GI Tract

Radiologic appearances & observation

Abnormal air in the GI disorder :
Abnormallylocated bowel
Pneumoperitoneum
Retropneumoperitoneum ( perforation, dicerticulitis, ulcerative disease etc. )
Gas within abscess ( subphrenic, renal-perirenal, hepatic, pancreatic etc. )
Gas in biliary system ( hepatobiliary fistula, emphysematous cholcystitis )
Gas in portal venous system ( intestinal necrosis, SMA synd., atresia ani,
esophageal atresia, )

Pneumoperitoneum : E/
Traumatic rupture, perforation, gas abscess of the pancreas.
Urinary tract gas
Dissected mediastinal air

ABNORMAL FLUID
ASCITES :
Transudate ( hypoproteinemiia, CHF, Constrictive pericarditis, CRF, Cirrhosis,
Budd-Chiari syndrome )
Exudate ( Carcinomatous, TB peritonitis, pancreatitis, Meigs synd. )
Haemorrhagic / chylous fluid
Neonatal ascites ( biliary atresia, choledochal cyst, meconium pers,
hydrometrocolpos, etc. )

Dilated Bowel / bowel distension

Small - Colon obstruction
Adynamic distension ( post op. ileus, hypoelectrolytemia, peritonitis, neurogenic
disease)
Pseudoobstruction
a. Transient pseudoobstruction ( electrolyte inbalance, renal failure,
congetive failure )
b. Cronic pseudoobstruction ( scleroderma, amyloidosis )

Achalasia / megaesophagus
1. idiophatic
2. chagas disease ( associtted megacolon & cardiomegaly )
3. amyloidosis Ehler-Danlos synd
4. scleroderma

ESOPHAGEAL FILLING DEFECT

Benign tumour < 1% of all esophageal tumour
a. Submucosal tumour ( 75% ) : Leiomyoma ( 50% of all benign
tumours ( nonepithelial, intraluminal ) Lipoma, fibroma, fibrolipoma, lymphangioma,
neurofibroma, schwannma.
 b. Mucosal tumour ( 25% ) : Fibrovascular, inflammatory polyp,
squamous ( epithelial, intraluminal ) papilloma, fibroadenoma, etc
Malignant tumours
a. Esophageal cancers, varicoid squamous ca.
b. Gastric cancer,
c. Leiomyosarcoma, carcinosarcoma
d. Metastase

SMALL BOWEL TUMORS

Benign small bowel tumours ( 80% asymptomatic, pain, weakness, palpable
abdominal mass 20% )
Leiomyoma 36-49%
Adenoma 15-20%
Lipoma 14-16%
Haemangioma 13-16%
Lymphangioma 5%
Neurogenic tumour

Malignant small bowel tumours ( asymphtomatic 10-30%, pain-obstruction 80%,

palpable )
Carcinoid 46-48% Leiomyosarcoma 9-10%
Adenocarcinoma 25-26% Vascular malignancy 1%
Lymphoma 16-17% Metastase

COLONIC OBSTRUCTION
Intraluminal
Bowel wall lesion
a. malignant 70% of obstructions, predominantly in sigmoid
b. inflammatory : Crohn disesase, ulcerative colitis, mesenteric ishaemia
( 15% )
c. infectious
d. congenital
Extrinsic
a. mass impression
b. severe constriction ( volvulus, hernia, adhesion )

Radiologic pattern : dilated small / colon only, disturbance of gas distributions,

segemented, necrotic intestine wall, airfluid level.

HIRSCHSPRUNG ( AGANGLIONIC MEGACOLON )

Absence of parasympathetic ganglia in muscle & submucosal layer ( Meissner &
Auerbach plexi )
Secondary to an arrest of craniocaudal migration of neuroblast before 12 week
leading to relaxation failure of the aganglionic segment.
Infant first 6 weeks of life ( 70-80% ), extremely rare in premature infants
Assiciated with Trisomy-21
 Location prox. Anus ussually recto-sigmoid
a. short segment 80%
b. long segment 15%
c. total colonic aganglionosis 5%
d. skip aganglionosis
Failure to pass meconium within 24 hours of life
Intermittent constipation & paradoxcical diarrhea 25%