The pediatric gastrointestinal tract: ultrasound findings in acute diseases

  • Francesco Esposito
  • Marco Di SerafinoEmail author
  • Carmela Mercogliano
  • Dolores Ferrara
  • Norberto Vezzali
  • Giovanni Di Nardo
  • Luigi Martemucci
  • Gianfranco Vallone
  • Massimo Zeccolini
Review Article


The study of the gastrointestinal tract by imaging, particularly using ultrasound, is a required instrument for diagnosis of acute and chronic gastrointestinal pathologies in pediatric age. Actually, ultrasound plays an increasing role in the evaluation of gastrointestinal tract in neonatal and pediatric patients because of their small body habitus and the presence of less fat tissue in the abdominal wall and peritoneal cavity. Ultrasound has certain advantages, thanks to the new wide-spectrum frequency probes able to assess a detailed study of the morphological aspects and functional characteristics of bowel loops, adding a new dimension to the imaging of this body system. In this paper, we review anatomy, ultrasound technique and sonographic findings of bowel pathology frequently encountered in neonatal and pediatric emergency setting.


Ultrasonography Pediatrics Emergencies Gastrointestinal diseases 


Lo studio ecografico dell’apparato gastrointestinale recentemente è diventato uno strumento indispensabile per la diagnosi di patologie gastrointestinali ad insorgenza acuta o con decorso cronico in età pediatrica. L’ecografia ha un ruolo crescente nello studio del tratto gastrointestinale e specie in ambito pediatrico e neonatale grazie al habitus dei piccoli pazienti ed alla scarsa presenza di adipe interposto. I trasduttori multi-frequenza di ultima generazione forniscono immagini dettagliate, di alta qualità, per lo studio morfologico e funzionale delle anse intestinali, configurando una nuova dimensione degli ultrasuoni nella diagnostica per immagini dell’apparato gastro-intestinale. In questo articolo descriviamo la tecnica di esame e gli aspetti ecografici caratteristici delle più comuni patologie ad insorgenza acuta del tratto gastrointestinale in epoca neonatale e pediatrica.


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, and its late amendments. Additional informed consent was obtained from all patients for which identifying information is not included in this article.

Human and animal rights

This article does not contain any studies with human or animal subjects performed by any of the authors.


