Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Imaging Findings of Gastrointestinal Emergency in Infants and Young Children

영유아 환자 위장관 응급 질환의 영상 소견

  • Ji Young Kim (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • 김지영 (서울대학교 의과대학 분당서울대학교병원 영상의학과)
  • Received : 2020.05.15
  • Accepted : 2020.07.20
  • Published : 2020.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Acute abdomen is a condition with sudden abdominal pain that may require immediate surgical treatment. The causes of acute abdomen in pediatric patients are diverse, and can be categorized in broad range from diseases requiring surgery to diseases requiring medication or clinical observation only. The role of the imaging study in children with acute abdomen is to distinguish between patients who need medication and patients who need surgery by identifying diseases that cause abdominal pain, if possible. Since intussusception and appendicitis are the leading causes of acute abdomen requiring surgical treatment in children, it is important to exclude intussusception in young infants complaining of acute abdominal pain and exclude acute appendicitis in older children with acute abdomen. In this paper, we introduce intussusception, acute appendicitis, midgut volvulus, Meckel's diverticulum and duplication cyst, which has characteristic imaging finding of the disease that can cause acute abdomen in pediatric patients.

급성 복증(acute abdomen)은 갑자기 발생하는 심한 복부 통증으로 즉각적인 수술적 치료를 필요로 할 수도 있는 상태를 말한다. 소아 환자의 급성 복증의 원인은 다양하며, 수술적 치료를 해야 하는 질환부터 투약 치료를 받아야 하거나 임상적 관찰 만을 요하는 질환까지 다양하게 분류될 수 있다. 이러한 급성 복증의 환자에서 영상 검사의 역할은 가능하다면 복통의 원인이 되는 질환을 밝혀서 수술적 치료를 해야 하는 환자와 투약 치료를 해야 하는 환자를 구분해 주는 것이다. 장중첩증과 충수돌기염이 소아 환자에서 수술적 치료를 필요로 하는 급성 복증의 가장 흔한 원인 질환이므로, 급성 복통을 호소하는 영아에서는 장중첩증을, 좀 더 나이가 많은 소아에서는 충수돌기염을 영상 검사를 이용해 배제해 주는 것이 중요하다. 이 논문에서는 영유아 환자의 급성 복통을 유발할 수 있는 질환 중 특징적 영상 소견을 보이는 장중첩증, 충수돌기염, 중장 염전, 메켈 게실 및 중복낭종에 대해 소개하고자 한다.

