Congenital anomalies of the upper gastrointestinal tract

MR Imaging of the Fetal Gastrointestinal Anomalies

Fetal MR imaging has been shown to be a useful tool for the diagnosis of fetal gastro-intestinal pathologies. To recognize the various pathologies, it is, however, essential to know the normal MR imaging appearance of the fetal bowel at various gestational ages. By providing additional information to ultrasound in case of a fetal gastrointestinal anomaly, MR imaging helps to improve planning for the delivery, postnatal management, and improves parental counseling.

Duodenal stenosis in adult malrotation: When Ladd procedure is not enough: A case report

INTRODUCTION

Congenital causes of duodenal obstruction can be grouped into intrinsic and extrinsic causes. The degree of obstruction caused by such etiologies determines the severity and timing of symptom presentation. Early neonatal diagnosis is common in patients with etiologies that present with high degrees of obstruction such as atresia whereas etiologies that cause lesser degrees of obstruction such as malrotation and duodenal stenosis can go undiagnosed into adulthood.

PRESENTATION OF CASE

We report a case of a 24-year-old female who presented with acute on chronic abdominal pain with bilious vomiting. She was diagnosed with intermittent small bowel volvulus which resolved spontaneously but was found to have adult intestinal malrotation diagnosed intraoperatively. She had a Ladd procedure done but had persistent obstructive small bowel symptoms after the Ladd procedure. She was found to have duodenal stenosis from fibrosis of the duodenum on relaparotomy which was treated surgically with Heineke-Mikulicz strictureplasty leading to total resolution of symptoms.

DISCUSSION

Congenital extrinsic and intrinsic causes of partial duodenal obstruction such as Ladd bands in malrotation and duodenal stenosis respectively, can co-exist and persist into adulthood due to their lesser symptomatology and degree of obstruction. Surgical treatment must identify and correct both conditions when they co-exist to ensure complete resolution of symptoms.

CONCLUSION

This case report highlights the association of duodenal stenosis with adult malrotation which may account for persistent symptoms after the Ladd procedure and suggests the use of Heineke-Mikulicz strictureplasty as a complementary procedure for complete symptom resolution.

Ileal duplication in adults: A rare case

INTRODUCTION AND IMPORTANCE

Intestinal duplication is an uncommon congenital malformation affecting the alimentary tract. This article presents a case of enteric duplication cyst (EDC) in an adult, accompanied by a review of the available literature.

CASE PRESENTATION

A 34-year-old woman with polymyositis underwent a routine CT scan as part of her medical assessment revealing an 8 cm mass near the caecum and terminal ileum. Diagnostic procedures confirmed a cystic spherical mass. The patient underwent ileo-cecal resection, with primary anastomosis and an uneventful recovery.

CLINICAL DISCUSSION

Studies indicate that the frequency of polymyositis coexisting with a neoplasm range from 6 % to 40 %. Therefore, a body CT scan is recommended for patients with myopathy as in our patient. Intestinal duplications are predominantly found in children but can also occur in adults, often discovered incidentally or due to complications. Diagnostic imaging techniques, such as ultrasonography and CT scan, are crucial in identifying duplication location and characteristics. In this case, colonoscopy indicated ileocecal valve compression, and histological examination confirmed an enteric duplication cyst with ectopic gastric mucosa.

CONCLUSION

Enteric duplication cysts are rare, and the existing literature on the topic somewhat limited. Early diagnosis and surgical intervention are essential to stave off potential complications and reduce morbidity. Clinician awareness of enteric duplication cysts enables timely management, enhancing patient outcomes. Further research is needed to improve understanding and optimize patient care.

Multiple thoracic and abdominal foregut duplication cysts: A case report

BACKGROUND

Congenital enteric duplication cysts are tubular or cystic structures that normally lie alongside the gastrointestinal (GI) tract. Enteric duplication cysts are typically solitary lesions that occur anywhere near the GI tract from the neck to the rectum, but having multiple duplication cysts is rare, and presentation within the pancreas is extremely rare.