  1. 1.
    Gale HI, Gee MS, Westra SJ, Nimkin K (2016) Abdominal ultrasonography of the paediatric gastrointestinal tract. World J Radiol 8(7):656–667. CrossRefGoogle Scholar
  2. 2.
    John SD, Hollingsworth C (2011) The pediatric gastrointestinal tract. In: Rumack C (ed) Diagnostic ultrasound, 4th edn. Elsevier Mosby, MissouriGoogle Scholar
  3. 3.
    Lobo ML, Roque M (2014) Gastrointestinal ultrasound in neonates, infants and children. Eur J Radiol 83(9):1592–1600. CrossRefGoogle Scholar
  4. 4.
    Cogley JR, O’Connor SC, Houshyar R, Al Dulaimy K (2012) Emergent paediatric US: what every radiologist should know. Radiographics 32(3):651–665. CrossRefGoogle Scholar
  5. 5.
    Puylaert JB (1986) Mesenteric adenitis and acute terminal ileitis: US evaluation using graded compression. Radiology 161(3):691–695CrossRefGoogle Scholar
  6. 6.
    Arys B, Mandelstam S, Rao P, Kernicks S, Kumbla S (2014) Sonography of the pediatric gastrointestinal system. Ultrasound Q 30(2):101–117. CrossRefGoogle Scholar
  7. 7.
    Atkinson NSS, Bryant RV, Dong Y, Maaser C, Kucharzik T, Maconi G, Asthana AK, Blaivas M, Goudie A, Gilja OH, Nuernberg D, Schreiber-Dietrich D, Dietrich CF (2017) How to perform gastrointestinal ultrasound: anatomy and normal findings. World J Gastroenterol 23(38):6931–6941. CrossRefGoogle Scholar
  8. 8.
    Markowitz RI (2014) Olive without a cause: the story of infantile hypertrophic pyloric stenosis. Pediatr Radiol 44(2):202–211. (Epub 2013 Nov 27) CrossRefGoogle Scholar
  9. 9.
    Helton K, Strife J, Warner B, Byczkowski T, Donovan E (2004) The impact of a clinical guideline on imaging children with hypertrophic pyloric stenosis. Pediatr Radiol 34(9):733–736CrossRefGoogle Scholar
  10. 10.
    Hernanz-Schulman M (2009) Pyloric stenosis: role of imaging. Pediatr Radiol 39(S2):134–139CrossRefGoogle Scholar
  11. 11.
    Costa Dias S, Swinson S, Torrão H, Gonçalves L, Kurochka S, Vaz CP, Mendes V (2012) Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. Insights Imaging 3(3):247–250. (Epub 2012 May) CrossRefGoogle Scholar
  12. 12.
    Hernanz-Schulman M, Zhu Y, Stein SM, Heller RM, Bethel LA (2003) Hypertrophic pyloric stenosis in infants: US evaluation of vascularity of the pyloric canal. Radiology 229(2):389–393CrossRefGoogle Scholar
  13. 13.
    Warner B, Oldham KT, Colombani PM (1997) Malrotation. In: Foglia RP (ed) Surgery of infants and children: scientific principles and practice. Lippincott Williams and Wilkins, Philadelphia, p 1229Google Scholar
  14. 14.
    Dilley AV, Pereira J, Shi EC, Adams S, Kern IB, Currie B (2000) The radiologist says malrotation: does the surgeon operate? Pediatr Surg Int 16(1–2):45–49CrossRefGoogle Scholar
  15. 15.
    Shalaby MS, Kuti K, Walker G (2013) Intestinal malrotation and volvulus in infants and children. BMJ 26:347. (f6949) Google Scholar
  16. 16.
    Marine MB, Karmazyn B (2014) Imaging of malrotation in the neonate. Semin Ultrasound CT MR 35(6):555–570. (Epub 2014 Aug 9) CrossRefGoogle Scholar
  17. 17.
    Chandramohan A, Gibikote S, Saxena AK (2010) US as a primary tool in the work-up of malrotation. Pediatr Radiol 40(11):1844–1845. (author reply 1846-7) CrossRefGoogle Scholar
  18. 18.
    Garel C, Blouet M, Belloy F, Petit T, Pelage J-P (2015) Diagnosis of paediatric gastric, small-bowel and colonic volvulus. Pediatr Radiol 46(1):130–138. CrossRefGoogle Scholar
  19. 19.
