Imaging of congenital anomalies of the gastrointestinal tract

An unusual cause of recurrent pediatric vomiting (an extraluminal pyloric duplication cystic): A case report

Vomiting is a common symptom of a multitude of diseases in children. It is usually part of benign illness and can occur at any age. Recurrent vomiting can be a symptom of life-threatening medical or surgical emergencies. It can be rarely caused by an extraluminal pyloric duplication cyst. Early recognition is essential for preventing delays in management and potential complications.

Here we report a case of an extraluminal pyloric duplication presenting as progressive gastric outlet obstruction cyst in a 14-month-old Syrian boy. The diagnosis was made through abdominal ultrasound, gastrointestinal endoscopy and abdominal computed tomography scan.

Clinical characteristics of gastrointestinal tract duplications in children: A single-institution series review

Due to the various presentations of gastrointestinal tract duplications (GTD), diagnosing and management for this disease might be varied and difficult. We intend to improve the experiences for these difficult, in terms of the clinical presentations, diagnostic investigations, management.We reviewed recent literature and retrospectively analyzed 72 pediatric patients with enteric duplication. Diagnosis was confirmed by surgery and pathological examination for imaging characteristics and clinical and pathological features.The ages of patients ranged from one month to 12.5 years. The clinical presentations of the patients included 57 cases with abdominal pain, followed with nausea or vomiting, abdominal distension, etc. All of the patients were diagnosed by ultrasonography, and most of them presented as intra-abdominal cystic masses. Four cases were diagnosed with the cysts other than GTDs, like, mesenteric cyst, chledochal cyst and abscess, and so on. Computed tomography was performed on 65 patients. X-rays and barium meal showed the outline of the cyst structure, with intestinal displacement due to the pressure from the cyst. Among the 72 cases of enteric duplication, 45 were located with ileocecal area, 41 were ileal and 8 were colonic duplications.Enteric duplication is very rare in children and is prone to misdiagnosis. The preoperative diagnosis of enteric duplication can be improved through comprehensive analysis of various imaging exams and closely related clinical presentations.

Novel contrast media based on the liquid metal gallium for in vivo digestive tract radiography: a feasibility study

The barium sulfate has been playing an important role as the contrast medium in gastrointestinal radiography and disease diagnosis. However, its application has been gradually reduced due to the limitation of its imaging effect and the progress of other imaging techniques. Here, the liquid metal gallium was proposed as an improved contrast agent, which was applied in the in vivo digestive tract radiography of the mice for the first time. Under the CT scanning, the gallium produced excellent contrast effect intuitively. According to the records of discharge time, the tissue sections of organs, the survival state and body weight, the liquid metal was proven to be capable and safe for gastrointestinal radiography. Further, the mixture of the gallium and the barium sulfate has been tested, which showed better performance in both contrast and detail. Therefore, with the characteristics of better imaging contrast effect and acceptable safety, the gallium and its mixture with the barium sulfate might be useful as potential candidates for digestive tract contrast agent in animal experiments, even possibly as alternative contrast agents for clinical use.

Application of color Doppler ultrasound combined with Doppler imaging artifacts in the diagnosis and estimate of congenital hypertrophic pyloric stenosis

Congenital Hypertrophic Pyloric Stenosis (CHPS) is a disease condition that is caused as a result of pylorus wall hypertrophy and hyperplasia. In this study, we used color Doppler flow imaging (CDFI) and Doppler artifacts technique to observe the blood flow of hypertrophic pylorus tissue and the dynamic imaging of liquid passing through the pyloric canal in CHPS infants. 65 cases of CHPS infants and 50 infants without CHPS served as control group. We found that there were statistically significant differences between the blood flow grade of muscular layer and mucosal layer between CHPS and control infants, but no significant differences were observed in the same group. Doppler artifacts technique demonstrated the whole process of contrast agent flow through pyloric canal was directly observed in 35 of 65 subjects, and the internal diameter of the pyloric canal was 1.93 ± 0.33mm.Conclusion that CDFI combined with color Doppler artifacts technique was proved to be effective to observe the distribution feature and blood flow grade in each layer of pyloric canal in CHPS patients. This method provides the evidence for judging the degree of pyloric stenosis clinically, and furnishes the basis of therapy along with its clinical significance and good application value.

Ultrasonography: Applications in Pediatric Abdomen

Ultrasonography (US) is a valuable imaging tool for evaluation of different clinical conditions in children, in general and abdominal conditions, in particular. The interest in US derives primarily from the lack of ionizing radiation exposure, low cost, portability, real-time imaging and Doppler capabilities. In addition, US application requires no preparation or sedation, making it particularly attractive in the pediatric population. Because of these advantages, US has been adopted as the primary imaging tool for evaluation of a number of pediatric abdominal conditions that would have involved the use of ionising radiation in the past, e.g., pyloric stenosis, intussusception and various renal and bladder abnormalities, to name a few. Certain limitations, however, are inherent to US including large body habitus, excessive bowel gas, postoperative state and the learning curve. In addition, pediatric US is particularly challenging as the children are frequently unable to co-operate for breath holding and many of them are crying during the scanning. In the present review, the authors discuss the various applications of US in the evaluation of pediatric abdomen.

