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Kraus MS, Selvam S, Siddiqui I, Reyes JA, Chavhan GB. Imaging of pediatric gastrointestinal tumors: A tertiary center experience over 19 years. Eur J Radiol 2024; 175:111461. [PMID: 38615503 DOI: 10.1016/j.ejrad.2024.111461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE Gastrointestinal tract (GIT) tumors in children are rare and there is a scarcity of data on their imaging features. The purpose of this study was to determine thefrequency of various GIT tumor types in children and to identify key imaging characteristics. METHODS This retrospective, single-center study was approved by the local ethics committee. Children with histologically proven GIT tumours (malignantand benign) who had imaging available on the institutional PACS between May 1, 2000 and Dec 31, 2019 were included. Demographic data and available imaging was reviewed by two blinded radiologists. RESULTS In total, 90 children (45 male, mean age 9.3 ± 4.3 years) with GIT tumours were included. The final diagnoses included polyps (n = 28), lymphomas/PTLD (n = 27), neuroendocrine tumours (n = 16), adenocarcinoma (n = 6), adenoma (n = 5), gastrointestinal stromal tumor (GIST) (n = 3), inflammatory myofibroblastic tumours (n = 2) and lastly leiomyoblastoma, leiomyoma and lipoma (1 each). All GIT segments were affected, but overall the small and large bowel had most lesions. Eighty-one percent children had a single lesion while remaining 19 % had multiple lesions. The neoplastic process manifested as intra-luminal lesion (58 %) or wall thickening (42 %) on imaging. Multiple cystic areas and vascular pedicle for polyps; and hypoechogenecity of the mass or wall thickening and aneurysmal dilatation for lymphomas, were the characteristic imaging features. None of the neuroendocrine tumours affecting appendix were seen on pre-resection imaging. CONCLUSIONS Variety of benign and malignant tumors are seen throughout the childhood. Polyps, lymphomas and appendiceal neuroendocrine tumors are common lesions. Characteristic imaging features of juvenile polyps and lymphomas on ultrasound may help narrowing the differentials, and guide further work up.
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Affiliation(s)
- Mareen S Kraus
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave, Toronto, M5G 1X8, Canada; Department of Diagnostic Radiology, Dalhousie University/IWK, 5850/5980 University Ave, Halifax, NS B3K 6R8, Canada
| | - Swathi Selvam
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave, Toronto, M5G 1X8, Canada; Medical Imaging Department, Royal Children s Hospital, 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - Iram Siddiqui
- Department of Pathology, Hospital for Sick Children, 555 University Ave, Toronto, M5G 1X8, Canada
| | - Jeanette A Reyes
- Department of Pathology, Hospital for Sick Children, 555 University Ave, Toronto, M5G 1X8, Canada
| | - Govind B Chavhan
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave, Toronto, M5G 1X8, Canada; Department of Medical Imaging, University of Toronto, Canada.
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Opramolla A, Gazzin A, Cisarò F, Pinon M, Calvo P, Rigazio C. Intestinal ultrasonography in pediatric population. Minerva Pediatr (Torino) 2024; 76:100-107. [PMID: 33871250 DOI: 10.23736/s2724-5276.21.06371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bowel ultrasound (US) is a low-cost, non-invasive, bed side practice and a reproducible procedure that represents a high yield tool in clinical practice and in the diagnostic workup of a consistent group of acute and chronic gastrointestinal (GI) tract disease. Moreover, in case of GI diseases of neonatal and pediatric age, it allows an easier evaluation due to the small body size and scarce presence of fat tissue in the abdominal wall and peritoneal cavity and gas content. No particular preparation of the patient is needed, nevertheless a 3- to 5-hour fasting state improves the quality of the examination. The exam focuses on wall thickness and stratification, lumen content, distensibility and compressibility, presence of peristalsis of explorable segment of the GI tract and includes the investigation of mesentery, perivisceral tissues and nodes features. Color doppler flowmetry admits a qualitative evaluation of GI wall and mesentery vascularization. Healthy GI wall appears at a US evaluation as a multilayered structure in which hyperechoic and hypoechoic layers alternate sequentially. In this article we provide a quickly available overview on findings, signs and applications of US in major GI pediatric diseases.
