatively gasless abdomen

Features of intestinal obstruction in plain abdominal radiographs

Disproportional bowel dilatation

Disproportional bowel dilatation

Bowel caliber difference in low intestinal obstruction

Orderly arranged bowel loops

Absent rectal gas

THE GASTROINTESTINAL OBSTRUCTIONS

High Obstructions

• Gastric outlet obstruction – Hypertrophic pyloric stenosis

– Gastric volvulus

– Pyloric atresia

• Duodenal obstruction – Duodenal atresia

– Duodenal stenosis

– Annular pancreas

– Preduodenal portal vein

– Midgut volvulus

• Jejunal obstruction – Jejunal atresia

– Jejunal stenosis

Low Obstructions

• Distal small bowel – Ileal atresia

– Meconium ileus

• Colonic obstruction – Dysmotility state

• Meconium plug syndrome

• Small left colon syndrome

• Hirchsprung’s disease

– Colonic atresia

– Intussusception

High Obstructions

Hypertrophic pyloric stenosis

Gastric volvulus

Duodenal atresia

Duodenal atresia

with anomalous

distal common bile duct

Duodenal stenosis

Midgut volvulus

Jejunal atresia

Low Obstructions

Ileal atresia

Absent rectal gas in ileal atresia

Ileal atresia

Small left colon syndrome

Hirschsprung disease

Transition zone on contrast enema

Rectosigmoid ratio

Irregular contractions of distal aganglionic segment

Distal colonic agangionosis

Shortening of bowel

in Hirchsprung disease

EC-associated Hirschsprung

disease

Colonic atresia

Intussusception

Donut sign

Hay-fork sign