    Esposito F, Vitale V, Noviello D, Di Serafino M, Vallone G, Salvatore M, Oresta P (2014) Ultrasonographic diagnosis of midgut volvulus with malrotation in children: 7-years single center experience. J Pediatr Gastroenterol Nutr 59(6):786–788. CrossRefGoogle Scholar
  20. 20.
    Esposito F, Vitale V, Noviello D, Di Serafino M, Vallone G, Salvatore M, Oresta P (2015) Authors’ response. J Pediatr Gastroenterol Nutr 60(3):e25. CrossRefGoogle Scholar
  21. 21.
    Esposito F, Di Serafino M, Vitale V, Aragione N et al (2017) Malrotazione e volvolo: può bastare la sola ecografia? Il giornale italiano di Radiologia Medica 4:1073–1077. Google Scholar
  22. 22.
    Di Serafino M, Severino R, Gullotto C, Listanti F, Scarano E (2017) Idiopathic renal infarction mimicking appendicitis. Case Rep Emerg Med 2017:8087315. Google Scholar
  23. 23.
    Coyne SM, Zhang B, Trout AT (2014) Does appendiceal diameter change with age? A sonographic study. AJR Am J Roentgenol 203(5):1120–1126. CrossRefGoogle Scholar
  24. 24.
    Linam LE, Munden M (2012) Sonography as the first line of evaluation in children with suspected acute appendicitis. J Ultrasound Med 31(8):1153–1157CrossRefGoogle Scholar
  25. 25.
    Binkovitz LA, Unsdorfer KM, Thapa P, Kolbe AB, Hull NC, Zingula SN, Thomas KB, Homme JL (2015) Pediatric appendiceal ultrasound: accuracy, determinacy and clinical outcomes. Pediatr Radiol 45(13):1934–1944. CrossRefGoogle Scholar
  26. 26.
    Trout AT, Towbin AJ, Fierke SR, Zhang B, Larson DB (2015) Appendiceal diameter as a predictor of appendicitis in children: improved diagnosis with three diagnostic categories derived from a logistic predictive model. Eur Radiol 25(8):2231–2238. Epub 2015 Apr 28 CrossRefGoogle Scholar
  27. 27.
    Xu Y, Jeffrey RB, Shin LK, DiMaio MA, Olcott EW (2016) Color doppler imaging of the appendix: criteria to improve specificity for appendicitis in the borderline-size appendix. J Ultrasound Med 35(10):2129–2138. CrossRefGoogle Scholar
  28. 28.
    Hwang JY (2017) Emergency ultrasonography of the gastrointestinal tract of children. Ultrasonography 36(3):204–221. CrossRefGoogle Scholar
  29. 29.
    Tulin-Silver S, Babb J, Pinkney L, Strubel N, Lala S, Milla SS, Tomita S, Fefferman NR (2015) The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity. Pediatr Radiol 45(6):820–830. CrossRefGoogle Scholar
  30. 30.
    Trout AT, Sanchez R, Ladino-Torres MF, Pai DR, Strouse PJ (2012) A critical evaluation of US for the diagnosis of paediatric acute appendicitis in a real-life setting: how can we improve the diagnostic value of sonography? Pediatr Radiol 42(7):813–823CrossRefGoogle Scholar
  31. 31.
    Doria AS (2009) Optimizing the role of imaging in appendicitis. Pediatr Radiol 39(S2):144–148CrossRefGoogle Scholar
  32. 32.
    Stein-Wexler R, O’Connor R, Daldrup-Link H, Wootton-Gorges SL (2015) Current methods for reducing intussusception: survey results Pediatr Radiol 45(5):667–674. (Epub 2014 Nov 29) Google Scholar
  33. 33.
    Esposito F, Ambrosio C, De Fronzo S, Panico MR, D’Aprano M, Giugliano AM et al (2015) Fluoroscopy-guided hydrostatic reduction of intussusception in infancy: role of pharmacological premedication. Radiol Med 120(6):549–556CrossRefGoogle Scholar
  34. 34.
    Applegate KE (2005) Clinically suspected intussusception in children: evidence-based review and self-assessment module. Am J Roentgenol 185(3 Suppl):S175–S183CrossRefGoogle Scholar
  35. 35.
    Menke J, Kahl F (2015) Sonography-guided hydrostatic reduction of ileocolic intussusception in children: analysis of failure and success in consecutive patients presenting timely to the hospital. Eur J Pediatr 174(3):307–316. CrossRefGoogle Scholar
