the images of gi tract emergencies in pediatrics
DESCRIPTION
The images of GI tract emergencies in pediatricsTRANSCRIPT
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