Non traumatic traumatic abdominal abdominal emergencies emergencies

66 Pages·2017·10.04 MB·English

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Berna Oğuz MD
Hacettepe University Faculty of Medicine
Department of Radiology
Pediatric Radiology Division
Ankara, Turkey
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• Outline the variations of pathology that cause acute abdomen in children
• Recognise imaging findings in the diagnosis of pediatric gastrointestinal
system emergencies
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• Acute abdominal pain in children is one of the most
common presentations at the emergency room.
• There are numerous conditions that present with
abdominal pain ranging from a very simple viral illness
to a life-threatening surgical condition.
• Accurate and rapid diagnosis of these conditions helps
in reducing related complications.
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• Nonspecific nature of symptoms
• Atypical clinical presentations
• Inability to give reliable history
• Less reliable physical exam
The radiologist, therefore, plays a key role in the initial
care of abdominal emergencies in children
The aim in the diagnosis is differentiating
surgical versus nonsurgical conditions
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• First imaging of abdominal emergencies in childhood is
a radiograph of the abdomen
• Followed by ultrasound
• Further imaging depends on the results of these studies
• GIS enema, CT or MRI in some cases
Etiology of abdominal pain
Newborn - infancy Childhood Adolescence
• Gastroenteritis • Appendicitis • Appendicitis
• İntussusception • Constipation • Ectopic pregnancy
• Volvulus • Gastroenteritis • Biliary disease
• İncarcerated hernia • Henoch-Schonlein Purpura • Gastroenteritis
• Hirschsprung’s disease • Hemolytic uremia • İnflammatory bowel
syndrome disease
• Necrotising enterocolitis
• İnflammatory bowel • Nephrolithiasis
• Pyloric stenosis
disease
• Ovarian torsion
• Urinary tract infection
• Meckel’s diverticulum
• Pancreatitis
• Pancreatitis
• PID
• Pneumonia
• UTI / pyelonephritis
• Strep throat
• Testicular torsion
• Ulcer
• Urinary tract infection
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• Most common, serious abdominal emergency in neonates
• Usually in premature infants
• Presents in the immediate newborn period
• Acute fulminant disease associated with focal and/or diffuse
ulceration and necrosis of the distal small intestine and the colon.
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Signs and symptoms
• Abdominal distension
• Abdominal tenderness
• Feeding intolerance
• Jaundice
• Bilious vomiting
• Bloody stools
• Lethargy
• Apneic episodes
• Respiratory distress
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Radiography findings
• Ileus- asymmetric pattern of bowel gas with varying
degrees of dilatation
• Pneumatosis intestinalis- air in bowel wall
• Specific finding
• 70-80%
• Portal venous gas
• Gasless abdomen
• Pneumoperitoneum
• Perforation finding