  36. 36.
    Vazquez JL, Ortiz M, Doniz MC, Montero M, Del Campo VM (2012) External manual reduction of paediatric idiopathic ileocolic intussusception with US assistance: a new, standardised, effective and safe manoeuvre. Pediatr Radiol 42(10):1197–1204. CrossRefGoogle Scholar
  37. 37.
    Daneman A, Navarro O (2003) Intussusception. Part 1: a review of diagnostic approaches. Pediatr Radiol 23(2):79–85. CrossRefGoogle Scholar
  38. 38.
    Ilivitzki A, Shtark LG, Arish K, Engel A (2012) Deep sedation during pneumatic reduction of intussusception. Pediatr Radiol 42(5):562–565. CrossRefGoogle Scholar
  39. 39.
    Mackey WC, Dineen P (1983) A fifty year experience with Meckel’s Diverticulum. Surg Gynecol Obstet 156:56–64Google Scholar
  40. 40.
    Rattan KR, Singh J, Dalal P, Rattan A (2016) Meckel’s diverticulum in children: our 12-year experience. Afr J Paediatr Surg 13(4):170–174. CrossRefGoogle Scholar
  41. 41.
    Gambling TC, Glenn J, Herring D, McKinney WB (2003) Bowel obstruction caused by a Meckel’s diverticulum enterolith: a case report and review of the literature. Curr Surg 60(1):63–64CrossRefGoogle Scholar
  42. 42.
    Sagar J, Kumar V, Shah DK (2006) Meckel’s diverticulum: a systematic review. J R Soc Med 99(10):501–505CrossRefGoogle Scholar
  43. 43.
    Di Serafino M, Mercogliano C, Vallone G (2015) Ultrasound evaluation of the enteric duplication cyst: the gut signature. J Ultrasound 19(2):131–133. CrossRefGoogle Scholar
  44. 44.
    Gleason CA, Sandra EJ. (2018) Gastrointestinal system. In: Avery’s diseases of the newborn.
  45. 45.
    Di Serafino M, Severino R, Mercogliano C, Lisanti F, De Martino C, Rocca R, Abate R, Salata M, Vallone G, Maroscia D (2016) A complicated ileal duplication cyst in a young adult: the value of the “Gut Signature”. Open J Radiol 6:100–104. CrossRefGoogle Scholar
  46. 46.
    Adolph VR, Bernabe K (2008) Polyps in children. Clin Colon Rectal Surg 21(4):280–285. CrossRefGoogle Scholar
  47. 47.
    de Ridder L, Lingen AV, Taminiau J, Benninga M (2007) Rectal bleeding in children: endoscopic evaluation revisitied. Eur J Gastroenterol Hepatol 19:317–320CrossRefGoogle Scholar
  48. 48.
    Parra DA, Navarro OM (2008) Sonographic diagnosis of intestinal polyps in children. Pediatr Radiol 38:680–684CrossRefGoogle Scholar
  49. 49.
    Vitale V, Di Serafino M, Mercogliano C, Vallone G (2014) Giant colon polyp in a child with suspected inflammatory bowel disease: US finding. J Ultrasound 19(1):53–55. CrossRefGoogle Scholar
  50. 50.
    Baldisserotto M, Spolidoro JV, Bahu Mda G (2002) Graded compression sonography of the colon in the diagnosis of polyps in paediatric patients. AJR Am J Roentgenol 179(1):201–205CrossRefGoogle Scholar
  51. 51.
    Drose Julia A (2007) Sonographic abdominal anatomy. In: Sanders RC, Winter T (eds) Clinical sonography-a practical guide, 4th edn. Lippincott Williams and Wilkins, Hagerstown, p 51Google Scholar
  52. 52.
    Giardiello FM, Hamilton SR, Kern SE, Offerhaus GJ, Green PA, Celano P, Krush AJ et al (1991) Colorectal neoplasia in juvenile polyposis or juvenile polyps. Arch Dis Child 66:971–975CrossRefGoogle Scholar
  53. 53.
    Neu J, Walker WA (2011) Necrotizing enterocolitis. N Engl J Med 364(3):255CrossRefGoogle Scholar
  54. 54.
    Ballance WA, Dahms BB, Shenker N, Kliegman RM (1990) Pathology of neonatal necrotizing enterocolitis: a ten-year experience. J Pediatr 117(1 Pt 2):S6CrossRefGoogle Scholar
  55. 55.