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Affiliation(s)
- Anna Opramolla
- Unit of Pediatric Gastroenterology, Department of Pediatrics, Città della Salute e della Scienza, Turin, Italy -
| | - Andrea Gazzin
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Fabio Cisarò
- Unit of Pediatric Gastroenterology, Department of Pediatrics, Città della Salute e della Scienza, Turin, Italy
| | - Michele Pinon
- Unit of Pediatric Gastroenterology, Department of Pediatrics, Città della Salute e della Scienza, Turin, Italy
| | - Pierluigi Calvo
- Unit of Pediatric Gastroenterology, Department of Pediatrics, Città della Salute e della Scienza, Turin, Italy
| | - Caterina Rigazio
- Unit of Pediatric Gastroenterology, Department of Pediatrics, Città della Salute e della Scienza, Turin, Italy
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Zhang M, Lin H, Hu J, Jing XX, Qin LL. The value of colorectal filling contrast ultrasonography in diagnosing pediatric juvenile polyps. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:564-572. [PMID: 35318682 DOI: 10.1002/jcu.23198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To describe a facilitated procedure of colorectal filling contrast ultrasonography (CFCUS) and explore its value in the diagnosis of pediatric juvenile polyps. METHODS One hundred and eleven children with clinical signs of colorectal polyps admitted to our hospital between May 2018 and May 2021 were retrospectively reviewed. All children underwent conventional transabdominal ultrasonography (CTUS) and CFCUS prior to undergoing colonoscopy. Pathologic findings were used as the gold standard. Chi-squared tests and Mann-Whitney U tests were used for the statistical analysis. RESULTS Forty-five children with fifty-two colorectal polyps were confirmed via pathological examination. The sensitivity, specificity, positive predictive value, and negative predictive value of CFCUS vs. CTUS were 92.3% versus 80.7%, 100% versus 100%, 100% versus 100%, and 93.3% versus 84.8%, respectively. The missed polyps were significantly smaller than the polyps detected in diameter (7.50 ± 2.12 mm vs. 19.62 ± 7.89 mm, p < 0.0001) by CTUS. A significant difference between CTUS and CFCUS was observed in the detection rate of polyps with a diameter < 1 cm (p = 0.031) and pedicles (p < 0.001). The kappa values for the assessment of Yamada's classification between CTUS and colonoscopy and CFCUS and colonoscopy were 0.51 and 0.84, respectively. Moreover, CFCUS incidentally revealed a punctate hyperechoic area on the surface of colonic polyps in six cases, which may be suggestive of a correlation with erosion and bleeding findings. CONCLUSION CFCUS can increase the detection rate of polyps and pedicles, especially polyps with diameters <1 cm, and accurately evaluate Yamada's classification, providing useful preoperative information for colonoscopy.
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Affiliation(s)
- Min Zhang
- Department of Ultrasound, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Hai Lin
- Department of Pediatric Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Jie Hu
- Department of Ultrasound, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Xiang Xiang Jing
- Department of Ultrasound, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Ling Ling Qin
- Department of Ultrasound, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
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Hosokawa T. Colorectal filling contrast ultrasonography for close inspection of pediatric juvenile polyps. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:573-574. [PMID: 35521928 DOI: 10.1002/jcu.23200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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Diagnostic performance of ultrasound without any colon preparation for detecting colorectal polyps in pediatric patients. Pediatr Radiol 2019; 49:1306-1312. [PMID: 31302736 DOI: 10.1007/s00247-019-04467-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/05/2019] [Accepted: 06/25/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND There are limited data on the sensitivity, specificity and accuracy of ultrasound for detecting colorectal polyps in children and young adults. OBJECTIVE To evaluate the diagnostic accuracy of ultrasound, without any colon preparation, for detecting colorectal polyps in pediatric patients and to determine the causes of false-negative results. MATERIALS AND METHODS We included 74 children with clinical signs like rectal bleeding, abdominal pain or diarrhea who underwent both ultrasound and colonoscopy. We evaluated the diagnostic performance of ultrasound for detecting colorectal polyps before colonoscopy, which served as the reference standard. We used Fisher exact and Student's t-tests for statistical analyses. RESULTS Fifteen pediatric patients were diagnosed with colorectal polyps in the transverse (n=3), descending (n=1) and sigmoid (n=6) colon, and rectum (n=5) by colonoscopy. The sensitivity, specificity and accuracy of ultrasound to detect colorectal polyps were 47% (7/15, 95% confidence interval [CI] 21-73%), 100% (59/59, 95% CI 94-100%) and 89% (66/74, 95% CI 80-95%), respectively. The volume (mean ± standard deviation) of polyps not detected by ultrasound was significantly smaller than that detected (270±380 mm3 vs. 4,600±3,900 mm3, P=0.0124). We observed a significant difference in the location between the polyps detected and not detected by ultrasound (rectal/non-rectal=0/7 vs. 5/3, P=0.0256). No significant age or gender difference was observed. CONCLUSION The accuracy for detecting colorectal polyps by ultrasound was 89% (95% CI, 80-95%) in our cohort. Polyps found in the rectum and relatively smaller polyps accounted for several false-negative cases.
