Ultrasonography

in malformative
gastro-intestinal pathology

Dr. Carmen Asavoaie

Spitalul de Urgenta pentru Copii, Cluj
Background
Most result in some type of intestinal obstruction
Present
feeding difficulties
abdominal distention
vomiting (bilious/non-bilious)
prenatal diagnosis
 Objectives

present common GIT malformations in children

(obstructive lesions, anomalies of rotation and fixation,
anorectal anomalies and intestinal duplications)
illustrate the role of ultrasonography (US) and present
the possible US findings in upper and lower GIT
malformations
discuss the integrated role of the different imaging
techniques in the diagnosis of GIT malformations
Imaging
always necessary in GIT malformations
multimodality approach (plain films, contrast fluoroscopy,
ultrasonography, CT, MRI and sometimes isotope studies)
plain radiographs - complete upper GIT obstruction
upper GIT contrast series or fluoroscopy - incomplete intestinal
obstruction
contrast enemas - lower GIT obstructions
- sometimes therapeutic (meconium plug) (meconium
plug)
Role of US
modality of choice in pediatric abdominal pathology
part of the initial assessment
can be diagnostic in some GIT malformations
offer diagnostic clues
assess associated malformations/complications
CT and MRI - not used routinely or as initial assessment
US technique

patient placed in supine position

fluids may be administered before/during exam
a high-resolution, linear transducer (4-12 MHz)
excellent visualization of digestive wall, mesenteric fat,
free air or fluid when present, vessels, abdominal wall
 US check-list

examine all GIT from distal esophagus to the anus

evaluate:
anatomical location
distention and content of each segment
wall stratification and vascularity
bowel movement
mesenteric vessels: superior mesenteric artery (SMA)
and vein (SMV)
mesenteric fat
presence of free fluid or air
relationship with surrounding structures
check for associated abdominal malformations
GI malformations classification
Dragos, 6 wks, non-bilious vomiting, failure to thrive

Hypertrophic pyloric stenosis

Pyloric stenosis

https://radiopaedia.org/articles/pyloric-stenosis
Osea, 1 day old, vomiting
Duodenal atresia
Rhianna, 2 mths old,
recurrent bilious vomiting
AMS/VMS
relationship Malrotation “whirlpool” sign
Ingrid, 6 hours old
Ileal atresia
Amalia, 3 days old

“gut signature”

Duplication cyst
DDX

Ovarian cyst
 Roxana, 6 hours old, anal imperforation

Perineal approach

Rectal pouch
 Take home!
GIT malformations – often surgical emergencies
imaging mandatory for diagnosis
incomplete obstructions/duplication cysts – may be diagnosed later
diagnostic appearance on radiographs (esophageal atresia)
upper GIT or a contrast enema – upper/lower tract GIT
malformation
US - diagnostic in hypertrophic pylorus stenosis, duplication cysts
diagnosis hints in other obstructive malformations
US brings additional information (bowel wall, vascularity, aspect of
mesenteric fat, peristalsis)
US - suitable for follow-up
Thank you!