The images of GI tract emergencies in pediatrics

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The images of GI tract emergencies in pediatrics

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The images of GI tract emergencies in pediatrics

  1. 1. IMAGINGS of GI Tract Emergencies in Pediatrics Int. Thorsang Chayovan 17.06.2013
  2. 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. 3. GI Tract Emergencies in Pediatrics • Chief complaints – Abdominal pain – Vomiting – Abdominal distension – Hematochezia • Causes Obstructions Non-obstructions
  4. 4. GI Tract Emergencies in Pediatrics Obstructions Non-obstructions • Pneumoperitoneum • Necrotizing enterocolitis • Acute appendicitis • Acute pancreatitis
  5. 5. • Investigations – Plain abdominal radiographs: supine and upright – In bowel obstructions >> contrast examinations – Ultrasonography – CT
  6. 6. • Gastrointestinal obstructions – Common in children coming to ED – Imaging • High VS low • Complete VS partial
  7. 7. Anatomy and normal radiologic findings
  8. 8. Neonates
  9. 9. Older childrens
  10. 10. Proportional dilatation
  11. 11. Normal rectal gas
  12. 12. Same height of air fluid levels in the same loop in bowel ileus
  13. 13. Relatively gasless abdomen
  14. 14. Features of intestinal obstruction in plain abdominal radiographs
  15. 15. Disproportional bowel dilatation
  16. 16. Disproportional bowel dilatation
  17. 17. Bowel caliber difference in low intestinal obstruction
  18. 18. Orderly arranged bowel loops
  19. 19. Absent rectal gas
  20. 20. THE GASTROINTESTINAL OBSTRUCTIONS
  21. 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. 22. High Obstructions
  23. 23. Hypertrophic pyloric stenosis
  24. 24. Gastric volvulus
  25. 25. Duodenal atresia
  26. 26. Duodenal atresia with anomalous distal common bile duct
  27. 27. Duodenal stenosis
  28. 28. Midgut volvulus
  29. 29. Jejunal atresia
  30. 30. Low Obstructions
  31. 31. Ileal atresia
  32. 32. Absent rectal gas in ileal atresia
  33. 33. Ileal atresia
  34. 34. Small left colon syndrome
  35. 35. Hirschsprung disease
  36. 36. Transition zone on contrast enema
  37. 37. Rectosigmoid ratio
  38. 38. Irregular contractions of distal aganglionic segment
  39. 39. Distal colonic agangionosis
  40. 40. Shortening of bowel in Hirchsprung disease
  41. 41. EC-associated Hirschsprung disease
  42. 42. Colonic atresia
  43. 43. Intussusception
  44. 44. Donut sign
  45. 45. Hay-fork sign

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