CASE SUMMARY

We herein demonstrate a case of esophageal, gastric, and gastric-type duplication cyst of the pancreas in a seventeen-month-old girl who presented with failure to thrive, abdominal pain, vomiting, hematemesis, and melena since the age of three months. The cysts were excised by thoracoscopy and laparoscopy in the same setting. To our knowledge, no such case has been published.

CONCLUSION

Enteric duplications can occur throughout the entire alimentary tract. When they occur in the pancreas, they present a formidable challenge in both diagnosis and treatment. Due to the risk of complications and malignant transformation, surgical removal is the recommended treatment of all duplication cysts.

Nonhypertrophic Pyloric Stenosis in a Neonate: A Rare Presentation

Gastric outlet obstruction in neonates due to nonhypertrophic pyloric stenosis (NHPS) is a rare cause. We report the case of a 37-day-old baby boy who presented with complaints of vomiting for the last 2 weeks and an inconsolable cry over the last 2 days. He has been vomiting seven to eight times a day, a few hours after breastfeeding. On ultrasonography, the stomach was distended, while the pylorus was not hypertrophied. An upper gastrointestinal (GI) contrast study was done, which was suggestive of gastric volvulus. We performed a laparoscopy for the same. Intraoperatively, the volvulus was already resolved. We performed gastropexy. Postoperatively, he had persistent symptoms, for which an upper GI endoscopy was performed. It demonstrated a narrow pylorus, consistent with the NHPS. We performed a laparoscopic Heineke-Mikulicz pyloroplasty. The patient's symptoms had improved postoperatively. He was discharged after 5 days.

Imaging Features of Neonatal Bowel Obstruction

Radiologic evaluation of neonatal bowel obstruction is challenging owing to the overlapping clinical features and imaging appearances of the most common differential diagnoses. The key to providing an appropriate differential diagnosis comes from a combination of the patient's gestational age, clinical features, and imaging findings. While assessment of radiographs can confirm bowel obstruction and indicate whether it is likely proximal or distal, additional findings at upper or lower gastrointestinal contrast study together with use of US are important in providing an appropriate differential diagnosis. The authors provide an in-depth assessment of the appearances of the most common differential diagnoses of proximal and distal neonatal bowel obstruction at abdominal radiography and upper and lower gastrointestinal contrast studies. These are divided into imaging patterns and their associated differential diagnoses on the basis of abdominal radiographic findings. These findings include esophageal atresia variants including the "single bubble," "double bubble," and "triple bubble" and distal bowel obstruction involving the small and large bowel. Entities discussed include esophageal atresia, hypertrophic pyloric stenosis, pyloric atresia, duodenal atresia, duodenal web, malrotation with midgut volvulus, jejunal atresia, ileal atresia, meconium ileus, segmental volvulus, internal hernia, colonic atresia, Hirschsprung disease, and functional immaturity of the large bowel. The authors include the advantages of abdominal US in this algorithm, particularly for hypertrophic pyloric stenosis, duodenal web, malrotation with midgut volvulus, and segmental volvulus. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.

Population-based prevalence study of common congenital malformations of the alimentary tract and abdominal wall in Thailand: a study using data from the National Health Security Office

Background

The study aimed to estimate the prevalence of major congenital anomalies of the alimentary system and the abdominal wall in Thailand using a nationwide hospital discharge database from the National Health Security Office (2017-2020).

Methods

The study extracted data from records with International Classification of Diseases-10 (ICD-10) codes related to esophageal malformation (ESO), congenital duodenal obstruction (CDO), jejunoileal atresia (INTES), Hirschsprung's disease (HSCR), anorectal malformation (ARM), abdominal wall defects (omphalocele (OMP) and gastroschisis (GAS)), and diaphragmatic hernia from the database with patient age selection set to less than 1 year.

