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Glutig K, Veldhoen S. [Developmental disorders of the gastrointestinal tract]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:392-399. [PMID: 38598006 DOI: 10.1007/s00117-024-01302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Developmental disorders of the gastrointestinal tract comprise a broad spectrum of congenital malformations of different etiologies and locations from the mouth to the anus. METHODS The authors present the most important malformations of the gastrointestinal tract on the basis of basic and current reviews. RESULTS Gastrointestinal developmental disorders occur both sporadically and in connection with malformation syndromes. Symptoms are highly variable and range from postnatal emergencies to asymptomatic abnormalities, which may be incidental radiological findings. Prenatal ultrasound examinations can often identify gastrointestinal developmental disorders at an early stage. Here, fetal magnetic resonance imaging can be a useful addition to the diagnostic process. In the first few days of life, simple X‑ray overview images, supplemented by images after the administration of contrast medium, are often sufficient. CONCLUSION Many patients with a malformation of the gastrointestinal tract require lifelong medical care, so that not only pediatric radiologists need specific knowledge about this group of diseases.
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Affiliation(s)
- K Glutig
- Pädiatrische Radiologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - S Veldhoen
- Pädiatrische Radiologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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Feng W, Zhang B, Fan L, Song A, Hou J, Die X, Liu W, Wang Y, Guo Z. Clinical characteristics and influence of postoperative Hirschsprung-associated enterocolitis: retrospective study at a tertiary children's hospital. Pediatr Surg Int 2024; 40:106. [PMID: 38613719 DOI: 10.1007/s00383-024-05688-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE To explore the influence of postoperative Hirschsprung-associated enterocolitis (post-HAEC) on long-term outcomes and to identify risk factors of post-HAEC. METHODS The medical records of 304 eligible patients diagnosed with Hirschsprung's disease (HSCR) were reviewed. We analyzed the clinical characteristics of post-HAEC and its influence on long-term outcomes. Furthermore, risk factors for early and recurrent HAEC were identified separately. RESULTS The overall incidence of post-HAEC was 29.9% (91/304). We categorized early HAEC as occurring within postoperative 3 months (n = 39) and recurrent HAEC as occurring ≥ 3 episodes within postoperative 6 months (n = 25). Patients with early HAEC were more likely to experience worse nutritional status, defecation function, and quality of life compared to those with late or no episodes (P < 0.05). Similarly, the adverse influences of recurrent HAEC on these outcomes were also significant (P < 0.05). The risk factors for early HAEC included preoperative undernutrition, long-segment HSCR, and postoperative Grade 3-4 complications within 30 days. For recurrent HAEC, risk factors were preoperative malnutrition, non-parental caregivers, long-segment HSCR, and postoperative Grade 3-4 complications within 30 days. CONCLUSION Classification of post-HAEC based on the first episode time and frequency was necessary. The earlier or more frequent episodes of post-HAEC have detrimental influences on long-term outcomes. Furthermore, risk factors for early and recurrent HAEC were different.
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Affiliation(s)
- Wei Feng
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Bobin Zhang
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Linxiao Fan
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Aohua Song
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Jinping Hou
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Xiaohong Die
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Wei Liu
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Yi Wang
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China
| | - Zhenhua Guo
- Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
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Sowulewski O, Bubińska M, Zagierska A, Zagierski M, Szlagatys-Sidorkiewicz A. High-Resolution Anorectal Manometry as a Screening Tool for Hirschsprung's Disease: A Comprehensive Retrospective Analysis. J Clin Med 2024; 13:1268. [PMID: 38592083 PMCID: PMC10932072 DOI: 10.3390/jcm13051268] [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: 12/19/2023] [Revised: 01/26/2024] [Accepted: 02/14/2024] [Indexed: 04/10/2024] Open
Abstract
Hirschsprung's disease (HD) is characterized by a congenital absence of enteric ganglion cells in the intestine, posing challenges in diagnosis, particularly in pediatric patients. The gold standard, rectal suction biopsy (RSB), carries risks, prompting an exploration of non-invasive alternatives such as high-resolution anorectal manometry (HR-ARM) for HD screening. We conducted a retrospective analysis of 136 patients suspected of HD between 2018 and 2022, which were stratified into three age groups: ≤12 months, ≤24 months, and >24 months. Criteria for suspicion included delayed meconium passage, unresponsive chronic constipation, and abnormal prior test results. HR-ARM, supplemented by additional tests, confirmed 16 HD cases. HR-ARM exhibited 93.75% sensitivity, 89.47% specificity, 99.03% negative predictive value (NPV), and 55.56% positive predictive value (PPV). Notably, HR-ARM consistently performed well in patients ≤ 2 years old but demonstrated reduced efficacy in older children, which was likely due to complications from chronic constipation. This study underscores HR-ARM's promise as a non-invasive HD screening tool, especially in younger patients. However, its limitations in older children warrant consideration. Establishing standardized protocols, particularly for assessing the recto-anal inhibitory reflex, is crucial. Further research is imperative to optimize HR-ARM's diagnostic role across varied age groups in HD assessment.
