The images of GI tract emergencies in pediatrics

1. IMAGINGS of
GI Tract Emergencies
in Pediatrics
Int. Thorsang Chayovan
17.06.2013

2. 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

3. GI Tract Emergencies in Pediatrics
• Chief complaints
– Abdominal pain
– Vomiting
– Abdominal distension
– Hematochezia
• Causes
Obstructions
Non-obstructions

4. GI Tract Emergencies in Pediatrics
Obstructions
Non-obstructions
• Pneumoperitoneum
• Necrotizing enterocolitis
• Acute appendicitis
• Acute pancreatitis

5. • Investigations
– Plain abdominal radiographs: supine and upright
– In bowel obstructions >> contrast examinations
– Ultrasonography
– CT

6. • Gastrointestinal obstructions
– Common in children coming to ED
– Imaging
• High VS low
• Complete VS partial

7. Anatomy and normal radiologic findings

8. Neonates

9. Older childrens

10. Proportional dilatation

11. Normal rectal gas

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

13. Relatively gasless abdomen

14. Features of intestinal obstruction
in plain abdominal radiographs

15. Disproportional bowel dilatation

16. Disproportional bowel dilatation

17. Bowel caliber difference
in low intestinal obstruction

18. Orderly arranged bowel loops

19. Absent rectal gas

20. THE GASTROINTESTINAL
OBSTRUCTIONS

21. 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

22. High Obstructions

23. Hypertrophic pyloric stenosis

26. Gastric volvulus

27. Duodenal
atresia

28. Duodenal
atresia
with
anomalous
distal
common
bile duct

29. Duodenal stenosis

30. Midgut volvulus

32. Jejunal atresia

33. Low Obstructions

34. Ileal atresia

35. Absent rectal gas
in ileal atresia

36. Ileal
atresia

38. Small left colon syndrome

39. Hirschsprung disease

40. Transition zone on contrast enema

41. Rectosigmoid ratio

42. Irregular contractions of distal
aganglionic segment

43. Distal colonic agangionosis

44. Shortening
of bowel
in Hirchsprung
disease

45. EC-associated
Hirschsprung
disease

46. Colonic atresia

47. Intussusception

50. Donut sign

51. Hay-fork sign