Results

A total of 2539 matched ICD-10 records were found in 2376 individuals over the 4-year study period. Concerning foregut anomalies, the prevalence of ESO was 0.88/10 000 births, while that of CDO was 0.54/10 000 births. The prevalence figures of INTES, HSCR, and ARM were 0.44, 4.69, and 2.57 cases per 10 000 births, respectively. For abdominal wall defects, the prevalences of OMP and GAS were 0.25 and 0.61 cases/10 000 births, respectively. The mortality in our cases was 7.1%, and survival analysis found that associated cardiac defects had a statistically significant influence on survival in most anomalies studied. In HSCR, both Down syndrome (DS) (hazard ratio (HR)=7.57, 95% confidence interval (CI)=4.12 to 13.91, p<0.001) and cardiac defects (HR=5.82, 95% CI=2.85 to 11.92, p<0.001) were significantly associated with poorer survival outcomes. However, only DS (adjusted HR=5.55, 95% CI=2.63 to 11.75, p<0.001) independently predicted worse outcomes by multivariable analysis.

Conclusions

Our analysis of the hospital discharge database found that the prevalence of gastrointestinal anomalies in Thailand was lower than that reported in other countries, except for HSCR and anorectal malformations. Associated Down syndrome and cardiac defects influence the survival outcomes of these anomalies.

Acquired double pylorus presenting as a gastrointestinal bleeding

We present the case of a 65-year-old man without a past medical history who was admitted for gastrointestinal bleeding. The case shows an acquired double pylorus due to probable pre pyloric ulcer.

Sonographic Detection of Congenital Intestinal Malrotation: A Case Report

Intestinal malrotation is a rare fetal anomaly resulting from the failure of midgut rotation and fixation. Sonography is typically the first modality of choice for assessing pediatric pathology due to its high sensitivity, portability, real-time imaging capability, and non-ionizing technique; however, its role in diagnosing small bowel rotational anomalies remains limited and controversial. Fluoroscopic upper gastrointestinal imaging (UGI) is the primary diagnostic examination at most institutions. However, even on UGI, imaging findings may be equivocal. In such cases, sonography may provide additional information at facilities where it is not used as a primary diagnostic tool. This case report represents the first reported case showing how patient position is important as the typical vascular sonographic features of rotation were normal in one position but abnormal in another. In addition, this case shows how congenital intestinal malrotation was decisively diagnosed using sonographic imaging.

Radiation burden in patients with esophageal atresia: a systematic review

Esophageal atresia (EA) is the most common congenital esophageal disorder. Radiological imaging facilitates diagnosis, surgical interventions, and follow-up. Despite this, standardized monitoring guidelines are lacking. We aimed to: (1) review the literature regarding radiation burden in children with EA; (2) establish the presence of guidelines for diagnosis and follow-up in children with EA. The systematic review was performed according to PRISMA protocol. Two investigators conducted independent searches (PubMed, Ovid, Cochrane Review) and data extraction. Analysis focused on pre- and post-operative imaging type and frequency to determine the radiation burden. Seven studies met the inclusion criteria (337 patients). All authors agreed upon the need to minimize radiation burden, recommending symptoms-guided management, use of dosimeters, and non-radiating imaging. One study identified a median 130-fold increase in cumulative lifetime cancer risk in children with EA compared with other babies in the special care unit. The most common investigations were X-ray and CT (pre-operatively), and X-ray and contrast swallow (post-operatively). Standardized guidelines focused upon the frequency and type of radiological imaging for children with EA are lacking. Children with EA are subjected to more radiation exposure than the general population. Implementation of non-radiating imaging (ultrasonography, manometry) is recommended.

An ileal duplication cyst case report: From diagnosis to treatment

Enteric duplication cysts (EDCs) are rare congenital malformations of the children and can develop everywhere along the gastrointestinal (GI) tract, being the ileum the most frequent localization. We herein present an unusual case of duplication cyst of ileal origin who show a tubular morphology and doesn't communicate with GI lumen. A 2-month-old boy was admitted to our hospital for investigation of an anechoic formation of the lower right abdomen for the surgical planning. The patient was asymptomatic. Ultrasound (US) and magnetic resonance imaging (MRI) showed features of a cystic lesion. Laparoscopic surgery was performed and the cyst excised. Macroscopic examination and histologic findings confirmed the diagnosis of a enteric duplication cyst arising from the ileum. In a patient with an abdominal cystic mass, although asymptomatic, it's worth assessing the nature of the lesion and planning a surgery in order to avoid future complications. A correct use of diagnostic it's fundamental to identify the etiology and the characteristics of a cystic mass.