Multidetector computed tomography in the evaluation of pediatric acute abdominal pain in the emergency department

The accurate diagnosis of pediatric acute abdominal pain is one of the most challenging tasks in the emergency department (ED) due to its unclear clinical presentation and non-specific findings in physical examinations, laboratory data, and plain radiographs. The objective of this study was to evaluate the impact of abdominal multidetector computed tomography (MDCT) performed in the ED on pediatric patients presenting with acute abdominal pain. A retrospective chart review of children aged <18 years with acute abdominal pain who visited the emergency department and underwent MDCT between September 2004 and June 2007 was conducted. Patients with a history of trauma were excluded. A total of 156 patients with acute abdominal pain (85 males and 71 females, age 1-17 years; mean age 10.9 ± 4.6 years) who underwent abdominal MDCT in the pediatric ED during this 3-year period were enrolled in the study. One hundred and eighteen patients with suspected appendicitis underwent abdominal MDCT. Sixty four (54.2%) of them had appendicitis, which was proven by histopathology. The sensitivity of abdominal MDCT for appendicitis was found to be 98.5% and the specificity was 84.9%. In this study, the other two common causes of nontraumatic abdominal emergencies were gastrointestinal tract (GI) infections and ovarian cysts. The most common etiology of abdominal pain in children that requires imaging with abdominal MDCT is appendicitis. MDCT has become a preferred and invaluable imaging modality in evaluating uncertain cases of pediatric acute abdominal pain in ED, in particular for suspected appendicitis, neoplasms, and gastrointestinal abnormalities.

Ultrasonographic diagnosis of congenital membranous jejunal stenosis and gastric duplication cyst in a newborn: a case report

Introduction

Congenital jejunal stenosis and gastric duplication cysts are very rare congenital anomalies of the gastrointestinal tract in the newborn. We present a case of congenital membranous jejunal stenosis associated with gastric duplication cysts, which was diagnosed by ultrasonography. To the best of our knowledge, this is the first report of ultrasonographic diagnosis of congenital membranous jejunal stenosis associated with a gastric duplication cyst in a newborn.

Case presentation

A 1-month-old Chinese baby girl presented with projectile vomiting and hyperpyrexia for 3 days. An upper gastrointestinal contrast study showed incomplete duodenal obstruction; however, ultrasonography revealed congenital membranous jejunal stenosis associated with a gastric duplication cyst. After surgical excision of the jejunal membrane and gastric duplication cyst, she recovered well with no bilious vomiting at the 1-year follow-up.

Conclusion

Ultrasonography is a useful tool for the evaluation of membranous jejunal stenosis and the identification of small, asymptomatic gastrointestinal duplication cysts.

Intestinal obstruction due to dual gastrointestinal atresia in infants: diagnosis and management of 3 cases

Background

Several types of congenital lesions can cause complete or incomplete obstruction of the intestine. Our purpose is to present 3 neonates with dual intestinal type I atresia, i.e., simultaneous obstructive lesions at 2 locations in which the atresia manifested as diaphragm-like tissue.

Case presentation

All 3 cases were female infants ranging in age from 2 to 14 months. The common symptom in all cases was intermittent persistent vomiting. In some cases the vomitus was bilious, and other symptoms included abdominal distention and delayed meconium passage. Prior surgeries at another hospital were unsuccessful at relieving the symptoms in one case. One case had dual lesions in the colon, one dual lesions in the duodenum, and one atresia at both the distal portion of the ileum and the descending colon. Surgical exploration and removal of the lesions at our hospital was successful in all cases, and the infants were discharged in good condition.

Conclusions

Type I atresia can manifest as a diaphragm-like tissue obstructing the continuity of gastrointestinal tract, and in rare cases multiple areas may be present. Base on the intermittent nature of the associated symptoms, diagnosis can be difficult and is often delayed. Physicians should be aware of this condition during the work-up of an infant with persistent intermittent vomiting.

Ultrasound in newborns and children suffering from non-traumatic acute abdominal pain: imaging with clinical and surgical correlation

The purpose of this article is to review ultrasonographic appearance of the most common causes of non-traumatic acute abdominal pain in pediatric patients and to understand the applications and limitations of this technique giving a practical approach showing different clinical cases. A pictorial review of cases was made presenting the most common causes of neonatal and pediatric non-traumatic acute abdominal pain; sonographic features are discussed. Ultrasound in conjunction with Color Doppler imaging is a valuable tool in the evaluation of neonatal and pediatric non-traumatic acute abdominal pain; causes of acute abdomen in children could vary depending on the ages of the children.

Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS): report of a case with prolonged survival and literature review

Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) was first described in 1976. A rare congenital autosomal recessive alteration that predominantly affects females (4:1 ratio), it is characterized by the presence of distended bladder (without distal urinary tract obstruction), microcolon, and decreased or absent intestinal peristalsis. Inconsistent and non-specific histological changes affecting the bladder and intestinal smooth muscle, and intrinsic innervations, have been reported most frequently. MMIHS usually has a fatal prognosis in the first year of life; nevertheless there are some case reports of longer survival. Here is presented the case report of a boy with a diagnosis of MMIHS who has achieved prolonged survival, followed by a review of the literature.

