Imaging of the Pediatric Gastrointestinal Tract

The acute abdomen is a common surgical problem in pediatrics for which there are many causes. The clinical and laboratory findings may be nonspecific, thus imaging procedures are often required for further evaluation. This chapter will outline the more common gastrointestinal (GI) causes of the acute abdomen in children and will review the role of various imaging procedures in this clinical setting. 1. The plain abdominal radiograph still plays an important role in delineating the pattern of bowel gas, fluid levels and free air, as well as in detecting calcification and soft tissues masses. However, apart from the importance of detecting bowel obstruction and perforation, the findings on plain radiographs may often be nonspecific. 2. GI contrast studies: In many situations (e.g. malrotation), upper GI series will be essential to provide information for appropriate management. In other clinical settings (e.g. congenital low bowel obstruction), the contrast enema is necessary, not only for diagnosis, but also for therapy (e.g. meconium plug syndrome and meconium ileus and intussusception). 3. Sonography has, however, come to play an ever increasing role in the diagnosis of intra-abdominal pathology in children with acute abdomen (e.g. acute appendicitis, intussusception, Meckel’s diverticulum, biliary and pancreatic disease). Furthermore, sonography plays an important role in guiding therapeutic procedures such as the drainage of fluid collections and abscesses, biopsies and also intussusception reduction. 4. Computed tomography (CT) is rarely required in the clinical setting of the acute abdomen, but is valuable if findings on sonography are equivocal or if there are complex fluid or abscess collections.