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  1. University of Arkansas for Medical Sciences
  2. College of Medicine
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  4. An Overview of Gastrointestinal Pathology

An Overview of Gastrointestinal Pathology

Last modified: October 13, 2022
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In the world of pediatric radiology, gastrointestinal anomalies are perhaps the most common, yet clinically confusing group of pathologies, which is why they are aptly suited to imaging for establishing the correct diagnosis (2). Although the differentials are aplenty, we will attempt to address some of the common and more important pediatric GI pathologies which the radiology resident on call may expect to encounter and what to do about them. The clinical entities covered in this part of the review focused on the GI tract will be (in order of incidence) appendicitis, intussusception, gastrointestinal tract obstruction including malrotation, and midgut volvulus; pyloric stenosis; lower gastrointestinal obstructive syndromes including Hirschsprung’s disease, and foreign body ingestion. We will not go over malpositioned feeding tubes (gastrostomy/gastrojejunostomy/Nasogastric/Nasojejunal tubes) and necrotizing enterocolitis (NEC) but these are additional things to consider when you’re reading abdominal radiographs of infants admitted in the ICU.

  • Appendicitis
  • Obstruction
    • Lower GI obstruction
      1. Intussusception
      2. Hirschsprung’s disease
    • Upper GI obstruction
      1. Pyloric stenosis
      2. Duodenal atresia/web
      3. Malrotation and midgut volvulus
  • Ingested foreign body

