1) Review important acute pediatric abdomen presentations to ensure that appropriate etiologies are considered when a pediatric patient is imaged for an acute abdomen. 2) Understand the role of different imaging modalities in the assessment of an acute pediatric abdomen so that the right test may be performed in an appropriate time frame. 3) Understand the importance of critical pediatric imaging findings so that the important information is conveyed to the surgeon/clinician.
Children are not little adults and imaging of the acute pediatric abdomen requires a different approach than for adults. The history accompanying the clinical presentation may be vague or absent, the clinical symptoms are often nonspecific and the presentation often occurs after the condition is well established. Consequently, diagnostic imaging often plays an important role in the identification of the etiology and correct interpretation of the images is essential for an optimum outcome.
Congenital abnormalities may be identified before birth and may not require post natal imaging prior to surgery, but other conditions will present in the neonatal period and require upper and/or lower GIT contrast studies. Hypertrophic pyloric stenosis is not the only cause of projectile vomiting in infants but the ultrasound findings can be diagnostic when recognized.
Malrotation of the bowel giving rise to midgut volvulus is a surgical emergency that will result in bowel infarction if not relieved. Intermittent volvulus due to duodenal malrotation is more difficult to recognise when there is no bowel obstruction. The key landmark being the position of the D-J flexure; however, the D-J flexure can be falsely low when there is over distension of the stomach or the patient is imaged in an oblique position. It can also be in the correct position by chance due to increased mobility of the bowel and a repeat study should be considered if strong clinical suspicion remains.
Intussusception (especially ileocolic) may lead to bowel perforation and/or infarction and peritonitis but can be safely treated if recognized and treated early. Appropriate use of medical imaging in the identification of patients with appendicitis can improve the management of these patients but it may provide false reassurance if the limitations of the study are not recognized.
The role of imaging in these and other abdominal emergencies will be discussed.
Cain, T,
Acute Pediatric Abdomen. Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL.
http://archive.rsna.org/2014/14000985.html