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The pediatric gastrointestinal tract: ultrasound findings in acute diseases. J Ultrasound 2019; 22:409-422. [PMID: 30758808 DOI: 10.1007/s40477-018-00355-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/15/2018] [Indexed: 02/07/2023] Open
Abstract
The study of the gastrointestinal tract by imaging, particularly using ultrasound, is a required instrument for diagnosis of acute and chronic gastrointestinal pathologies in pediatric age. Actually, ultrasound plays an increasing role in the evaluation of gastrointestinal tract in neonatal and pediatric patients because of their small body habitus and the presence of less fat tissue in the abdominal wall and peritoneal cavity. Ultrasound has certain advantages, thanks to the new wide-spectrum frequency probes able to assess a detailed study of the morphological aspects and functional characteristics of bowel loops, adding a new dimension to the imaging of this body system. In this paper, we review anatomy, ultrasound technique and sonographic findings of bowel pathology frequently encountered in neonatal and pediatric emergency setting.
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Qu NN, Liu RH, Shi L, Cao XL, Yang YJ, Li J. Sonographic diagnosis of colorectal polyps in children: Diagnostic accuracy and multi-factor combination evaluation. Medicine (Baltimore) 2018; 97:e12562. [PMID: 30278557 PMCID: PMC6181612 DOI: 10.1097/md.0000000000012562] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
This study was established to evaluate the diagnostic value of ultrasonography in screening colorectal polyps in children and to discuss the necessity of colonic preparation before an ultrasonic examination.In this study, 288 children with colorectal polyps managed at our hospital between January 2007 and December 2016 were retrospectively reviewed. All patients were examined before and after basic colon preparation. The colorectal polyps were confirmed by colonoscopy/laparotomy and histopathology. Among all 288 patients, solitary polyps were identified in 278 patients (96.52%), and multiple polyps were identified in 10 patients (43 polyps) (3.48%) by colonoscopy/laparotomy and histopathology.By ultrasonic examination, 264 cases (264/278) were detected as solitary polyp and 9 cases (9/10) as multiple polyps (31 polyps). In 278 solitary polyps, 180 (64.74%) were detected by ultrasonic examination without a colon preparation. Following glycerine enema (10-20 mL) treatment, 264 (94.96%) cases were detected by ultrasonic examination. The sensitivity and specificity of ultrasonography with glycerine enema for the detection of colorectal polyps were 94.96% and 100%, respectively. Colon preparation significantly increased the proportion of polyps identified by ultrasonography (P < .0001), as well as the diagnostic rate of polyps in rectum, sigmoid colon and descending colon (P < .05).Ultrasonography can be the primary diagnostic method for screening colorectal polyps in children on the strength of its safety, validity, and accuracy. Basic colon preparation with glycerine enema is recommended for children, which enable the detection of intraluminal lesions before ultrasonic examination.
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Affiliation(s)
- Ni-Na Qu
- Department of Ultrasound, Affiliated Yantai Yuhuangding Hospital of Qingdao University
- Department of Ultrasound, Qilu Hospital of Shandong University
| | - Rui-Hua Liu
- Department of Ultrasound, Affiliated Yantai Yuhuangding Hospital of Qingdao University
| | - Lei Shi
- Department of Ultrasound, Affiliated Yantai Yuhuangding Hospital of Qingdao University
| | - Xiao-Li Cao
- Department of Ultrasound, Affiliated Yantai Yuhuangding Hospital of Qingdao University
| | - Yong-Jun Yang
- Ultrasound Department, Second Hospital of Shandong University, Jinan, China
| | - Jie Li
- Department of Ultrasound, Qilu Hospital of Shandong University
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Ultrasound assessment of the bowel: inflammatory bowel disease and conditions beyond. Pediatr Radiol 2017; 47:1082-1090. [PMID: 28779191 DOI: 10.1007/s00247-017-3877-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/22/2017] [Accepted: 04/20/2017] [Indexed: 12/15/2022]
Abstract
Ultrasound (US) is a versatile imaging study for the evaluation of the bowel in children. US imaging of the bowel can be used as the initial examination or in follow-up for many common pediatric diseases. In this article, we highlight our bowel US technique and describe how US can depict the features of a select group of bowel pathologies relevant to pediatric practice.