Esophageal Mucosal Bridge of Unknown Etiology Causing Dysphagia in an Elderly Female: Endoscopic Management and Literature Review

Esophageal mucosal bridge is an elastic stretchable structure, connecting across the lumen, extending either obliquely or horizontally, more commonly seen in the mid or lower esophagus. It can be either congenital or secondary (acquired). Acquired ones are secondary to reflux esophagitis, corrosive esophageal injury, drug-induced esophagitis, radiation esophagitis, Crohn's disease, Mallory-Weiss syndrome, malignant tumors, and infections like candidiasis, HSV, CMV, or tuberculosis. We present a case of an elderly female, who presented with progressive dysphagia for 3 months, more commonly to solids without any history of anorexia or weight loss. No history of corrosive ingestion, radiation exposure, or prior history of any surgical or endoscopic intervention was present. Upper gastrointestinal endoscopy revealed esophageal mucosal bridge at 20 and 25 cm from incisors and mucosal tag. Endoscopic resection was carried out successfully with hot biopsy forceps and needle knife after prophylactic application of hemoclips at two ends of each bridge, without any adverse event. Esophageal mucosal bridge, though rarely reported, should be kept in the differential diagnosis of patients presenting with dysphagia. Endoscopic resection with hot biopsy forceps or needle knife seems to be effective.

Duodenal Stenosis: A Diagnostic Challenge in a Neonate With Poor Weight Gain

Cases of isolated duodenal stenosis in the neonatal period are minimally reported in pediatric literature. Causes of small bowel obstruction such as duodenal atresia or malrotation with midgut volvulus have been well documented and are often diagnosed due to their acute clinical presentation. Duodenal stenosis, however, causes an incomplete intestinal obstruction with a more indolent and varying clinical presentation thus making it a diagnostic challenge. We present a neonate with a unique case of congenital duodenal stenosis. The neonate presented with poor weight gain and frequent "spit-ups" as per the mother at the initial newborn visit. The clinical presentation was masked as the patient was being fed infrequently and with concentrated formula. We postulate that this may be due to the fact that the mother was an adolescent and relatively inexperienced with newborn care. During the hospital course, the patient had recurrent episodes of emesis with notable electrolyte abnormalities including hypochloremia and metabolic alkalosis. Further investigation with an abdominal X-ray showed dilated loops of bowel. Pyloric stenosis was ruled out via abdominal ultrasound. An upper gastrointestinal (GI) series ultimately confirmed a diagnosis of duodenal stenosis and the infant underwent surgical repair with full recovery. Congenital duodenal stenosis may have atypical presentations in neonates requiring pediatricians to have a high index of suspicion for diagnosis and to ensure timely therapy.

Feline abdominal ultrasonography: What's normal? What's abnormal? The diseased gastrointestinal tract

PRACTICAL RELEVANCE

Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. B-mode ultrasonography is likely the most widely used modality for imaging the gastrointestinal (GI) tract in cats and it can help in the diagnosis of GI masses, foreign bodies and disorders of the ileocaecocolic junction.

CLINICAL CHALLENGES

Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even differentiating between normal variations and pathological changes can be challenging for all but the most experienced. For example, while for inflammatory conditions of the feline GI tract changes are frequently identified on ultrasound, there may occasionally be no changes to the appearance of the intestine; hence a 'normal' ultrasound does not exclude the possibility of inflammatory disease.

AIM

This review, part of an occasional series on feline abdominal ultrasonography, describes the appearance of a range of conditions that affect the feline GI tract; the normal GI tract is addressed in an accompanying article in this issue of JFMS. Aimed at general practitioners who wish to improve their knowledge and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material.