References

  1. Dunn EA, Olsen ØE, Huisman TAGM. The Pediatric Gastrointestinal Tract: What Every Radiologist Needs to Know. In: Hodler J, Kubik-Huch RA, von Schulthess GK, eds. Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging – IDKD Book. Cham (CH): Springer; March 21, 2018.157-166.
  2. S., L. B., Amar, G., & Ellen, P. (2017). Imaging of Pediatric Gastrointestinal Emergencies. Journal of the American Osteopathic College of Radiology, 6(1), 5–14. https://www.jaocr.org/articles/imaging-of-pediatric-gastrointestinal-emergencies
  3. Gadiparthi, R., & Waseem, M. (2020). Pediatric Appendicitis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/pubmed/28722894
  4. Leung, A. K. C., & Sigalet, D. L. (2003). Acute Abdominal Pain in Children – American Family Physician. In American Family Physician (Vol. 67, Issue 11). www.aafp.org/afpAMERICANFAMILYPHYSICIAN2321
  5. Mittal, M. K., Dayan, P. S., Macias, C. G., Bachur, R. G., Bennett, J., Dudley, N. C., Bajaj, L., Sinclair, K., Stevenson, M. D., & Kharbanda, A. B. (2013). Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort. Academic Emergency Medicine, 20(7), 697–702. https://doi.org/10.1111/acem.12161
  6. Leite, N. P., Pereira, J. M., Cunha, R., Pinto, P., & Sirlin, C. (2005). CT evaluation of appendicitis and its complications: Imaging techniques and key diagnostic findings. In American Journal of Roentgenology (Vol. 185, Issue 2, pp. 406–417). American Roentgen Ray Society. https://doi.org/10.2214/ajr.185.2.01850406
  7. Mandeville, K., Chien, M., Willyerd, F. A., Mandell, G., Hostetler, M. A., & Bulloch, B. (2012). Intussusception: Clinical presentations and imaging characteristics. In Pediatric Emergency Care (Vol. 28, Issue 9, pp. 842–844). Pediatr Emerg Care. https://doi.org/10.1097/PEC.0b013e318267a75e
  8. Vo, N. and Sato, T., 2020. Intussusception In Children. [online] Uptodate.com. Available at: <https://www.uptodate.com/contents/intussusception-in-children?search=intusscuception&source=search_result&selectedTitle=1~114&usage_type=default&display_rank=1#H14> [Accessed 2 August 2020].
  9. Hernanz-Schulman, M. (n.d.). Pyloric stenosis: role of imaging. https://doi.org/10.1007/s00247-008-1106-4
  10. Costa Dias, S., Swinson, S., Torrão, H., Gonçalves, L., Kurochka, S., Vaz, C. P., & Mendes, V. (2012). Hypertrophic pyloric stenosis: Tips and tricks for ultrasound diagnosis. In Insights into Imaging (Vol. 3, Issue 3, pp. 247–250). Springer. https://doi.org/10.1007/s13244-012-0168-x
  11. Sharwood, E., 2020. Pyloric Stenosis. [online] Don’t Forget The Bubbles. Available at: <https://dontforgetthebubbles.com/pyloric-stenosis/> [Accessed 2 August 2020].
  12. Muzio, B. and Qaqish, N., 2020. Hypertrophic Pyloric Stenosis (Ultrasound Measurements Mnemonic) | Radiology Reference Article | Radiopaedia.Org. [online] Radiopaedia.org. Available at: <https://radiopaedia.org/articles/hypertrophic-pyloric-stenosis-ultrasound-measurements-mnemonic-1?lang=us> [Accessed 2 August 2020].
  13. Bomer, J., Stafrace, S., Smithuis, R. and Holscher, H., 2020. The Radiology Assistant : Acute Abdomen In Neonates. [online] Radiologyassistant.nl. Available at: <https://radiologyassistant.nl/pediatrics/acute-abdomen/acute-abdomen-in-neonates> [Accessed 2 August 2020].
  14. Lampl, B., Levin, T. L., Berdon, W. E., & Cowles, R. A. (2009). Malrotation and midgut volvulus: A historical review and current controversies in diagnosis and management. In Pediatric Radiology (Vol. 39, Issue 4, pp.359–366). Pediatr Radiol. https://doi.org/10.1007/s00247-009-1168-y
  15. Bhatia, S., Jain, S., Singh, C. B., Bains, L., Kaushik, R., & Gowda, N. S. (2018). Malrotation of the Gut in Adults: An Often Forgotten Entity. Cureus, 10(3). https://doi.org/10.7759/cureus.2313
  16. Rokade, M. L., Yamgar, S., & Tawri, D. (2011). Ultrasound “ Whirlpool Sign” for Midgut Volvulus. Journal of Medical Ultrasound, 19(1), 24–26. https://doi.org/10.1016/j.jmu.2011.01.001
  17. Orsagh-Yentis, D., McAdams, R. J., Roberts, K. J., & McKenzie, L. B. (2019). Foreign-body ingestions of young children treated in US emergency departments: 1995–2015. Pediatrics, 143(5), 20181988. https://doi.org/10.1542/peds.2018-1988
  18. Guelfguat, M., Kaplinskiy, V., Reddy, S. H., & DiPoce, J. (2014). Clinical guidelines for imaging and reporting ingested foreign bodies. In American Journal of Roentgenology (Vol. 203, Issue 1, pp. 37–53). American Roentgen Ray Society. https://doi.org/10.2214/AJR.13.12185
  19. Wong, K., Van Tassel, D., Lee, J., Buchmann, R., Riemann, M., Egan, C., & Youssfi, M. (2020). Making the diagnosis of midgut volvulus: Limited abdominal ultrasound has changed our clinical practice. Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2020.04.012
  20. Bass, K., Rothenberg, S., & Chang, J. (1998). Laparoscopic Ladd’s procedure in infants with malrotation. Journal of Pediatric Surgery, 33(2), 279-281. doi:10.1016/s0022-3468(98)90447-x
  21. Agrawal, R., Vadera, S. Hirschsprung disease. Reference article, Radiopaedia.org. (accessed on 13 Jul 2022) https://doi.org/10.53347/rID-1456
  22. O’Donovan A, Habra G, Somers S, Malone D, Rees A, Winthrop A. Diagnosis of Hirschsprung’s Disease. AJR Am J Roentgenol. 1996;167(2):517-20. doi:10.2214/ajr.167.2.8686640
  23. Vivier, P., 2005. Hirschsprung’s disease in a neonate. [online] Eurorad – Brought to you by the ESR. Available at: <https://www.eurorad.org/case/3384> [Accessed 13 July 2022].
  24. Rao JN, Wang JY. Regulation of Gastrointestinal Mucosal Growth. San Rafael (CA): Morgan & Claypool Life Sciences; 2010. Introduction.
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