THE PAEDIATRIC
ABDOMEN
INTUSSUSCEPTION
Diagnosis by Ultrasound
Treatment by Imaging and Air Enema
Anne Connell
Mater Children’s Radiology
INTUSSUSCEPTION
PART OF THE INTESTINE FOLDS ON ITSELF LIKE A TELESCOPE
Anne Connell
Mater Children’s Radiology
SYMPTOMS
Crying
Pulling Up Legs
Vomiting
Stools like “currant jelly”
PALE
Anne Connell
Mater Children’s Radiology
CAUSES
90% Idiopathic
Unsure but it is believed that a virus may be the
cause.( Anomalies with peristalsis)
10% Pathologic
A polyp, tumour or other mass within the intestinal
tract is caught by the normal contractions, creating a
“lead point” which pushes along causing the
intussusception
Anne Connell
Mater Children’s Radiology
Plain Films
Anne Connell
Mater Children’s Radiology
Anne Connell
Mater Children’s Radiology
Anne Connell
Mater Children’s Radiology
Anne Connell
Mater Children’s Radiology
TYPES of INTUSSUSCEPTION
IleoIleal
Small bowel/small bowel.
May spontaneously resolve
Straight to surgery
Child with up to 5 at same time.
Mater Children’s Radiology
TYPES of INTUSSUSCEPTION
Ileo Cecal
Small bowel/ Large bowel
Radiology Intervention
Air Enema to reduce by “pushing it back”
Mater Children’s Radiology
TYPES of INTUSSUSCEPTION
Colocolic
Large bowel/large bowel
Usually the elderly
No Radiology intervention
Straight to surgery
Mater Children’s Radiology
Ultrasound examination
1. PRESENCE ?
No
Full Abdomen scan
Yes
2. WHERE IS IT
Further down the colon- the longer it’s
been there decreases the chance of
reduction
3. FLUID
Free Fluid and trapped fluid
These are signs of possible rupture
Mater Children’s Radiology
ULTRASOUND PICTURE
Anne Connell
Mater Children’s Radiology
Mater Children’s Radiology
Mater Children’s Radiology
Mater Children’s Radiology
4. LEAD POINTS
Nodes
Polyps
Meckel’s Diverticulum
Duplication cysts
5.PERFUSSION( Blood Flow)
Within the walls of the
intussusception
Reduced flow can be necrosis
BUT oedema also causes this.
Mater Children’s Radiology
Anne Connell
Mater Children’s Radiology
Mater Children’s Radiology
Mater Children’s Radiology
Mater Children’s Radiology
INTUSSUSCEPTION
Anne Connell
REDUCTION
Mater Children’s Radiology
AIR ENEMA REDUCTION ENEMA
ALWAYS PERFORMED WITH SURGICAL
COVER PRESENT
AIR REDUCTION ENEMAS ARE ALWAYS
ATTEMPTED
EASIER THAN SURGERY WITH G.A’s etc.
Mater Children’s Radiology
AIR ENEMA
Anne Connell
Mater Children’s Radiology
Anne Connell
Mater Children’s Radiology
Anne Connell
Mater Children’s Radiology
Anne Connell
Mater Children’s Radiology
Anne Connell
Mater Children’s Radiology
NECROTISING ENTEROCOLITIS
NEC
Disease of premature infants in the Intensive Care
Unit
Breakdown of the mucosal wall of the intestine which
allows bacteria &/or air to enter the bowel wall
Believed to be related to some combination of
infection and ischemia
Anne Connell
Mater Children’s Radiology
PRESENTATION
First or Second Week of Life
SYMPTOMS
Abdominal Distension
Feeding Intolerance
Increased Aspirates From N.G.tube
Sepsis
Anne Connell
Mater Children’s Radiology
DECUBITUS
SUPINE
HORIZONTAL BEAM
Anne Connell
Mater Children’s Radiology
RADIOGRAPHIC FINDINGS
Normal
Suggestive
Diagnostic
Anne Connell
Mater Children’s Radiology
SUGGESTIVE
Focal dilation of bowel
Featureless “unfolded” appearance of
small bowel loops with separation of
bowel loops suggestive of bowel wall
thickening
Anne Connell
Mater Children’s Radiology
NEC
Appearance of “unfolding” of loops of small bowel
Anne Connell
Mater Children’s Radiology
SUGGESTIVE
Focal dilation of bowel
Featureless “unfolded” appearance of small
bowel loops with separation of bowel loops
suggestive of bowel wall thickening
An unchanging gas pattern over serial films is of
concern.
Anne Connell
Mater Children’s Radiology
DIAGNOSTIC
Definite Sign
PNEUMATOSIS ( gas in bowel wall)
Anne Connell
Mater Children’s Radiology
Anne Connell
Mater Children’s Radiology
Anne Connell
Mater Children’s Radiology
TREATMENT
When NEC is suspected
Bowel rest ( nothing orally)
Antibiotics
Monitored with serial abdomen films
Anne Connell
Mater Children’s Radiology
DIAGNOSTIC
DEFINITE SIGN
PNEUMATOSIS ( gas in bowel wall)
FREE INTRAPERITONEAL AIR INDICATES SURGERY
Anne Connell
Mater Children’s Radiology
Anne Connell
Mater Children’s Radiology
POSITION
Anne Connell
LOCATION UAC and UVC LINES
Mater Children’s Radiology
Anne Connell
anne.connell@mater.org.au
Mater Children’s Radiology
GRATEFUL THANKS FOR ULTASOUND
ASSISTANCE
Ivan Simic
And
Dr Umesh Shetty for his advice
Anne Connell
Mater Children’s Radiology