EQUIPMENT

Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience.

EVIDENCE BASE

Information provided in this article is drawn from the published literature and the author's own clinical experience.

Distal Duodenal Obstruction: a Surgical Enigma

The postbulbar segment also known as the distal duodenum is a separate clinical entity in terms of the intrinsic pathologies of this region and its varied anatomical relations. The common bile duct and the pancreatic duct open through the major papilla, which marks the beginning of this segment. Distal duodenal obstruction can be defined as a clinicoradiological entity that is characterized by features of gastric outlet obstruction with recurrent bilious vomiting and a radiological evidence of postbulbar obstruction. A Medline search for distal duodenal obstruction revealed 1409 entries, mostly in the form of case reports. In the last 10 years, 310 cases are reported. Clinical features like abdominal pain, nausea, and vomiting are non-specific and quite similar to gastric outlet obstruction. Clinical findings are also non-specific and do not aid in diagnosis. Laboratory findings also do not add much. Contrast-enhanced CT scan and MR enterography are diagnostic modalities of choice. Distal duodenal obstruction is a clinical entity that has a wide list of differential diagnosis which requires due consideration in terms of its management and follow-up. Most of these lesions require adequate workup with the help of a multidisciplinary team consisting of radiologists, gastroenterologists, and pathologists to adequately diagnose and stage the disease before a treatment plan is formulated. A thorough knowledge is a must regarding the treatment options available for each of the conditions so that the management can be personalized leading to better results.

Ultrasound of the duodenum in children

Ultrasound is well suited for examining the pediatric duodenum, given the small size of the patients, the lack of ionizing radiation and high-resolution imaging potential. Technical considerations, normal anatomy, congenital and acquired pathology of the duodenum, and the advantages and limitations of US are discussed and illustrated in this review.

Congenital duodenal obstruction: causes and imaging approach

Bilious emesis is a common cause for evaluation in pediatric radiology departments. There are several causes of congenital duodenal obstruction, most of which require elective surgical correction, but the potential of malrotation with midgut volvulus demands prompt imaging evaluation. We review the various causes of congenital duodenal obstruction with an emphasis on the approach to imaging evaluation and diagnosis.

MRI Findings of Intrinsic and Extrinsic Duodenal Abnormalities and Variations

This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma. MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

Multimodality imaging of diseases of the duodenum

The duodenum is a unique segment of intestine, occupying both intra and extra-peritoneal locations. There is a wide spectrum of abnormalities of the duodenum that range from congenital anomalies to traumatic, inflammatory, and neoplastic entities. The duodenum may be overlooked on cross-sectional imaging due to its location and small size. Duodenal pathologies may, therefore, be missed or wrongly diagnosed. Knowledge about duodenal pathologies and optimal imaging techniques can increase diagnostic yield and permit optimal patient management. Conventionally, the duodenum was evaluated with upper GI studies on fluoroscopy; however, endoluminal evaluation is better performed with endoscopy. Additionally, a broad array of cross-sectional imaging modalities permits comprehensive assessment of the duodenum and surrounding viscera. While endoscopic sonography is increasingly used to locally stage duodenal malignancies, MDCT remains the primary modality widely used in the detection and characterization of duodenal abnormalities. MRI is used as a "problem solving" modality in select conditions. We present a comprehensive review of duodenal abnormalities with an emphasis on accurate diagnosis and management.

Chest pain and anxiety in an adolescent: an unusual etiology

Chest pain in children is commonly caused by benign etiologies but may be caused by conditions that carry significant morbidity if not treated. Emergency medicine physicians must identify the patients that require further evaluation and treatment. We describe a case of a 13-year-old boy with 10 months of progressive chest pain that had been attributed to anxiety and was ultimately diagnosed as an esophageal duplication cyst requiring surgical repair.