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Affiliation(s)
- Oliver Sowulewski
- Department of Paediatrics, Gastroenterology, Allergology & Paediatric Nutrition, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (M.B.); (A.Z.); (M.Z.); (A.S.-S.)
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Ju H, Feng S, Huang Y. Diagnostic value of the microcolon using ultrasonography in small bowel atresia. BMC Pediatr 2022; 22:576. [PMID: 36203132 PMCID: PMC9535889 DOI: 10.1186/s12887-022-03629-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background Microcolon helps diagnose small bowel atresia (SBA) using contrast enema. However, there are no ultrasonography (US) microcolon criteria for diagnosing SBA. Therefore, this study aimed to evaluate colon accuracy and other characteristics for diagnosing SBA by US, using surgical or clinical information as the reference standard. Methods US was performed on 46 neonates aged ≤ 7 days old. In the study group (n = 15), neonates with SBA were confirmed following surgery. In the study group without SBA (n = 15), neonates with other gastrointestinal problems besides SBA were confirmed by surgical or clinical follow-up. Sixteen neonates without gastrointestinal problems were classified as the control group. The colonic diameter was measured, and colonic gas was sought and observed. Statistical analysis was performed to compare US parameters between the study group and other two groups. The optimal cut-off value of the colonic diameter for SBA diagnosis was obtained using receiver operating characteristic analysis. Results Colonic diameters (0.5 cm) in the study group (interquartile ranges [IQR], 0.5–0.6 cm) was significantly smaller than that in the group without SBA (0.9 cm; IQR, 0.8–1.2 cm) (P < 0.001) and in the control group (1.2 cm; IQR, 0.8–1.35 cm) (P < 0.001). Optimum cut-off value for diagnosing SBA was 0.65 cm (sensitivity, 90.3%; specificity, 86.7%; accuracy, 89.1%) for the colonic diameter. Combining microcolon and gas-negativity showed the best performance in SBA diagnosis using US, with increased accuracy (91.3%). Conclusion A colon < 0.65 cm in diameter should be called a microcolon; combining US with gas-negativity is an essential diagnostic basis for SBA. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03629-z.
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Affiliation(s)
- Hao Ju
- Department of Ultrasound, Shengjing Hospital of China Medical University, 110004, Shenyang, China
| | - Shu Feng
- Department of Ultrasound, Shengjing Hospital of China Medical University, 110004, Shenyang, China
| | - Ying Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, 110004, Shenyang, China.
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Lim YJ, Jung HK. Sonographic findings of total colonic aganglionosis in a neonate with Haddad syndrome: A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:810-813. [PMID: 35080777 DOI: 10.1002/jcu.23147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/12/2021] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
Haddad syndrome is a rare congenital disorder characterized by congenital central hypoventilation syndrome and Hirschsprung disease. Total colonic aganglionosis is a rare and long-segment form of Hirschsprung disease, which is primarily diagnosed using contrast enemas. However, the diagnostic performance of contrast enemas is relatively low, making the diagnosis of total colonic aganglionosis challenging. In neonates, ultrasound may be used as an additional imaging modality for the diagnosis of Hirschsprung disease. We describe the unique sonographic findings of total colonic aganglionosis in a term neonate with failure to pass meconium and respiratory distress, who was subsequently diagnosed with Haddad syndrome.
