Abdominal disorder in paediatric imaging, part I , anterior abdominal wall abnormalities( omphalocele, gastroschisis, epispadias, bladder exstrophy and respiratory distress)

1. Paediatric
abdominal imaging
Grainger and Allison’s diagnostic radiology
Presentation by – Dr Maw Maw Oo

2. Outline
The neonate
The infant and older child
The immunocompromised child
Abdominal manifestation of
cystic fibrosis
Abdominal trauma
Liver
Biliary system
Pancreas
Spleen

3. The neonate
Visible abnormalities of the anterior
abdominal wall
Respiratory distress and choking
Non bilious vomiting
Bilious vomiting
Abdominal distension
Delayed passage of meconium

4. Visible abnormalities of the anterior abdominal wall
Gastroschisis
Omphalocele
Bladder exstrophy –
epispadias-
cloacal exstrophy complex
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5. Respiratory distress and choking
Oesophageal atresia and trachea-oesophageal fistula
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6. • Obstruction of the stomach
• Enteric duplication cyst
• Microgastria
• Gastric perforation
Non-bilious vomiting

7. Bilious vomiting
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 Small bowel malrotation and volvulus
 Duodenal atresia and stenosis
 Small bowel atresia and stenosis

8. Abdominal distension
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 Necrotising enterocolitis ( NEC)
 Colon atresia
 Intrabdominal lymphangioma
 Megacystis-microcolon-intestinal
hypoperistalsis(Berdon’s)syndrome

9. Delayed Passage of Meconium
Hirschsprung’s disease
Functional immaturity of the colon and
meconium plug syndrome
Meconium ileus
Distal ileal atresia
Anorectal and cloacal malformation

10. Visible abnormalities
of anterior abdominal
wall
Grainger and Allison’s diagnostic radiology
Presentation by – Dr Maw Maw Oo

11. • Complex Gastroschisis – bowel
atresia, perforation, volvulus and
necrosis
• GOR,malrotation, dilatation of
small bowel and prolong transit
time in repaired cases
• Classically to the right side of umbilicus
• Due to localized vascular accident or
failure and asymmetry of lateral body wall
• Mother <20 yr –greater risk
• USG- bowel floating freely in amniotic fluid
( second trimester –diagnosis)
• No covering membrane
• Exposure to amniotic fluid causes damage
to the bowel, thick fibrous peel coating
Gastroschisis

12. 12
Omphalocele
 Midline anterior abdominal wall
defect
 Solid viscera(liver tissue) or intestine
may herniate
 Sac (+)
 Giant –liver herniation or defect
more than 5 cm
 Due to persistence of physiological
herniation
 USG-second trimester onward
 Chromosomal and structural abnormalities
(+)in >50%
 EMG- exomphalos, macroglossia and
gigantism( Beckwith-Wiedemann syndrome)

13. 13

14. 14
Bladder exstrophy-epispadias-cloacal exstrophy complex
 Epispadias- male has urethra opening
on dorsum of penis, female has cleft
urethra
 Bladder exstrophy- exposed bladder
on the lower abdominal wall, drips
urine constantly
 Cause – abnormal development of
cloacal membrane and premature
rupture
 Elephant trunk sign- prolapse of
terimnal ileum pathognomonic
 Non visualization of bladder
+Omphalocele+myelomeningocele-
strong predictor
 Open caecum and prolapse terminal
ileum between two hemibladder
 Omphalocele- blind ending short
gut(+)
 External genitalia- ambiguous
 Bilateral inguinal hernia common in
both sexes
 Spinal dysraphism and open book
pelvis
 Associated renal and lower limb
abnormality

15. 15
http://radiopaedia.org/cases/bladder-exstrophy-2

16. 16

17. Respiratory distress and
choking

18. 18
Oesophageal atresia and trachea-oesophageal fistula
 Abnormal foregut ( to separate respiratory and
 GI
 Half- associated congenital abnl and limb defects,duodenal atresia, small bowel
malrotation and volvulus
 Polyhydraminos+ absent stomach bubble(50% positive predictive value)
 Post natal choking, cough and cyanosis(attempt to feed – severe)
 Postnatal-gastric tube curled in the proximal oesophageal pouch
 Lung-aspiration pneumonia
 Gas in abdomen-distal fistula (+)
 Gasless abdomen – isolated OA or rarely proximal fistula OA

19. 19
• H type- withdrawal oseophagram
• Infant –prone, horizontal x ray beam
• Steep oblique position with vertical X ray beam
• Water soluble contrast (1-2 ml)

20. 20
H type
Tube in proximal oseophageal pouch, duodenal atresia

21. ThankYou
to be continued
4:06 PM
12.7.2020
Kyaukme, Northern Shan State
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