Role of Ultrasound in the Assessment of Pediatric Non-Traumatic Gastrointestinal Emergencies

Abstract

Background: Non-traumatic gastrointestinal emergencies in the children and neonatal patients and the presenting characteristics ultrasound features on the longitudinal and axial axes are a dilemma for the radiologist in the emergency room. The most frequent emergencies are appendicitis, intussusceptions, hypertrophic pyloric stenosis, and volvulus due to intestinal malrotation. Objectives: this work aimed to assess the role of ultrasound in the assessment of pediatric non-traumatic gastrointestinal emergencies. Patients and Methods: A retrospective analysis of 205 ultrasound examinations performed for neonatal and children patients with fever, abdominal pain, vomiting and diarrhea were evaluated. Results: Of 205 cases, 19 cases of intussusceptions, 49 cases of appendicitis, 2 cases associated with abscess, 1 gangrenous appendicitis with absence a color Doppler, 30 cases of perforated appendicitis and 3 cases of volvulus were found. Conclusions: Acute abdominal pain is one of the most common complaints in childhood, and one that frequently requires rapid diagnosis and treatment in the emergency department. Although acute abdominal pain is typically self-limiting and benign, there are potentially life-threatening conditions that require urgent management, such as appendicitis, intussusception, or bowel obstruction. Meticulous history taking and repeated physical examinations are essential to determine the cause of acute abdominal pain and to identify children with surgical conditions.

Ultrasound of The Pediatric Gastrointestinal Emergencies

“…Their study showed that ultrasound is a reliable and efficient screening method that accurately identifies the causes of upper gastrointestinal disease in children [9] . Our results agree with those documented by [8] . In terms of Mesenteric ultrasonographic findings of the studied patients, parallel to our results, Banoub et al showed that Anechoic mesentery represented 5 (2.4%) patients, echogenic represented 12.2% of the patients, hyperechoic represented 90 (43.9%) patients and hypervascularization represented 32 (15.6%) patients [8] .…”

“…Our results agree with those documented by [8] . In terms of Mesenteric ultrasonographic findings of the studied patients, parallel to our results, Banoub et al showed that Anechoic mesentery represented 5 (2.4%) patients, echogenic represented 12.2% of the patients, hyperechoic represented 90 (43.9%) patients and hypervascularization represented 32 (15.6%) patients [8] . Regarding site of pathology of the studied patients, conforming our results, Banoub et al showed that 5 (2.4%) patients had pyloric lesions, 7 (3.4%) patients had duodenum lesions, 5 (2.4%) patients had jejunum lesions, 22 (10.7%) patients had ileum lesions, 53 (25.9%) patients had ileocecal lesions, 9 (4.4%) patients had large intestine lesions and 104 (50.7%) patients had not determined/not GIT lesions.…”

“…The demographic data of the patients studied showed similar results to those reported by Banoub et al The majority of the patients were over 10 years old, accounting for around 38% of the study population. Males were slightly more represented than females, with 56.6% of the patients being male and 43.4% being female [8] . In terms of clinical presentation of the studied patients, our results are compatible with Banoub et al who documented that 72 (35.1%) patients had Rt lower ¼ pain, 194 (94.6%) patients had abdominal pain, 33 (16.1%) patients had ileus, 65 (31.7%) patients had diarrhea, 28 (13.7%) patients had hematochezia, 143 (69.8%) patients had vomiting, 63 (30.7%) patients had fever and 102 (49.8%) patients had worse general conditions.…”

“…In terms of clinical presentation of the studied patients, our results are compatible with Banoub et al who documented that 72 (35.1%) patients had Rt lower ¼ pain, 194 (94.6%) patients had abdominal pain, 33 (16.1%) patients had ileus, 65 (31.7%) patients had diarrhea, 28 (13.7%) patients had hematochezia, 143 (69.8%) patients had vomiting, 63 (30.7%) patients had fever and 102 (49.8%) patients had worse general conditions. Abdominal pain was the predominant clinical presentation among the group of patients under study, accounting for approximately 94.6% of cases [8] . According to Mwango et al, transabdominal sonography is an effective diagnostic tool for assessing upper gastrointestinal disease in children and should be prioritized over fluoroscopy as the initial imaging modality to minimize ionizing radiation exposure.…”

“…This conclusion is consistent with the findings of Banoub et al, who also discovered a significant relationship between the etiology of nontraumatic gastrointestinal crises in pediatric patients and the presence of portal venous gas (P 0.001). In particular, all patients with necrotizing enterocolitis (NEC) contained portal venous gas, whereas none of the other cases had this characteristic [8] . There was a strong correlation between the etiology of non-traumatic gastrointestinal crises in pediatric patients and the appearance of the doughnut sign.…”