Use of diagnostic imaging in the evaluation of gastrointestinal tract duplications

Background

Gastrointestinal tract duplication is a rare malformation associated with the presence of additional segment of the fetal gut. The aim of this study was to retrospectively review clinical features and imaging findings in intraoperatively confirmed cases of gastrointestinal tract duplication in children.

Material/Methods

The analysis included own material from the years 2002–2012. The analyzed group included 14 children, among them 8 boys and 6 girls. The youngest patient was diagnosed at the age of three weeks, and the oldest at 12 years of age.

Results

The duplication cysts were identified in the esophagus (n=2), stomach (n=5), duodenum (n=1), terminal ileum (n=5), and rectum (n=1). In four cases, the duplication coexisted with other anomalies, such as patent urachus, Meckel’s diverticulum, mesenteric cyst, and accessory pancreas. Clinical manifestation of gastrointestinal duplication cysts was variable, and some of them were detected accidently. Thin- or thick-walled cystic structures adjacent to the wall of neighboring gastrointestinal segment were documented on diagnostic imaging.

Conclusions

Ultrasound and computed tomography are the methods of choice in the evaluation of gastrointestinal duplication cysts. Apart from the diagnosis of the duplication cyst, an important issue is the detection of concomitant developmental pathologies, including pancreatic heterotopy.

Isolated duodenal duplication cyst presenting as a complex solid and cystic mass in the upper abdomen

Duodenal duplication cysts are a rare subtype of gastrointestinal duplications cysts. Approximately 5% of gastrointestinal duplication cysts occur in the duodenum. An 18-year-old woman presented with epigastric pain and a subjective abdominal bulge. A computed tomography scan was subsequently performed and showed a solid and cystic mass with wall calcifications in the lesser sac of the upper abdomen. A duodenal duplication cyst was found unexpectedly on histopathologic analysis. This was also an unusual case as there was no evidence of malignancy. Four years after surgery, the patient remains asymptomatic. We present a brief literature review on duodenal duplication cysts and discuss its differential diagnosis.

Spectrum of imaging manifestations in non-neoplastic gastric pathologies

This article illustrates a wide spectrum of non-neoplastic gastric pathologies on cross-sectional imaging. Salient features of inflammatory, infectious, vascular, traumatic, and miscellaneous conditions of the stomach have been discussed and imaging clues to reach an accurate diagnosis are stressed upon.

Neoplastic stomach lesions and their mimickers: spectrum of imaging manifestations

This review illustrates a wide spectrum of gastric neoplasms with emphasis on imaging findings helpful in characterizing various gastric neoplasms. Both the malignant and benign neoplasms along with focal gastric masses mimicking tumour are illustrated. Moreover, imaging clues to reach an accurate diagnosis are emphasized.

Congenital double pylorus

The double pylorus is an uncommon finding and maybe congenital due to gastrointestinal duplication abnormality or more commonly secondary to peptic ulcer disease. The case we present is an elderly patient with mild dyspeptic symptoms who had an upper endoscopy as part of her investigative workup. The congenital double pylorus, being asymptomatic, may often go undetected. It is sometimes found incidentally on upper endoscopy, but needs no directed therapy. It is not associated with any specific complication.

Isolated intramuscular fibrous band masquerading antral web in a premature neonate. A case report

Isolated fibrous gastric antral band in a neonate causing partial gastric obstruction and mimicking prepyloric antral web is not reported in the English literature, and we would like to report the first case. A premature neonate with feeding difficulties and bilious aspirate underwent upper gastrointestinal contrast examination. The upper gastrointestinal series showed a thin, radiolucent, circumferential band in the antrum with delayed gastric emptying. Radiographic diagnosis of prepyloric antral web with partial gastric obstruction was made. Intraoperatively, a circumferential fibrous cord was found in the muscle layer (tunica muscularis) of the antrum, which was completely divided. Clinically and radiographically, the 2 conditions could not be differentiated but require 2 separate surgical techniques for their management.

