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Bowel Obstruction and Acute Abdomen in infants Ricardo Faingold, MD. Department of Medical Imaging Montreal Children's Hospital McGill University Maputo, 2018

Bowel Obstruction and Acute Abdomen in infants · Ileus. High Obstruction Prox to mid-ileum Hypoplasia /Atresia of Stomach Duodenal Atresia , Stenosis and Web associated with annular

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Bowel Obstruction and Acute Abdomen in infants

Ricardo Faingold, MD.

Department of Medical Imaging

Montreal Children's Hospital

McGill University

Maputo, 2018

Objectives

Diagnostic Imaging

Identify normal

Tips and clues to interpret plain films

Review of common findings and

complications in neonatal bowel

obstruction and acute abdomen.

Abdominal Radiograph

Normal gas pattern

Obstruction

High

Low

Others

Pneumoperitoneum

Acute abdomen

Calcification

Masses

Normal Gas Pattern

Ileus

High Obstruction

• Prox to mid-ileum

• Hypoplasia/Atresia of Stomach

• Duodenal Atresia, Stenosis and Web

associated with annular pancreas (20%) ,

Down’s (30%) or part of VATER

– “Double Bubble”

• Malrotation with Midgut Volvulus

High Obstruction

• Jejunal Atresia and Stenosis

– “Triple Bubble”

• Prox Ileal Atresia and Stenosis

Low Obstruction

Distal Ileum and Colon

Ileal Atresia

Meconium Ileus

Hirschsprung Disease

Functional Immaturity of the Colon

(Meconium Plug Syndrome and Small Left

Colon)

Inguinal Hernia

Intussusception

Others

Others

Others

Premature

Others

HRUS & Color Doppler

Necrotizing Enterocolitis: Assessment of Bowel Viability with Color Doppler US

CDS can detect normal neonatal bowel perfusion Normative data

Bowel viability assessment by color Doppler sonography in necrotizing enterocolitis (NEC) Different perfusion patterns in NEC Absence of bowel wall perfusion by CDS is more

sensitive then AXR to detect necrotic bowel in NEC

Faingold et al, Radiology May 2005;235:587-594

CDS in NEC

Others

Others

Gas Pattern

Intraluminal

Extraluminal:

Bowel wall- pneumatosis

Free air

Portal venous gas

Biliary tree

Others

Others

Cysts

Calcifications

Liths

Stones

Tumors

Meconium peritonitis

Others

Others

Others

Others

Interventional Radiology

Non – Vascular Procedures

Biopsies and Drainages

Gastrointestinal

MSK intervention

BIOPSIES

US GUIDANCE

DRAINAGEUS guidance

New Technologies

PACS (Picture Archiving &communication syst.)

Availability,Improvement of Diagnosis

&care

Integration & teaching

New Horizons and Research

MRI, MRA & Functional Imaging

CTA

HRUS & Color Doppler/Perfusion

Assessment

Obrigado!