Pediatric Gastrointestinal Radiology

Chapter 12 examines radiologic images for common and uncommon pediatric gastrointestinal disorders. These include neonatal high bowel obstructions such as midgut malrotation and volvulus, duodenal atresia, duodenal web, annular pancreas, and pyloric stenosis. The chapter goes on to look at neonatal low bowel obstruction, including ileal disease such as ileal atresia and meconium ileus and colonic disease such as Hirschsprung disease and meconium plug. We then look at causes of pediatric bowel obstruction in older patients, such as intussusception, appendicitis, enteric duplication cysts, and inguinal hernia. Additional neonatal disorders discussed include necrotizing enterocolitis, and meconium peritonitis. Diseases of the pancreas examined include cystic fibrosis and pancreatitis. Liver tumors reviewed are infantile hepatic hemangioma and hepatoblastoma. Diseases of the biliary system looked at include choledochal cysts and biliary cysts, and biliary atresia. Splenic abnormalities examined include polysplenia and asplenia, heterotaxy syndromes, and sickle cell disease.

Intestinal atresia: histopathologist view

Background: Intestinal atresia forms one of a common cause for intestinal obstruction in neonates. There is a debate about its pathogenesis and many theories have been suggested. Studies regarding its clinical and histomorphological features are less in Indian literature. The present study aimed to determine the clinical and histomorphological features of cases of intestinal atresia.Methods: Thirty-nine cases of intestinal atresia were studied both retrospectively (twenty-six) and prospectively (thirteen) over a period of two years. Their clinical and histomorphological features were studied.Results: Intestinal obstruction was most common clinical diagnosis. Type II atresia was most common. Ileal atresia was highest in number. Associated congenital anomalies noted were situs inversus with splenunculi, patent vitelo-intestinal duct, duplication cyst, Meckel’s diverticulum, ileocecal web, duodenal web and omphalocele. Histological features such as inspissated meconium, calcification, ulceration, fibrosis, thick-walled vessels, edema were noted.Conclusions: Findings such as mucosal edema, congestion, ulceration, submucosal edema, thick-walled blood vessels, fibrosis, hemorrhage, transmural ischemia, calcification, suggest that an intra vascular accident may be responsible for origin of the atresia.

Delayed presentation of a congenital duodenal web managed successfully with incision of web

One of the causes of congenital incomplete duodenal obstruction is the presence of congenital duodenal web with fenestration. This condition requires a high index of suspicion for an early and accurate diagnosis. We present an unusual presentation of duodenal web in a 6-year-old girl who presented with a 3-year history of cyclical and seasonal vomiting and abdominal pain. The diagnosis of congenital duodenal web with fenestration was made on contrast study and endoscopy and was treated surgically by incision of the web.