"What is inside this right lower quadrant sac?" Spectrum of computed tomography abnormalities that affect the cecum

The current pictorial is a comprehensive review of the various cecal pathologies, including both those that solely involve the cecum and those in which the cecum may be secondarily involved. The various cecal abnormalities will be categorized as inflammatory, infectious, vascular, neoplastic, congenital, and foreign bodies. Emphasis will be placed on the imaging features that, when coupled with the clinical history, help to reach a diagnosis or to narrow the differential diagnosis.

Complications of congenital and developmental abnormalities of the gastrointestinal tract in adolescents and adults: evaluation with multimodality imaging

There is a wide variety of congenital anomalies that may affect the gastrointestinal tract. Most symptomatic congenital anomalies are found in newborns and infants. Such anomalies are relatively rare in adolescents and adults, and they may be difficult to identify because clinical symptoms often are nonspecific and insidious, causing them to be mistaken for other common abdominal conditions. Multimodality imaging is useful in evaluating congenital anomalies of the gastrointestinal tract in adults. The imaging features at radiography, fluoroscopy, ultrasonography, computed tomography, and magnetic resonance imaging may help identify congenital gastrointestinal anomalies such as congenital esophageal stenosis, gastric volvulus, duodenal web, annular pancreas, heterotopic pancreas, cecal volvulus, anomalies of the omphalomesenteric duct, Hirschsprung disease, and gastrointestinal duplication cyst. Familiarity with the imaging features of the various congenital anomalies of the gastrointestinal tract and their complications is important to establish the correct diagnosis and determine appropriate treatment, which is critical to avoid life-threatening complications.

[Diagnostic imaging evaluation of neonatal vomiting]

Vomiting during the neonatal period is frequent. The purpose is to detect neonates and infants with digestive pathology requiring urgent management such as duodenal atresia, small bowel volvulus, acute intussusception, and hypertrophic pyloris stenosis. All of these conditions may be diagnosed by ultrasound which should be performed when clinically suspected.

Annular pancreas: a rare cause of duodenal obstruction in adults

Annular pancreas is an uncommon congenital anomaly which usually presents itself in infants and newborn. Rarely it can present in late adult life with wide range of clinical severities thereby making its diagnosis difficult. Pre-operative diagnosis is often difficult. CT scan can illustrate the pancreatic tissue encircling the duodenum. ERCP and MRCP are useful in outlining the annular pancreatic duct. Surgery still remains necessary to confirm diagnosis and bypassing the obstructed segment.We report a case of 61 year female presenting with duodenal obstruction due to annular pancreas.

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.

Cistos congênitos do mediastino: aspectos de imagem

Cistos congênitos mediastinais são lesões benignas incomuns, geralmente causadas por falhas no desenvolvimento embriológico do intestino anterior e/ou da cavidade celômica. São formações expansivas, comumente assintomáticas, mas que podem se manifestar principalmente pela compressão de estruturas adjacentes. Entre as principais entidades deste grupo temos: cistos broncogênico, pericárdico, entérico e tímico, linfangioma e cisto de duplicação esofágica. A morfologia dos cistos congênitos mediastinais é típica, sendo os exames de imagem suficientes, em grande parte dos casos, para a confirmação diagnóstica. O tratamento cirúrgico está indicado apenas nos casos sintomáticos, pois estas lesões não apresentam potencial de degeneração maligna. O objetivo deste trabalho é comentar e ilustrar os aspectos de imagem mais relevantes destas lesões, a partir do estudo retrospectivo de dez casos de arquivo das instituições envolvidas.

A rare gastric outlet anomaly: pyloric ostium on incissura angularis

Congenital gastric outlet anomalies are rarely seen defects resulting from early embryologic development of foregut. We report a case of congenital pyloric outlet anomaly in a 60-year-old man with mild postprandial epigastric discomfort of approximately 3 months' duration. Endoscopic examination of the stomach showed a pyloric ostium on incissura angularis connecting the stomach to the duodenum. Usual site of pylorus at the end of antrum was closed like a sac. No signs of acute or chronic peptic ulcer were noted. A biopsy was taken from the region showed normal mucosal layers with a mild gastritis. There was no history of surgery, ulcer disease, or use of any medication. The case was considered to be congenital in origin and was successfully treated conservatively with proton-pump inhibitors and gastrokinetics.

