Abdominal ultrasonography of the pediatric gastrointestinal tract

Abstract

Ultrasound is an invaluable imaging modality in the evaluation of pediatric gastrointestinal pathology; it can provide real-time evaluation of the bowel without the need for sedation or intravenous contrast. Recent improvements in ultrasound technique can be utilized to improve detection of bowel pathology in children: Higher resolution probes, color Doppler, harmonic and panoramic imaging are excellent tools in this setting. Graded compression and cine clips provide dynamic information and oral and intravenous contrast agents aid in detection of bowel wall pathology. Ultrasound of the bowel in children is typically a targeted exam; common indications include evaluation for appendicitis, pyloric stenosis and intussusception. Bowel abnormalities that are detected prenatally can be evaluated after birth with ultrasound. Likewise, acquired conditions such as bowel hematoma, bowel infections and hernias can be detected with ultrasound. Rare bowel neoplasms, vascular disorders and foreign bodies may first be detected with sonography, as well. At some centers, comprehensive exams of the gastrointestinal tract are performed on children with inflammatory bowel disease and celiac disease to evaluate for disease activity or to confirm the diagnosis. The goal of this article is to review up-to-date imaging techniques, normal sonographic anatomy, and characteristic sonographic features of common and uncommon disorders affecting the gastrointestinal tract in children.

Accuracy of Ultrasound in the Evaluation of Pediatric Abdominal Surgical Emergency: A Comparison with Intra-Operative Findings

“…Ultrasound examination may be required if physical findings are inconclusive or in cases of acute scrotum [18]. Ultrasound can also be used in assessing peristalsis, wall thickness and vascularity of the bowel in the hernia sac [19]. Chen et al reported that ultrasound is 95.5% accurate in detecting inguinal hernia in boys [20].…”

Contrast-enhanced ultrasound of the pediatric bowel

“…To mitigate peristalsis, some examiners recommend administering antispasmolytics prior to CEUS exams. Pre-contrast US assesses the diseased bowel location, total length, wall thickness, morphology of the bowel wall, and vascularity using color/power Doppler US [ 29 , 30 ]. Other imaging features examined on baseline US include echogenicity and vascularity of the mesenteric fat, presence of enlarged lymph nodes, and complications such as inflammatory mass, abscesses, strictures and fistulae.…”

<p>A Serosa-Originated Gastric Stromal Tumor Misdiagnosed by Ultrasonography and Frozen Section Pathology: A Case Report</p>

“…6 Under normal condition, five echo layers, namely, superficial mucosa, muscularis mucosa, submucosa, muscularis proper, and serosa, could be demonstrated by ultrasonography. 7 Involvement of the echo layers might help determine local infiltration of GIST in the stomach wall. We recently treated a gastric GIST with intact five layers of stomach wall between the gastric cavity and the tumor, which turned out to be a serosa-derived GIST.…”