ARRS 2022 Abstracts

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E1740. Imaging of Surgical Abdomen in A Neonate
Authors
  1. Ankita Chauhan; Le Bonheur Children's Hospital; University of Tennessee Health Science Center
  2. Chandrea Smothers; Le Bonheur Children's Hospital; University of Tennessee Health Science Center
Background
Determining the cause of an acute abdomen in a neonate is particularly challenging as the symptoms are nonspecific (inconsolable crying, fussiness, and lethargy). Associated signs often direct differential considerations and subsequent imaging. This exhibit will focus on different disease processes leading to an acute abdomen in the neonatal period, primarily focusing on the conditions that require surgical intervention.

Educational Goals / Teaching Points
A variety of congenital (or developmental) and acquired disease processes may result in an acute abdomen in neonates, such as proximal and distal bowel atresia, duodenal web, annular pancreas, malrotation, duplication cyst, hypertrophic pyloric stenosis, meconium ileus, small left colon syndrome, and Hirschsprung’s disease. As abdominal radiographs are obtained in most neonates with suspected bowel pathologies, it is crucial to have a basic understanding of the normal bowel gas pattern to identify abnormal bowel gas patterns and narrow down the differential diagnosis based on the radiographic bowel gas pattern. Our exhibit will discuss the characteristic imaging appearances and features of different disease processes leading to an acute abdomen in the neonatal age group. Participants will learn how to approach neonatal obstruction and perform appropriate imaging to ensure prompt diagnosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A neonate presenting with bilious vomiting with or without abdominal distension suggests potential high-grade proximal small bowel obstruction. Conventional radiography is diagnostic in some cases (for example, gasless abdomen in esophageal atresia without proximal tracheoesophageal fistula, “double-bubble” sign of duodenal atresia, and “triple bubble” sign of jejunal atresia). In others, it helps narrow down the diagnoses (for example, obstructive bowel gas pattern with three or fewer dilated bowel loops suggests high intestinal obstruction, whereas more than three are generally seen with low intestinal obstruction in neonates). Additionally, it is essential to timely identify free intraperitoneal gas and pneumatosis on the radiographs to avoid any delay in surgical intervention. Ultrasound is often one of the initial modalities detecting abnormalities of the GI tract in children, often as part of a targeted exam at the site of symptoms. Radiologists interpreting sonographic examinations in children should be familiar with the normal and abnormal GI tract's sonographic appearance to provide the best care for pediatric patients with abdominal diseases. We will review the imaging spectrum of bowel pathologies in a neonate, particularly those requiring surgical intervention.

Conclusion
Depending on the presenting symptoms, the differential diagnosis and the choice of the imaging modality varies. To be able to differentiate a normal radiographic bowel gas pattern from an abnormal one is very important. We will summarize the typical imaging features of different bowel conditions that may present as a surgical abdomen in the neonates.