Dynamic change of intestinal duplication in an adult patient: a case report and literature review

Intestinal duplication in an adult is an uncommon congenital abnormality because only minority of cases present in adulthood. More than 80% of cases occur before the age of two years as an acute abdomen, bowel obstruction or other complications associated with it. Duplication has two types, either cystic or tubular. Here, we report a case of an adult who was diagnosed preoperatively on CT scan as tubular intestinal duplication. CT images showed change in the morphology of the cystic mass after one week of antibiotics administration. On histopathological analysis, the resected duplicated segment had esophageal epithelium in addition to the intestinal gland. So far, we found no report describing CT findings of dynamic change of ileal duplication in the English literatures.

Intestinal duplication in an adult patient diagnosed by multidetector computed tomography enteroclysis: report of a case

This study reports a case of small-bowel duplication, a rare congenital malformation, in an adult with abdominal pain and sub-obstruction signs. CT enteroclysis allowed the diagnosis that conventional imaging failed to demonstrate and it confirmed itself the most accurate exam in small-bowel disease diagnosis. This is the first report of a small-bowel duplication diagnosed by CT enteroclysis.

Sonographic evaluation of gastrointestinal obstruction in infants: a pictorial essay

Traditionally, gastrointestinal contrast studies have been the mainstay of evaluating infantile gastrointestinal problems. Because of technological advancements, good ultrasonography (USG) machines can provide high-resolution images with graphic anatomical clarity, especially in infants and children and thus change the traditional diagnostic trends. In this article, we illustrate the USG appearances of various causes of gastrointestinal obstruction in infants and discuss the role of USG in their evaluation.

Nonfluoroscopic pressure colostography in the evaluation of genitourinary fistula of anorectal malformations: experience in a resource-poor environment

BACKGROUND

Radiological imaging is paramount for defining the genitourinary fistulae commonly associated with anorectal malformations prior to definitive surgery. The imaging options are resource-limited in many parts of the world. Nonfluoroscopic pressure colostography after colostomy is a cheap method for the evaluation of anorectal malformations.

OBJECTIVE

To describe our experience with nonfluoroscopic pressure colostography in the evaluation of anorectal malformations in boys.

MATERIALS AND METHODS

The study included 12 boys with anorectal malformation who had colostomy and nonfluoroscopic pressure-augmented colostography with water-soluble contrast medium between January 2006 and December 2007.

RESULTS

Patient ages ranged from 2 days to 1 year. The types of genitourinary fistula were rectovesical (7.7%) and rectourethral (92.3%). Oblique radiographs were of diagnostic value in all patients. The types of anorectal malformations were high, intermediate and low in 75%, 8.3% and 16.7%, respectively. Short-segment urethral constriction was a common feature of rectourethral fistula (75%, n=9).

CONCLUSION

Our experience has shown that genitourinary fistulae associated with anorectal malformations can be demonstrated reliably by nonfluoroscopic pressure colostography with two oblique radiographs, providing an option in resource-poor settings where fluoroscopic equipment is scarce.

Gastric duplication cyst: a unique presentation

Duplications of the alimentary tract are rare and occur in 1 of 4500 births (Duplication of the stomach: report of a case and review of the English literature. Arch Surg 1961; 82:634-640). Gastric duplications constitute 8% of these or roughly 17 of every 1,000,000 births (Shew SB, Holcomb GW. Alimentary tract duplications. In: Ashcraft KW, Holcomb GW, Murphy JP, editors. Pediatric surgery. Philadelphia, PA: Elsevier, 2005. p. 543-552). Symptoms often occur by 2 years and can include nausea, vomiting, hematemesis, and vague abdominal pain. Occasionally, a palpable abdominal mass may be identified on physical examination. We offer an unusual and previously unreported presentation of a gastric duplication cyst.

Neonatal gastrointestinal imaging

Radiological imaging is an important part of the evaluation and management of neonates with suspected anomalies of the gastrointestinal tract. Clinical presentation is often non-specific, commonly with abdominal distension and vomiting for which the underlying cause may or may not be clinically apparent. In a proportion of patients, the clinical assessment alone may suffice in providing the diagnosis and no further imaging is necessary. The reader must have an understanding of the normal radiographic appearances of the gastrointestinal tract in neonates and appreciate normal variants and differences to adults. In certain cases, the abdominal radiograph alone is diagnostic. In others, sonography and contrast studies are useful adjunct investigations and the indications for CT and MRI are few, but specific. Appropriate radiological investigation will help to establish the diagnosis and guide surgical intervention whilst also avoiding unnecessary radiation. Some of the conditions require transfer to specialist paediatric institutions for care. Thus, in some circumstances it is appropriate for imaging to be delayed and performed at the specialist centre with early referral often essential for the continued well being of the child.