ARRS 2022 Abstracts


E1676. Neonatal Gastrointestinal Surgical Emergencies: A Review of Prenatal and Postnatal Imaging
  1. Stephanie Jankovic; University of Rochester Medical Center
  2. Apeksha Chaturvedi; University of Rochester Medical Center
  3. Nadia Sultan; University of Rochester Medical Center
Neonatal gastrointestinal (GI) abnormalities that present with symptoms of obstruction make up the most common surgical emergency in the neonatal period. These are generally divided into high and low obstructions, depending on where the congenital abnormality is located along the GI tract, with high obstructions occurring proximal to the ileum and low obstructions distal. Occasionally, GI abnormalities are diagnosed in the prenatal period via ultrasound (US) but can also be detected by fetal MRI. Some diagnoses require subsequent confirmation after birth, such as with contrast fluoroscopic imaging. Other diagnoses, such as hypertrophic pyloric stenosis, are diagnosed postnatally. Abnormalities causing obstruction, such as esophageal and intestinal atresia, malrotation with midgut volvulus, and imperforate anus, are surgical emergencies and must be promptly and accurately diagnosed to allow for proper surgical planning.

Educational Goals / Teaching Points
This exhibit aims to review the embryology and pathophysiology of congenital GI abnormalities; normal progression of air within the GI tract in the neonate with expected radiographic appearance; and neonatal GI surgical emergencies, divided by high and low obstructions. We present the imaging findings associated with these pathologies as seen on prenatal ultrasound and fetal MRI, as well as their postnatal imaging correlates. We also discuss next steps in management of these surgical emergencies.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
High and low obstructions can be differentiated radiographically based on the number of dilated bowel loops that are seen, with more than three "bubbles" suggesting low intestinal obstruction. High obstructions with single, double, or triple bubble signs are more specific, but occasionally, a contrast upper GI series is performed to confirm the diagnosis, as well as to provide information for surgical planning. Low intestinal obstructions are not as specific on radiography, and usually require contrast enema for further diagnosis. Fetal MRI can provide high diagnostic accuracy for obstructions in the prenatal period. T1-weighted sequences will allow for accurate characterization of the meconium pattern, while T2-weighted fluid-sensitive sequences aid in visualization of the location of dilation, such as in esophageal or duodenal atresia.

Prenatal diagnosis of certain GI obstructions is possible via US and fetal MRI, thus aiding in early detection and allowing for appropriate counseling as well as surgical planning. Postnatal radiography can differentiate between high and low obstructions, with contrast fluoroscopic imaging confirming the diagnosis. Prompt and accurate diagnosis of these surgical emergencies allows for timely management.