The value of ultrasound in diagnosis of neonatal upper and lower gastrointestinal perforation / 中国小儿急救医学

Objective@#To explore the value of ultrasound in the differential diagnosis of neonatal upper and lower gastrointestinal tract(GIT)perforation.@*Methods@#We retrospectively reviewed the ultrasound findings of 42 neonates of surgery-confirmed neonatal GIT perforation in our hospital from January 1, 2015 to December 31, 2018.The accuracy of ultrasound for detecting GIT perforation and the ultrasound features of upper and lower GIT perforation were evaluated.@*Results@#(1)Of the 42 neonates with GIT perforation, 1 case didn′t undergo ultrasound, 2 cases were missed, and 1 case was misdiagnosed.Thirty-eight neonates were diagnosed of GIT perforation by ultrasound preoperatively, with a detection rate of 92.7%(38/41). The locations of GIT perforation were identified by ultrasound in 30 cases(78.9%, 30/38), including 11 cases of upper GIT perforation and 19 cases of lower GIT perforation.(2)A common sonographic finding of GIT perforation in 38 cases was pneumoperitoneum, which appeared as an echogenic line with posterior reverberation artifact under diaphragm or anterior to hepatic/splenic surface and a "stratosphere" sign in M-mode sonography.Free gas changed position when the patient′s position was changed, and didn′t change due to respiratory change.Besides, free gas dispersed with compression on abdomen, and gathered without compression.(3)Upper GIT perforation was showed that poor filling of the stomach cavity, and the abdominal free gas sharply increased.Lower GIT perforation was characterized by collapsed bowel, blurred and interrupted intestinal wall structure, and more accompanied with intestinal obstruction.(4)There was no significant difference of detection rate between ultrasound and X-ray in diagnosing GIT perforation[92.7%(38/41)vs.83.3%(35/42)](P>0.05), whereas ultrasound more sensitive for a very small amount of free gas in the early stage of perforation.(5)Helicobacter pylori infection was found in two cases of GIT perforation.@*Conclusion@#Ultrasound can be used for differential diagnosis of upper and lower GIT perforation, and could be recommended as the first choice for detecting GIT perforation in neonatal patients.

The value of ultrasound in diagnosis of neonatal upper and lower gastrointestinal perforation / 中国小儿急救医学

Objective To explore the value of ultrasound in the differential diagnosis of neonatal upper and lower gastrointestinal tract ( GIT) perforation. Methods We retrospectively reviewed the ultra-sound findings of 42 neonates of surgery-confirmed neonatal GIT perforation in our hospital from January 1, 2015 to December 31,2018. The accuracy of ultrasound for detecting GIT perforation and the ultrasound fea-tures of upper and lower GIT perforation were evaluated. Results (1)Of the 42 neonates with GIT perfora-tion,1 case didn′t undergo ultrasound,2 cases were missed,and 1 case was misdiagnosed. Thirty-eight neo-nates were diagnosed of GIT perforation by ultrasound preoperatively,with a detection rate of 92. 7%(38/41). The locations of GIT perforation were identified by ultrasound in 30 cases(78. 9%,30/38),including 11 cases of upper GIT perforation and 19 cases of lower GIT perforation. (2)A common sonographic finding of GIT perforation in 38 cases was pneumoperitoneum,which appeared as an echogenic line with posterior rever-beration artifact under diaphragm or anterior to hepatic/splenic surface and a "stratosphere" sign in M-mode sonography. Free gas changed position when the patient′s position was changed,and didn′t change due to re-spiratory change. Besides,free gas dispersed with compression on abdomen,and gathered without compres-sion. (3)Upper GIT perforation was showed that poor filling of the stomach cavity,and the abdominal free gas sharply increased. Lower GIT perforation was characterized by collapsed bowel,blurred and interrupted intestinal wall structure, and more accompanied with intestinal obstruction. ( 4 ) There was no significant difference of detection rate between ultrasound and X-ray in diagnosing GIT perforation [92. 7%(38/41) vs. 83. 3%(35/42)]( P>0. 05),whereas ultrasound more sensitive for a very small amount of free gas in the early stage of perforation. (5) Helicobacter pylori infection was found in two cases of GIT perforation. Conclusion Ultrasound can be used for differential diagnosis of upper and lower GIT perforation,and could be recommended as the first choice for detecting GIT perforation in neonatal patients.

Gastrointestinal Tract Perforation: MDCT Findings according to the Perforation Sites

Our objective is to describe the characteristic CT findings of gastrointestinal (GI) tract perforations at various levels of the gastrointestinal system. It is beneficial to localize the perforation site as well as to diagnose the presence of bowel perforation for planning the correct surgery. CT has been established as the most valuable imaging technique for identifying the presence, site and cause of the GI tract perforation. The amount and location of extraluminal free air usually differ among various perforation sites. Further, CT findings such as discontinuity of the bowel wall and concentrated free air bubbles in close proximity to the bowel wall can help predict the perforation site. Multidetector CT with the multiplanar reformation images has improved the accuracy of CT for predicting the perforation sites.

The Value of CT in detecting Pathologic Bowel Perforation

PURPOSE: To evaluate the usefulness of CT for assessing the location and cause of pathologic gastrointestinal perforation. MATERIALS AND METHODS: A retrospective analysis of abdominal CT was performed in 27 perforations of 26 patients with underlying gastrointestinal pathology. Fifteen benign and 12 malignant perforations consisted of five gastric cancers, one gastric ulcer, ten duodenal bulb ulcers, two bowel adhesions, one jejunal metastasis from lung cancer, one ileocolic Crohn's disease, one radiation colitis and six colon cancers. CT scans were evaluated for 1) diagnosis of bowel perforation, 2) assessment of the cause and site of perforation, and, in particular, differentiation between benignancy and malignancy, and 3) complications and their extent. RESULTS: CT easily detected varying amounts of free air or fluid collection, and infiltration or abscess formation adjacent to the main lesion, and the diagnosis of gastrointestinal perforation was therefore easy. In 11 of the 12 malignancies (92%), primary tumor was diagnosed, but detection of the site of perforation was possible in only seven cases (7/12, 58%). The 15 benign lesions revealed nonspecific CT findings, and the perforation site could be presumed in six (6/15, 40%). In one case of Crohn's disease, the primary cause was visualized. Among six colonic cancers, four pericolic abscesses and two fistulas to adjacent organs were found, but there was no evidence of diffuse peritonitis. CONCLUSION: CT was helpful to lead to optimal treatment of pathologic gastrointestinal On CT, the detectability of perforation, primary benign or malignant lesion, perforation site and extent of complication was high, and this modality was therefore a useful indicator of the optimal treatment for pathologic gastrointestinal perforations.