Imaging of the Pediatric Gastrointestinal Tract

  • A. Daneman
Conference paper
Part of the Syllabus book series (SYLLABUS)


The acute abdomen is a common surgical problem in pediatrics for which there are many causes. The clinical and laboratory findings may be nonspecific, thus imaging procedures are often required for further evaluation. This chapter will outline the more common gastrointestinal (GI) causes of the acute abdomen in children and will review the role of various imaging procedures in this clinical setting.
  1. 1.

    The plain abdominal radiograph still plays an important role in delineating the pattern of bowel gas, fluid levels and free air, as well as in detecting calcification and soft tissues masses. However, apart from the importance of detecting bowel obstruction and perforation, the findings on plain radiographs may often be nonspecific.

  2. 2.

    GI contrast studies: In many situations (e.g. malrotation), upper GI series will be essential to provide information for appropriate management. In other clinical settings (e.g. congenital low bowel obstruction), the contrast enema is necessary, not only for diagnosis, but also for therapy (e.g. meconium plug syndrome and meconium ileus and intussusception).

  3. 3.

    Sonography has, however, come to play an ever increasing role in the diagnosis of intra-abdominal pathology in children with acute abdomen (e.g. acute appendicitis, intussusception, Meckel’s diverticulum, biliary and pancreatic disease). Furthermore, sonography plays an important role in guiding therapeutic procedures such as the drainage of fluid collections and abscesses, biopsies and also intussusception reduction.

  4. 4.

    Computed tomography (CT) is rarely required in the clinical setting of the acute abdomen, but is valuable if findings on sonography are equivocal or if there are complex fluid or abscess collections.



Acute Appendicitis Acute Abdomen Abdominal Radiograph Anorectal Malformation Contrast Enema 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Suggested Reading

  1. Bramson RT, Blickman JG (1992) Perforation during hydrostatic reduction of intussuception: Proposed mechanism and review of the literature. J Pediatr Surg 27:589–591PubMedCrossRefGoogle Scholar
  2. Campbell J (1989) Contrast media in intussusception. Pediatr Radiol 19:293–296PubMedCrossRefGoogle Scholar
  3. Connolly B, Alton DJ, Ein SH, et al. (1995) Partially reduced intussusception: When are repeated delayed reduction attempts appropriate? Pediatr Radiol 25:104–107PubMedCrossRefGoogle Scholar
  4. Daneman A, Myers M, Shuckett B, Alton DJ (1997) Sonographic appearances of inverted Meckel diverticulum with intussusception. Pediatr Radiol 27:295–298PubMedCrossRefGoogle Scholar
  5. Daneman A, Alton DJ (1996) Intussusception: issues and controversies related to diagnosis and reduction. Radiol Clin N Am 34(4):743–756PubMedGoogle Scholar
  6. Daneman A, Alton DJ, Ein S, et al. (1995) Perforation during attempted intussusception reduction in children — a comparison of perforation with barium and air. Pediatr Radiol 25:81–88PubMedCrossRefGoogle Scholar
  7. Guo JZ, MA XY, Zhou QH (1986) Results of air pressure enema reduction of intussusception: 6396 cases in 13 years. J Pediatr Surg 21:1201–1203PubMedCrossRefGoogle Scholar
  8. Katz ME, Siegel MJ, et al. (1987) The position and mobility of the duodenum in children. AJR Am J Roentgenol 148(5):947–951PubMedCrossRefGoogle Scholar
  9. Kim G, Daneman A, Alton DJ, Myers M, Sandler A, Superina R (1997) The appearance of inverted Meckel diverticulum with intussusception on air enema. Pediatr Radiol 27:647–650PubMedCrossRefGoogle Scholar
  10. Kirks D (1991) Practical pediatric imaging, 2nd edn. Little, Brown, BostonGoogle Scholar
  11. Lang I, Daneman A, Cutz E, Hagen P, Shandling B (1997) Abdominal calcification in cystic fibrosis with meconium ileus: radiologic-pathologic correlation. Pediatr Radiol 27:523–527PubMedCrossRefGoogle Scholar
  12. Long F, Kramer SD, et al. (1996) Radiographic patterns of intestinal malrotation in children. Radiographics 16:547–556PubMedGoogle Scholar
  13. Long F, Kramer SD, et al. (1996) Intestinal malrotation in children: Tutorial on radiographic diagnosis in difficult cases. Radiology 198:775–780PubMedGoogle Scholar
  14. Miller SF, Landes AB, Dautenhahn LE, et al. (1995) Intussusception: Ability of fluoroscopic images obtained during air enemas to depict lead points and other abnormalities. Radiology 197:493–496PubMedGoogle Scholar
  15. Ratcliffe JF, Fong S, Cheong I, et al. (1984) The plain abdominal film in intussusception. The accuracy and incidence of radiographic signs. Pediatr Radiol 22:110–111CrossRefGoogle Scholar
  16. Rohrschneider WK, Troger J (1995) Hydrostatic reduction of intussusception under US guidance. Pediatr Radiol 25:530–534PubMedCrossRefGoogle Scholar
  17. Shiels WE II, Maves CK, Hedlung GL, Kirks DR (1991) Air enema for diagnosis and reduction of intussusception. Clinical experience and pressure correlates. Radiology 181:169–172PubMedGoogle Scholar
  18. Silverman FN, Kuhn J (1993) Caffey’s pediatric X-ray diagnosis, vol. 2, 9th edn. Mosby, St. LouisGoogle Scholar
  19. Stein M, Alton DJ, Daneman A (1992) Pneumatic reduction of intussusception: 5-year experience. Radiology 183:681–684PubMedGoogle Scholar
  20. Stringer DA (1989) Pediatric gastrointestinal imaging. BC Decker, TorontoGoogle Scholar
  21. Swischuk LE (1989) Imaging of the newborn, infant and the young child, 3rd edn. Williams and Wilkins, BaltimoreGoogle Scholar
  22. Todani T, Sato Y, Watanabe Y, et al. (1990) Air reduction for intussusception in infancy and childhood: Ultrasonographic diagnosis and management without X-ray exposure. Z Kinder-chir 45:222–226Google Scholar
  23. Wang G, Liu S (1988) Enema reduction of intussusception by hydrostatic pressure under ultrasound guidance. A report of 377 cases. J Pediatr Surg 23:814–818PubMedCrossRefGoogle Scholar
  24. Woo SK, Kim JS, Suh SJ, et al. (1992) Childhood intussusception: US-guided hydrostatic reduction. Radiology 182:77–80Google Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • A. Daneman
    • 1
  1. 1.Department of Diagnostic ImagingThe Hospital for Sick ChildrenTorontoCanada

Personalised recommendations