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GI Tract Emergencies in Pediatrics
Int. Thorsang Chayovan 17.06.2013
IMAGINGS of
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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
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GI Tract Emergencies in Pediatrics
• Chief complaints
– Abdominal pain
– Vomiting
– Abdominal distension
– Hematochezia
• Causes
Obstructions
Non-obstructions
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Obstructions
Non-obstructions
• Pneumoperitoneum
• Necrotizing enterocolitis
• Acute appendicitis
• Acute pancreatitis
GI Tract Emergencies in Pediatrics
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• Investigations
– Plain abdominal radiographs: supine and upright
– In bowel obstructions >> contrast examinations
– Ultrasonography
– CT
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• Gastrointestinal obstructions
– Common in children coming to ED
– Imaging
• High VS low
• Complete VS partial
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Anatomy and normal radiologic findings
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Neonates
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Older childrens
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Proportional dilatation
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Normal rectal gas
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Same height of air fluid levels in the same loop in bowel ileus
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Relatively gasless abdomen
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Features of intestinal obstruction in plain abdominal radiographs
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Disproportional bowel dilatation
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Disproportional bowel dilatation
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Bowel caliber difference in low intestinal obstruction
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Orderly arranged bowel loops
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Absent rectal gas
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THE GASTROINTESTINAL OBSTRUCTIONS
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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
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High Obstructions
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Hypertrophic pyloric stenosis
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Gastric volvulus
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Duodenal atresia
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Duodenal atresia
with anomalous
distal common bile duct
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Duodenal stenosis
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Midgut volvulus
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Jejunal atresia
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Low Obstructions
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Ileal atresia
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Absent rectal gas in ileal atresia
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Ileal atresia
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Small left colon syndrome
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Hirschsprung disease
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Transition zone on contrast enema
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Rectosigmoid ratio
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Irregular contractions of distal aganglionic segment
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Distal colonic agangionosis
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Shortening of bowel
in Hirchsprung disease
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EC-associated Hirschsprung
disease
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Colonic atresia
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Intussusception
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Donut sign
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Hay-fork sign