Prenatal Sonography in Suspected Proximal Gastrointestinal Obstructions: Diagnostic Accuracy and Neonatal Outcomes

Engwall-Gill, Abigail J.; Zhou, Alice L.; Penikis, Annalise B; Sferra, Shelby; Jelin, Angie C.; Kunisaki, Shaun M.

doi:10.1016/j.jpedsurg.2023.02.029

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Many prenatal sonographic textbooks still do not include imaging of the fetal pancreas. Recent studies have also shown that cases with sonographic double‐balloon findings and duodenal atresia are accompanied by a high rate of annular pancreas 18,19 . Therefore, evaluation of the fetal pancreas in Down syndrome cases may also have diagnostic potential.…”

Section: Discussionmentioning

confidence: 99%

Third‐trimester fetal pancreas imaging in uncomplicated pregnancies and association with pregnancy outcomes

Golbasi,

Bayraktar,

Golbasi

et al. 2024

J of Clinical Ultrasound

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ObjectiveTo examine third‐trimester sonographic imaging of the fetal pancreas in uncomplicated pregnancies and its association with pregnancy outcomes.MethodsThis was a prospective cohort study including 274 pregnant women. Uncomplicated pregnancies in the third trimester (28–40 weeks) were included in the study. Maternal chronic disease, pregnancy‐related disorders such as hypertension, diabetes, cholestasis, smoking, and fetal abnormalities were determined as exclusion criteria. Sonographic fetal pancreatic measurement and echogenicity were evaluated in all participants. For intra‐observer reliability, each participant's fetal pancreatic circumference was measured two times. The echogenicity of the pancreas was compared with the liver and ribs and classified as grade 1, 2, and 3. The pregnancy outcomes of all participants were obtained from the hospital digital registration system.ResultsThe average fetal pancreatic circumference in the third trimester was 70.7 ± 0.6 mm (median, 70 [44–100.7]), with high intra‐observer agreement (ICC 0.996 [0.995; 0.997]). A significant positive correlation was found between pancreatic circumference, body mass index (BMI), gestational age, and birth weight. Pancreatic measurements were significantly higher in composite adverse outcomes cases that included at least one of respiratory distress syndrome, hyperbilirubinemia, neonatal pneumonia, infection, and sepsis (p < 0.001). No relationship was found between pancreatic echogenicity and perinatal outcomes.ConclusionFetal pancreas size was positively correlated with gestational age, BMI, and birth weight, and increased fetal pancreas size was associated with composite adverse neonatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Third‐trimester fetal pancreas imaging in uncomplicated pregnancies and association with pregnancy outcomes

Golbasi,

Bayraktar,

Golbasi

et al. 2024

J of Clinical Ultrasound

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“…A high index of suspicion is vital for its accurate and rapid identification ( 5 ). However, acute malrotation with volvulus, a life-threatening emergency with high morbidity and mortality, is difficult to diagnose in the non-verbal pediatric populations ( 3 , 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…The distal duodenum does not reach the left side of the abdomen and, therefore, lacks the stability usually provided by the ligament of Treitz. It is estimated that 3.9-20 of 10,000 newborns present with intestinal malrotation (2)(3)(4), which may complicate acute, intermittent, or chronic midgut volvulus in children and adults (5). A high index of suspicion is vital for its accurate and rapid identification (5).…”

Section: Introductionmentioning

confidence: 99%

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

Yang,

Wang,

Wang

et al. 2024

Front. Pediatr.

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BackgroundIntestinal malrotation is a rare condition, and its delayed diagnosis can lead to fatal consequences. This study aimed to investigate the identification and treatment of malrotation in children.MethodsClinical data, imaging, operative findings, and early postoperative outcomes of 75 children with malrotation were retrospectively analyzed.ResultsThe mean age was 6.18 ± 4.93 days and 51.26 ± 70.13 months in the neonatal group (56 patients) and non-neonatal group (19 patients), respectively. Sixty-seven patients were under the age of 1 year at the time of diagnosis. The occurrence of bilious vomiting and jaundice was significantly higher in the neonatal group (89.29%) than that in the non-neonatal group (37.5%), p < 0.05 and p < 0.01, respectively. The incidence of abnormal ultrasound (US) findings was 97.30% and 100%, respectively, and the sensitivities of the upper gastrointestinal series were 84.21% and 87.5%, respectively. Sixty-six (88%) patients had midgut volvulus, including in utero volvulus (two patients) and irreversible intestinal ischemia (four patients). Most neonates (89.29%) underwent open Ladd's procedure with a shorter operative time (p < 0.01). Reoperation was performed for postoperative complications (four patients) or missed comorbidities (two patients).ConclusionsNon-bilious vomiting was the initial symptom in >10% of neonates and nearly 40% of non-neonates. This highlights the importance for emergency physicians and surgeons to be cautious about ruling out malrotation in patients with non-bilious vomiting. Utilizing US can obviate the need for contrast examinations owing to its higher diagnostic accuracy and rapid diagnosis and can be recommended as a first-line imaging technique. Additionally, open surgery is still an option for neonatal patients.

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Exploring the clinical characteristics and prevalence of the annular pancreas: a meta-analysis

Plutecki,

Ostrowski,

Bonczar

et al. 2024

HPB

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Prenatal Sonography in Suspected Proximal Gastrointestinal Obstructions: Diagnostic Accuracy and Neonatal Outcomes

Cited by 3 publications

References 19 publications

Third‐trimester fetal pancreas imaging in uncomplicated pregnancies and association with pregnancy outcomes

Third‐trimester fetal pancreas imaging in uncomplicated pregnancies and association with pregnancy outcomes

Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study

Exploring the clinical characteristics and prevalence of the annular pancreas: a meta-analysis

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