Keywords

References

  1. Del-Pozo G, Albillos JC, Tejedor D, Calero R, Rasero M, De-la-Calle U, et al. Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics 1999;19:299-319 https://doi.org/10.1148/radiographics.19.2.g99mr14299
  2. Applegate KE. Intussusception in children: evidence-based diagnosis and treatment. Pediatr Radiol 2009;39 Suppl 2:S140-143 https://doi.org/10.1007/s00247-009-1178-9
  3. Pracros JP, Tran-Minh VA, Morin de Finfe CH, Deffrenne-Pracros P, Louis D, Basset T. Acute intestinal intussusception in children. Contribution of ultrasonography (145 cases). Ann Radiol (Paris) 1987;30:525-530
  4. Hryhorczuk AL, Strouse PJ. Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception. Pediatr Radiol 2009;39:1075-1079 https://doi.org/10.1007/s00247-009-1353-z
  5. Swischuk LE, Hayden CK, Boulden T. Intussusception: indications for ultrasonography and an explanation of the doughnut and pseudokidney signs. Pediatr Radiol 1985;15:388-391 https://doi.org/10.1007/BF02388356
  6. Holt S, Samuel E. Multiple concentric ring sign in the ultrasonographic diagnosis of intussusception. Gastrointest Radiol 1978;3:307-309 https://doi.org/10.1007/BF01887084
  7. Daneman A. Intussusception: an approach to management. In Hodler J, Von Schulthess GK, Zollikofer CL, eds. Diseases of the abdomen and pelvis. Milano: Springer 2006:218-223
  8. Blickman JG, Parker BR, Barnes PD. Pediatric radiology: the requisites e-book. Amsterdam: Elsevier Health Sciences 2009
  9. Chang YW, Jeon TY, Lee MJ, Lim YJ, Kim JH, Yoon HK, et al. Guideline for fluoroscopy of low gastrointestinal tract in pediatrics. J Korean Soc Radiol 2015;73:67-90 https://doi.org/10.3348/jksr.2015.73.2.67
  10. Katz M, Phelan E, Carlin JB, Beasley SW. Gas enema for the reduction of intussusception: relationship between clinical signs and symptoms and outcome. AJR Am J Roentgenol 1993;160:363-366 https://doi.org/10.2214/ajr.160.2.8424351
  11. Katz ME, Kolm P. Intussusception reduction 1991: an international survey of pediatric radiologists. Pediatr Radiol 1992;22:318-322
  12. Meyer JS. The current radiologic management of intussusception: a survey and review. Pediatr Radiol 1992;22:323-325 https://doi.org/10.1007/BF02016244
  13. Applegate KE. Intussusception in children: imaging choices. Semin Roentgenol 2008;43:15-21 https://doi.org/10.1053/j.ro.2007.08.003
  14. Guo JZ, Ma XY, Zhou QH. Results of air pressure enema reduction of intussusception: 6396 cases in 13 years. J Pediatr Surg 1986;21:1201-1203 https://doi.org/10.1016/0022-3468(86)90040-0
  15. Del Pozo G. Intussusception: still work in progress. Pediatr Radiol 2005;35:92-94 https://doi.org/10.1007/s00247-004-1330-5
  16. Kirks DR. Diagnosis and treatment of pediatric intussusception: how far should we push our radiologic techniques? Radiology 1994;191:622-623 https://doi.org/10.1148/radiology.191.3.8184037
  17. Stein M, Alton DJ, Daneman A. Pneumatic reduction of intussusception: 5-year experience. Radiology 1992;183:681-684 https://doi.org/10.1148/radiology.183.3.1584919
  18. Byrne AT, Geoghegan T, Govender P, Lyburn ID, Colhoun E, Torreggiani WC. The imaging of intussusception. Clin Radiol 2005;60:39-46 https://doi.org/10.1016/j.crad.2004.07.007
  19. Heenan SD, Kyriou J, Fitzgerald M, Adam EJ. Effective dose at pneumatic reduction of paediatric intussusception. Clin Radiol 2000;55:811-816 https://doi.org/10.1053/crad.2000.0481
  20. Wood SK, Kim JS, Suh SJ, Paik TW, Choi SO. Childhood intussusception: US-guided hydrostatic reduction. Radiology 1992;182:77-80 https://doi.org/10.1148/radiology.182.1.1727313
  21. Gonzalez-Spinola J, Del Pozo G, Tejedor D, Blanco A. Intussusception: the accuracy of ultrasound-guided saline enema and the usefulness of a delayed attempt at reduction. J Pediatr Surg 1999;34:1016-1020 https://doi.org/10.1016/S0022-3468(99)90781-9
  22. Doria AS. Optimizing the role of imaging in appendicitis. Pediatr Radiol 2009;39 Suppl 2:144-148 https://doi.org/10.1007/s00247-008-1105-5
  23. Gray GF Jr, Wackym PA. Surgical pathology of the vermiform appendix. Pathol Annu 1986;21 Pt 2:111-144
  24. Lewis FR, Holcroft JW, Boey J, Dunphy E. Appendicitis. A critical review of diagnosis and treatment in 1,000 cases. Arch Surg 1975;110:677-684 https://doi.org/10.1001/archsurg.1975.01360110223039
  25. Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, et al. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 2006;241:83-94 https://doi.org/10.1148/radiol.2411050913
  26. Goldin AB, Khanna P, Thapa M, McBroom JA, Garrison MM, Parisi MT. Revised ultrasound criteria for appendicitis in children improve diagnostic accuracy. Pediatr Radiol 2011;41:993-999 https://doi.org/10.1007/s00247-011-2018-2
  27. Nghiem HV, Jeffrey RB Jr. Acute appendicitis confined to the appendiceal tip: evaluation with graded compression sonography. J Ultrasound Med 1992;11:205-207 https://doi.org/10.7863/jum.1992.11.5.205
  28. Pacharn P, Ying J, Linam LE, Brody AS, Babcock DS. Sonography in the evaluation of acute appendicitis: are negative sonographic findings good enough? J Ultrasound Med 2010;29:1749-1755 https://doi.org/10.7863/jum.2010.29.12.1749
  29. Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology 2000;215:337-348 https://doi.org/10.1148/radiology.215.2.r00ma24337
  30. Sivit CJ, Applegate KE, Stallion A, Dudgeon DL, Salvator A, Schluchter M, et al. Imaging evaluation of suspected appendicitis in a pediatric population: effectiveness of sonography versus CT. AJR Am J Roentgenol 2000;175:977-980 https://doi.org/10.2214/ajr.175.4.1750977
  31. Harswick C, Uyenishi AA, Kordick MF, Chan SB. Clinical guidelines, computed tomography scan, and negative appendectomies: a case series. Am J Emerg Med 2006;24:68-72 https://doi.org/10.1016/j.ajem.2005.07.015
  32. Williams RF, Blakely ML, Fischer PE, Streck CJ, Dassinger MS, Gupta H, et al. Diagnosing ruptured appendicitis preoperatively in pediatric patients. J Am Coll Surg 2009;208:819-825 https://doi.org/10.1016/j.jamcollsurg.2009.01.029
  33. Sulowski C, Doria AS, Langer JC, Man C, Stephens D, Schuh S. Clinical outcomes in obese and normal-weight children undergoing ultrasound for suspected appendicitis. Acad Emerg Med 2011;18:167-173 https://doi.org/10.1111/j.1553-2712.2010.00993.x
  34. Berdon WE. The diagnosis of malrotation and volvulus in the older child and adult: a trap for radiologists. Pediatr Radiol 1995;25:101-103 https://doi.org/10.1007/BF02010316
  35. Reeder MM. Reeder and Felson's gamuts in radiology: comprehensive lists of roentgen differential diagnosis. Berlin: Springer Science & Business Media 2013
  36. Pracros JP, Sann L, Genin G, Tran-Minh VA, Morin de Finfe CH, Foray P, et al. Ultrasound diagnosis of midgut volvulus: the "whirlpool" sign. Pediatr Radiol 1992;22:18-20 https://doi.org/10.1007/BF02011603
  37. Bernstein SM, Russ PD. Midgut volvulus: a rare cause of acute abdomen in an adult patient. AJR Am J Roentgenol 1998;171:639-641 https://doi.org/10.2214/ajr.171.3.9725289
  38. Taylor GA. CT appearance of the duodenum and mesenteric vessels in children with normal and abnormal bowel rotation. Pediatr Radiol 2011;41:1378-1383 https://doi.org/10.1007/s00247-011-2118-z
  39. Kangarloo H, Sample WF, Hansen G, Robinson JS, Sarti D. Ultrasonic evaluation of abdominal gastrointestinal tract duplication in children. Radiology 1979;131:191-194 https://doi.org/10.1148/131.1.191
  40. Stafrace S, Blickman JG. Radiological imaging of the digestive tract in infants and children. Berlin: Springer 2016