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Ultrasound of the Pediatric Gastrointestinal Emergencies

With recent technologies, ultrasound has become an extremely useful imaging modality for evaluating children with acute abdominal symptoms. Higher frequency transducers can be used in children than in adults, owing to their small body size, the presence of less fat tissue in the abdominal wall and peritoneal cavity leading to higher resolution than computed tomography in many circumstances without exposure to ionizing radiation. Real-time ultrasound imaging provides information about motion such as peristalsis, and newly developed harmonic imaging enables improved resolution with decreased artifacts. Beyond gray-scale ultrasound, color Doppler ultrasound provides information on vascularity which increases in inflammatory processes. Point-of-care examination includes ability to focus on the symptomatic area of the patient while performing real-time ultrasound imaging. Ultrasound is sufficient for the diagnosis of several gastrointestinal diseases that cause acute abdominal pain in pediatric patients helping to an accurate patient management in the emergency settings. Common gastrointestinal indications for abdominal ultrasound in children are hypertrophic pyloric stenosis, acute appendicitis, intussusception, inflammatory bowel disease, malrotation, midgut volvulus, hernia, and necrotizing enterocolitis. In this chapter, typical sonographic findings of aforementioned diseases, and possible differential diagnoses were discussed.