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Clinical and Ultrasonographic Features of Secondary Intussusception in Children. Eur Radiol 2016; 26:4329-4338. [PMID: 27048536 DOI: 10.1007/s00330-016-4299-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/01/2015] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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10
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Giant colon polyp in a child with suspected inflammatory bowel disease: US findings. J Ultrasound 2016; 19:53-5. [PMID: 26941874 DOI: 10.1007/s40477-014-0091-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 09/08/2013] [Indexed: 10/25/2022] Open
Abstract
A 6-year-old boy with a history of diarrhea and rectal bleeding was referred to our department where he underwent ultrasound (US) examination for suspected inflammatory bowel disease. US showed the presence of an echoic oval mass measuring about 30 × 24 mm located at the transition between the transverse and descending colon. It moved with the peristaltic waves and was attached to the intestinal wall through a pedicle. Color Doppler showed intralesional blood flow. On the basis of these findings, the patient was suspected of having a colon polyp. This diagnosis was confirmed at subsequent colonoscopy. The mass was removed using a diathermy snare, and histologic examination revealed hamartomatous polyp measuring 32 mm.
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Kobayashi Y, Yamada A, Watabe H, Takahashi R, Suzuki H, Hirata Y, Yamaji Y, Yoshida H, Koike K. Sonographic detection of a patency capsule prior to capsule endoscopy: case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:554-556. [PMID: 24648312 DOI: 10.1002/jcu.22147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 09/03/2013] [Accepted: 02/18/2014] [Indexed: 06/03/2023]
Abstract
To avoid retention of the capsule used in capsule endoscopy (CE), the patency capsule (PC), a self-disintegrating sham capsule, is administered prior to CE in patients suspected of small intestinal stenosis. If the PC is excreted intact within 30 hours of ingestion, the patient can undergo CE without retention. However, if the PC is not excreted within 30 hours, its location must be confirmed as in either the small intestine or the colon because of the potential for small intestinal stenosis in the former case. It is often difficult to confirm the location of the PC by abdominal radiograph. We report the case of one patient who did not excrete the PC within 30 hours and for whom it was difficult to distinguish whether the PC was in the small intestine or the colon on abdominal series. Abdominal sonography revealed the PC in the colon and subsequent CE was performed without complication.
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Affiliation(s)
- Yuka Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Common and uncommon applications of bowel ultrasound with pathologic correlation in children. AJR Am J Roentgenol 2014; 202:946-59. [PMID: 24758646 DOI: 10.2214/ajr.13.11661] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the indications and techniques for bowel ultrasound for inflammatory bowel disease and other common and uncommon entities and describe and illustrate their imaging appearances, including endoscopic or surgical correlation. CONCLUSION Ultrasound is a useful tool for the evaluation of inflammatory bowel disease and many other bowel diseases. Radiologists must become familiar with the full potential of ultrasound in the evaluation of the bowel in children because the need for alternative radiation-free imaging techniques continues to grow.
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Wang X, Jia C, Yang H, Wang X, Shi T, Ren W. Sonographic features of a juvenile polyp: a case report and literature review. Clin Imaging 2014; 38:215-7. [DOI: 10.1016/j.clinimag.2013.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 02/18/2013] [Accepted: 04/12/2013] [Indexed: 11/26/2022]
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Zhang Y, Li SX, Xie LM, Shi B, Ju H, Bai YZ, Zhang SC. Sonographic diagnosis of juvenile polyps in children. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1529-1533. [PMID: 22766117 DOI: 10.1016/j.ultrasmedbio.2012.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/17/2012] [Accepted: 05/24/2012] [Indexed: 06/01/2023]
Abstract
The aim of this study was to assess the diagnostic value of ultrasonography for juvenile polyps in children and their sonographic characteristics. A retrospective analysis was performed of the ultrasound findings in 27 children who were diagnosed preoperatively with juvenile polyp within the intestinal tract by ultrasonography and then confirmed by colonoscopy, laparotomy and histopathology. The ultrasonic finding common to all polyps was an isolated intraluminal nodular or massive protrusion, associated with multiple mesh-like fluid areas of different sizes. In 25 children, surrounding pedicle-like low echoes of varying lengths were seen connecting with the polyps to form "mushroom" sign. The color Doppler showed abundant blood flow signals within all polyps and pedicles in a shape of a branch or an umbrella. For seven children with an intussusception, the polyp shadow was detected in the cervical part or interior of the intussusception. Ultrasonography is, thus, considered to be a feasible method for diagnosing intestinal juvenile polyp.
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Affiliation(s)
- Yao Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, P. R. China.
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Laparoscopic-assisted resection of juvenile polyp of the jejunum in a 3-year-old girl. J Pediatr Surg 2012; 47:426-9. [PMID: 22325407 DOI: 10.1016/j.jpedsurg.2011.10.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 10/10/2011] [Accepted: 10/26/2011] [Indexed: 11/22/2022]
Abstract
Sporadic juvenile polyp of the jejunum is exceedingly rare, reported only once in the English literature. We describe a 3-year-old girl with a long-lasting history of chronic iron deficiency anemia and a delayed diagnosis of jejunal polyp. The lesion was eventually discovered by ultrasonography and successfully resected using a laparoscopic-assisted transumbilical approach.
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