Learning objectives
To review the spectrum of radiological findings in surgical causes of GI emergencies in infants.
To develop an approach to the diagnosis of surgical GI emergencies involving clinical and imaging data.
This presentation will show some examples of the common surgical GI emergencies in infants,
along with the imaging techniques used for the diagnosis of these disorders.
Background
Gastro-intestinal obstructions are one of the most common surgical emergencies in the infantile age group
The conditions can be further subdivided into those that present in the immediate postnatal period and those that occur later
DIAGNOSIS:
A.
Clinical signs and symptoms:
Emesis - Bilious ( proximal obstructions) or non bilious
Failure to pass meconium ( first 24 hours of life)
Constipation ( after first day of life)
Abdominal distension ( more common in lower obstructions)
B.
Diagnostic Imaging - constellation of findings on:
Conventional radography...
Findings and procedure details
For evaluation and diagnosis bowel obstruction in infants can be divided into:
1.
HIGH BOWEL OBSTRUCTION
occuring proximal to ileum
3 or fewer dilated bowel loops
various combination of gastric,
duodenal and jejunal dilatation
2.
LOW BOWEL OBSTRUCTION
diffuse dilatation of small bowel loops
more than 3 dilated bowel loops
involve distal ileum or colon
HIGH BOWEL OBSTRUCTION
1.
Hypertrophic Pyloric Stenosis
more common in first born male child
2-6 weeks after birth
Plain radiograph: single bubble sign (dilated stomach) Fig. 3
Ultrasonography:Pyloric muscle thickness...
Conclusion
Imaging studies provide a spectrum of specific findings in surgical GI emergencies in infants.
By providing a diagnostic approach these findings along with clinical features are helpful to form an accurate diagnosis and guide the appropriate management.
Conventional radiography,
GI contrast studies and Sonography coupled with color Doppler continue to prove as first line diagnostic modalities in surgical GI conditions of infants.
Successful management depends on timely diagnosis and appropriate intervention.
References
1.
Padma Rao.
Neonatal gastrointestinal imaging.
European Journal of Radiology.
November 2006
2.
W.
Mnari.
Neonatal intestinal obstruction: how to make etiological diagnosis?.
ECR 2013
3.
Daniel N.
Vinocur.
Neonatal Intestinal Obstruction.
AJR:198,
January 2012
4.A.D.A.M.
Student atlas of anatomy.
2nd edition.
2008
5.
Skandalakis Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery.
2004