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Radiology and contrast studies in newborns [autosaved]
- 1. Radiology and contrast studies in newborns DR SYED FAISAL USMAN PEDIATRIC SURGEON RTEH, MUZAFFARGARH MANAGED BY IHHN
- 2. introduction Radiology is helping in diagnosis of congenital anomalies of newborns • Intestinal obstruction • Intestinal perforation • Anomalies in chest • Functional obstruction like Hirschsprung Disease • Anorectal Malformation
- 5. Preparation of Radiological studies
- 6. Neonatal Intestinal Obstruction High Obstruction Low Obstruction Acquired Diseases Esopghgeal atresia Ileal atresia Nectrotizing enterocolitis Duodenal Atresia Meconium ileus Hypertrophic pyloric stenosis Duodenal web Meconium Plug Incarcerated Inguinal Hernia Annular pancreas Hirschsprung Disease Sepsis Malrotation Anal Atresia Jejunal atresia
- 7. Abdominal radiograph In case of intestinal onsruction first line of investigation is always Abdominal radiograph provided enough time given to intestine filled with air. Normal air progression time is as follows: Birth Stomach 1 hour Duodenum 3 hour Proximal small bowel 12 hour Almost whole small bowel 24 hour Rectum
- 8. Bowel gas Patterns on Radiograph Dilatation Number of loops Small bowel or large gut Air filled rectum Pnuematosis intestinalis Free air/ pneumoperitonium
- 9. Dilatation
- 10. Number of loops High obstruction Jejunal atresia Low obstruction Ileal atresia
- 11. Type of bowel
- 12. Air filled rectum Radiograph of Meconium ileus By 24 hr of life usually rectum filled With air If no air is there Suspicion of HD and meconium ileus must be in mind
- 14. Free air
- 15. Contrasts Studies Types of contrast agents 1. Iodinated 1. Ionic 2. Non ionic 2. Barium 3. Air 4. carbondioxide
- 16. Barium contrast Studies Inert Compound Water Insoulble Non absorbable for GIT
- 17. Barium Contrast studies Indications GI Tract Imaging Barium swallow- to study pharynx and esophagus Barium meal- for lower esophagus, stomach and duodenum Barium follow through- to study small intestine Barium enema- for large intestine and rectum Suspected H-type Fistula Suspected esophageal perforation Suspected GER
- 18. Malrotation
- 19. Duodenal Atresia
- 20. Jejunal Atresia
- 21. Ileal Atresia
- 22. Meconium ileus
- 23. Small Left colon syndrome??? Meconium plug syndrome is also known as small left colon syndrome. Meconium plugging in the left colon occurs when the colon is functionally immature with little motility. There is an association with maternal diabetes and drug use in pregnancy. The condition is temporarily and when the meconium plugs resolve, the colon distends normally and functions normally. The neonate is otherwise healthy and there is no association with cystic fibrosis. There is no air in the rectum on the radiograph. Colon enema shows a normal rectal diameter which excludes Hirschsprung disease. A microcolon is absent.
- 24. Hirschsprung disease In Hirschsprung disease ganglion cells are absent in the distal part of the colon. Because the intestinal ganglion cells migrate in a craniocaudal direction, the area of aganglionosis always involves the rectum. More extensive disease extends orally in a contiguous fashion. The involved bowel has a small diameter and the bowel proximal to the affected segment is dilated. In Hirschsprung disease the ratio between the denervated and the non-affected bowel is <1.
- 25. Hirschsprung disease Start the enema in the lateral position to evaluate the rectum. Save cine images from the first contrast injection, as with progressive filling signs can become obscured by too much bowel distention. Normally the rectum should be wider than the sigmoid. The image shows an abnormal recto-sigmoid index <1.
- 26. Long segment HD
- 27. Thank you & Any Questions