    Battersby C, Santhalingam T, Costeloe K, Modi N (2018) Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review. Arch Dis Child Fetal Neonatal Ed 103(2):F182CrossRefGoogle Scholar
  56. 56.
    Esposito F, Mamone R, Di Serafino M, Mercogliano C, Vitale V, Vallone G, Oresta P (2017) Diagnostic imaging features of necrotizing enterocolitis: a narrative review. Quant Imaging Med Surg 7(3):336–344. CrossRefGoogle Scholar
  57. 57.
    Casciani E, De Vincentiis C, Polettini E, Masselli G, Di Nardo G, Civitelli F, Cucchiara S, Gualdi GF (2014) Imaging of the small bowel: Crohn’s disease in paediatric patients. World J Radiol 6(6):313–328. CrossRefGoogle Scholar
  58. 58.
    Chiorean L, Schreiber-Dietrich D, Braden B, Cui X, Dietrich CF (2014) Transabdominal ultrasound for standardized measurement of bowel wall thickness in normal children and those with Crohn’s disease. Med Ultrason 16(4):319–324Google Scholar
  59. 59.
    Chiorean L, Schreiber-Dietrich D, Braden B, Cui XW, Buchhorn R, Chang JM, Dietrich CF (2015) Ultrasonographic imaging of inflammatory bowel disease in pediatric patients. World J Gastroenterol 21(17):5231–5241. CrossRefGoogle Scholar
  60. 60.
    Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, de Ridder L, Kolho KL, Veres G, Russell RK, Paerregaard A (2014) ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 58:795–806Google Scholar
  61. 61.
    Duigenan S, Gee MS (2012) Imaging of paediatric patients with inflammatory bowel disease. AJR Am J Roentgenol 199(4):907–915CrossRefGoogle Scholar
  62. 62.
    Anupindi SA, Halverson M, Khwaja A, Jeckovic M, Wang X, Bellah RD (2014) Common and uncommon applications of bowel ultrasound with pathologic correlation in children. AJR Am J Roentgenol 202(5):946–959. CrossRefGoogle Scholar
  63. 63.
    Chiorean L, Schreiber-Dietrich D, Braden B, Cui X-W, Buchhorn R, Chang J-M et al (2015) Ultrasonographic imaging of inflammatory bowel disease in paediatric patients. World J Gastroenterol 21(17):5231–5241CrossRefGoogle Scholar
  64. 64.
    Biko DM, Rosenbaum DG, Anupindi SA (2015) Ultrasound features of paediatric Crohn disease: a guide for case interpretation. Pediatr Radiol 45(10):1557–1566. (quiz 1554–6, Epub 2015 Jul 12) CrossRefGoogle Scholar
  65. 65.
    Frisoli JK, Desser TS, Jeffrey RB (2000) Thickened sub mucosal layer: a sonographic sign of acute gastrointestinal abnormality representing sub mucosal edema or hemorrhage. ARRS Executive Council Award II. American Roentgen Ray Society. AJR Am J Roentgenol 175(6):1595–1599CrossRefGoogle Scholar
  66. 66.
    Chaubal N, Dighe M, Shah M, Chaubal J (2006) Sonography of the gastrointestinal tract. J Ultrasound Med 25(1):87–97CrossRefGoogle Scholar

Copyright information

© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2019

Authors and Affiliations

  • Francesco Esposito
    • 1
  • Marco Di Serafino
    • 2
    Email author
  • Carmela Mercogliano
    • 3
  • Dolores Ferrara
    • 4
  • Norberto Vezzali
    • 5
  • Giovanni Di Nardo
    • 2
  • Luigi Martemucci
    • 2
  • Gianfranco Vallone
    • 4
  • Massimo Zeccolini
    • 1
  1. 1.Radiology DepartmentSantobono-Pausilipon Children HospitalNaplesItaly
  2. 2.Emergency and General Radiology DepartmentAntonio Cardarelli HospitalNaplesItaly
  3. 3.Paediatric DepartmentSantobono-Pausilipon Children HospitalNaplesItaly
  4. 4.Paediatric Radiology DepartmentFederico II University HospitalNaplesItaly
  5. 5.Radiology DepartmentRegional Hospital of BolzanoBolzanoItaly

Personalised recommendations