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Affiliation(s)
- Yun-Jung Lim
- Department of Radiology, Haeundae Paik Hostpital, Inje University, Busan, Republic of Korea
| | - Hyun Kyung Jung
- Department of Radiology, Haeundae Paik Hostpital, Inje University, Busan, Republic of Korea
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Manzoor A, Talat N, Adnan HM, Zia MW, Aziz MA, Ahmed E. Contrast Enema: Solving Diagnostic Dilemmas in Neonates With Lower Intestinal Obstruction. Cureus 2022; 14:e23458. [PMID: 35495017 PMCID: PMC9038504 DOI: 10.7759/cureus.23458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/05/2022] Open
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Choi G, Je BK, Kim YJ. Gastrointestinal Emergency in Neonates and Infants: A Pictorial Essay. Korean J Radiol 2022; 23:124-138. [PMID: 34983099 PMCID: PMC8743148 DOI: 10.3348/kjr.2021.0111] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 08/29/2021] [Accepted: 09/13/2021] [Indexed: 02/02/2023] Open
Abstract
Gastrointestinal (GI) emergencies in neonates and infants encompass from the beginning to the end of the GI tract. Both congenital and acquired conditions can cause various GI emergencies in neonates and infants. Given the overlapping or nonspecific clinical findings of many different neonatal and infantile GI emergencies and the unique characteristics of this age group, appropriate imaging is key to accurate and timely diagnosis while avoiding unnecessary radiation hazard and medical costs. In this paper, we discuss the radiological findings of essential neonatal and infantile GI emergencies, including esophageal atresia and tracheoesophageal fistula, hypertrophic pyloric stenosis, duodenal atresia, malrotation, midgut volvulus for upper GI emergencies, and jejunoileal atresia, meconium ileus, meconium plug syndrome, meconium peritonitis, Hirschsprung disease, anorectal malformation, necrotizing enterocolitis, and intussusception for lower GI emergencies.
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Affiliation(s)
- Gayoung Choi
- Department of Radiology, Korea University Ansan Hospital, Ansan, Korea
| | - Bo-Kyung Je
- Department of Radiology, Korea University Ansan Hospital, Ansan, Korea.
| | - Yu Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ma Y, Jiang Q, Zhang Z, Xiao P, Yan Y, Liu J, Li Q, Wang Z. Diagnosis of Hirschsprung disease by hydrocolonic sonography in children. Eur Radiol 2021; 32:2089-2098. [PMID: 34532759 DOI: 10.1007/s00330-021-08287-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/22/2021] [Accepted: 08/18/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare hydrocolonic sonography with histopathology for diagnosing children with symptoms highly suggestive of Hirschsprung disease (HD). METHODS In this prospective study, patients presenting refractory constipation highly suggestive of HD underwent hydrocolonic sonography with retrograde infusion of saline into the colon. The dilated segments, narrowed segments, luminal diameter ratio, transition zone (TZ), thickening, and blood perfusion of the upstream bowel were evaluated. The sensitivity and specificity of combined and single parameters were determined in comparison with biopsy. RESULTS One hundred and three children were included in this study; 49 were confirmed to have HD. The luminal diameter ratio showed superiority over other parameters. An area under the curve (AUC) of 0.969 (95% confidence interval [CI]: 0.936-1.000) and a cutoff value of 1.51 were established by receiver operating characteristic (ROC) curve analysis of the luminal diameter ratio (sensitivity: 89.8%; specificity: 96.3%). By combining the luminal diameter ratio as the major criterion with two minor criteria, hydrocolonic sonography showed the same sensitivity (91.8%) and better specificity (96.3% vs 87%) than contrast enema, but this difference was not statistically significant (p = 0.063). Consistency analysis showed a kappa value of 0.825 (p < 0.001), indicating excellent agreement between hydrocolonic sonography and contrast enema. CONCLUSIONS Hydrocolonic sonography is a valuable diagnostic tool with both high sensitivity and specificity for HD diagnosis, allowing morphological and vascular assessments of the colon, and correlates well with contrast enema. In the appropriate setting, hydrocolonic sonography may be an alternative screening method for HD in a large group of children with constipation. Key Points • Hydrocolonic sonography is a simple, well-tolerated diagnostic tool with both high sensitivity and specificity for HD diagnosis. • Hydrocolonic sonography allows morphological and vascular assessments of the colon, and correlates well with contrast enema. • Hydrocolonic sonography is a possible alternative modality for paediatric patients highly suggestive of HD.
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Affiliation(s)
- Ya Ma
- Department of Ultrasound, Capital Institute of Pediatrics, No. 2 Yabao Rd, Chaoyang District, Beijing, 100020, China
| | - Qian Jiang
- Department of Medical Genetics, Capital Institute of Pediatrics, Beijing, China
| | - Zijian Zhang
- Department of Ultrasound, Capital Institute of Pediatrics, No. 2 Yabao Rd, Chaoyang District, Beijing, 100020, China
| | - Ping Xiao
- Department of Pathology, Capital Institute of Pediatrics, Beijing, China
| | - Yuchun Yan
- Department of Radiology, Capital Institute of Pediatrics, Beijing, China
| | - Junting Liu
- Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing, China
| | - Qi Li
- Department of General Surgery, Capital Institute of Pediatrics, No. 2 Yabao Rd, Chaoyang District, Beijing, 100020, China.
| | - Zhengrong Wang
- Department of Ultrasound, Capital Institute of Pediatrics, No. 2 Yabao Rd, Chaoyang District, Beijing, 100020, China.
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