[Ultrasound and CT study of duodenal pathology]

The radiological evaluation of the duodenum has traditionally been based on barium transit studies; however, ultrasound (US) and computed tomography (CT) are becoming more important in the assessment of this portion of the intestine and the structures that surround it. This report describes and illustrates the CT and US findings for different entities that affect the duodenum, including diseases of the duodenum itself and those of neighboring organs that affect this portion of the small intestine. We classify the pathologies by etiology into congenital, traumatic, iatrogenic and foreign bodies, bezoars, hematologic, inflammatory and neoplastic. Moreover, we present the incidental duodenal and periduodenal findings in US and CT that radiologists should be familiar with given the widespread use of these techniques.

Pancreatic and peripancreatic diseases mimicking primary pancreatic neoplasia

A variety of anatomic variants and pathologic conditions in and around the pancreas may simulate primary pancreatic neoplasia at routine abdominal cross-sectional imaging. An ambiguous lesion whose appearance suggests a pancreatic origin requires a broad differential diagnosis that can subsequently be narrowed on the basis of both clinical history and features at optimal computed tomography (CT) and magnetic resonance (MR) imaging. Pancreas-specific multidetector CT and MR imaging techniques with thin collimation, multiplanar and multiphasic scans, and newly introduced curved planar reformation may help avoid potential diagnostic pitfalls. These techniques can help identify and characterize a mass in multiple viewing planes, thereby helping distinguish a true pancreatic neoplasm from peripancreatic adenopathy or from a tumor of the adjacent duodenum or small bowel. They can also help determine the cause of a tumor. It is important that the radiologist be familiar with the wide spectrum of anatomic variants and disease entities that can mimic primary pancreatic neoplasia in order to initiate the appropriate lesion-specific work-up and treatment and avoid unnecessary tests or procedures, including surgery.

Imaging of congenital anomalies of the gastrointestinal tract

The radiological imaging plays a vital role in the evaluation of patients with congenital anomalies of the gastrointestinal tract. The evaluation of these patients, most of which present early after birth, frequently requires the use of various imaging modalities for making the correct diagnosis and planning surgical correction. This article reviews the common congenital anomalies of the gastrointestinal tract including obstructive lesions, anomalies of rotation and fixation, anorectal anomalies, and intestinal duplications. The plain radiograph is often diagnostic in neonates with complete gastric of upper intestinal obstruction and further radiologic evaluation may be unnecessary. An upper gastrointestinal series should be performed in all patients with incomplete intestinal obstruction. Sonography is useful in the evaluation of many congenital anomalies affecting pediatric gastrointestinal tract especially hypertrophic pyloric stenosis, enteric duplication cysts, midgut malrotation, meconium ileus and meconium peritonitis. Moreover, CT and MRI has assumed a greater importance as these provide excellent anatomic details which may be necessary for correct diagnosis as well as treatment planning. This is particularly true in evaluation of congenital anomalies such as esophageal/enteric duplications, vascular rings and anorectal anomalies. It is important to be familiar with the role nad usefulness of the various imaging modalities so that these can be used judiciously to avoid unnecessary radiation exposure while minimizing the patient discomfort.

Atresia do trato gastrintestinal: avaliação por métodos de imagem

Um amplo espectro de anomalias congênitas pode afetar qualquer nível do trato gastrintestinal, do esôfago ao ânus. A atresia é uma importante causa de obstrução gastrintestinal, com alta taxa de morbidade em recém-natos. Há diversos mecanismos patológicos possíveis para explicar esta malformação e duas explicações clássicas de sua gênese são um defeito de recanalização do tubo intestinal ou uma interrupção no suprimento sanguíneo durante a vida intra-uterina. Os autores fazem uma revisão da literatura com ensaio iconográfico dos achados de imagem em crianças com atresia do trato gastrintestinal.