Patel Parth,  Shepp Kasey,  Aribindi Haritha,  Ibrahim Muaz

Final Pr. ID: Poster #: CR-011

The ingestions of magnetic foreign objects are a common occurrence in the pediatric population. The American Association of Poison Control has documented 95,700 incidents of foreign-body ingestion in the year 2011 alone with most cases occurring in children younger than 5 years of age. In this case, we present a two-year-old male who presented to the emergency department with a four-day history of bilious vomiting. Read More

Authors:  Patel Parth , Shepp Kasey , Aribindi Haritha , Ibrahim Muaz

Keywords:  jejuno-jejunal, fistula, small bowel obstruction

Durand Rachelle,  Francavilla Michael,  Edgar Christopher,  Maya Carolina,  Kaplan Summer

Final Pr. ID: Poster #: SCI-019

Although ultrasound has advantages for bowel assessment in infants, the majority of bowel evaluation still takes place by radiograph. Although radiographic signs of advanced necrotizing enterocolitis (NEC) have been well documented, there is poor understanding of gas patterns in less severe NEC or other causes of feeding intolerance. Progressively abnormal appearance of gas patterns in NEC has been described, but it is unclear what role a gastric sump plays. Because a sump decompresses bowel and changes the gas pattern, its role in the progression of abnormal bowel gas patterns warrants attention. Read More

Authors:  Durand Rachelle , Francavilla Michael , Edgar Christopher , Maya Carolina , Kaplan Summer

Keywords:  necrotizing enterocolitis, NEC, bowel

Cielma Tara,  Durfee Teela,  Bulas Dorothy,  Loomis Judyta,  Adeyiga Adebunmi,  Bandarkar Anjum

Final Pr. ID: Poster #: EDU-003 (T)

Bowel ultrasound is a critical component of gastrointestinal evaluation. Serial examination allows real-time assessment of disease progression or improvement, and assists the clinician in therapeutic decision making and clinical management.

The goals of this exhibit are:
1. Describe the technical approach of performing bowel ultrasound.
2. Review tips, and up to date technology that assist in optimizing studies.
3. Discuss sonographic appearance of various pathologies.
4. Review future potential techniques and applications including utility of Doppler flow and contrast enhanced ultrasound. Read More

Authors:  Cielma Tara , Durfee Teela , Bulas Dorothy , Loomis Judyta , Adeyiga Adebunmi , Bandarkar Anjum

Keywords:  gastrointestinal disorder, inflammatory bowel disease, bowel

Hendi Aditi,  Harty Mary,  Grissom Leslie

Final Pr. ID: Poster #: SCI-061

Colonic volvulus in the pediatric population is very rare with 40% mortality making timely diagnosis imperative. Radiologists should operate with a high degree of clinical suspicion in patients with risk factors for large bowel volvulus. Recognition of colonic volvulus on plain film, contrast enema and CT is paramount to work-up and definitive management. This case series is the largest from any single institution and describes the clinical course and imaging findings in cases of volvulus, with the goal of familiarizing the radiologist with the appearance of this disease entity on several imaging modalities. Read More

Authors:  Hendi Aditi , Harty Mary , Grissom Leslie

Keywords:  Colonic Volvulus, Pediatric, Large Bowel Volvulus, Colonic Obstruction, Acute Abdomen

Dennis Rebecca,  Silvestro Elizabeth,  Hill Lamont,  Andronikou Savvas,  Anupindi Sudha,  Hwang Misun

Final Pr. ID: Poster #: SCI-022

To create a three dimensional (3D) ultrasound (US) bowel phantom that simulates bowel sonographic characteristics to aid in education for bowel scanning techniques and for microbubble contrast utilization in bowel. Read More

Authors:  Dennis Rebecca , Silvestro Elizabeth , Hill Lamont , Andronikou Savvas , Anupindi Sudha , Hwang Misun

Keywords:  Bowel Phantom, Bowel Ultrasound, 3D Printing

Nguyen Haithuy,  Guillerman R,  Orth Robert,  Seghers Victor,  Bales Brandy,  Sammer Marla

Final Pr. ID: Paper #: 126

Rapid detection and accurate diagnosis of midgut volvulus are crucial due to the risk of bowel infarction with delayed diagnosis. The purpose of our study is to evaluate the diagnostic accuracy of abdominal ultrasound (US) for midgut volvulus in the clinical setting of multiple sonographers and radiologists. Read More

Authors:  Nguyen Haithuy , Guillerman R , Orth Robert , Seghers Victor , Bales Brandy , Sammer Marla

Keywords:  Midgut volvulus, Malrotation, bowel

Adu John,  Watson Tom

Final Pr. ID: Poster #: EDU-024

The inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) are multifaceted disorders as a consequence of complex interplay between genetic, environmental and immunological factors, leading to a dysregulated immune response of the host intestinal bacteria. In children both the mucosal immune system and the intestinal microflora are still developing. Taken together, it seems that patients with early onset IBD (EO-IBD) are a unique subset within IBD with particular gene defects, phenotypic appearance, drug responsiveness and immune pathology.
Imaging plays a key role in the diagnosis and follow-up of EO-IBD, with MRI enterography being the gold standard in modern IBD practice, largely because of its ability to provide excellent spatial resolution without ionising radiation. EO-IBD can also be elegantly demonstrated on ultrasound and can be used a complimentary imaging tool in both the diagnostic workup and follow up imaging.
The aims of this educational exhibit are to:
(i) Provide a pictorial review of the key imaging finding of EO-IBD as demonstrated on MRI and ultrasound.
(ii) Review the imaging techniques and protocols for MR enterography as applied to EO-IBD.
(iii) Discuss the role of genetic mutations and innate immune defects in the pathophysiology of EO-IBD. Read More

Authors:  Adu John , Watson Tom

Keywords:  Inflammatory bowel disease, diarrhoea, interleukin-10, crohns disease, ulcerative colitis

Burger Matthew,  Lindsay Aaron

Final Pr. ID: Poster #: EDU-011

Educational goals: Highlight epidemiology, clinical presentation, radiographic findings, and treatment for common neonatal obstructions considered high in the intestinal tract including malrotation with midgut volvulus, duodenal atresia, duodenal web, annular pancreas, and proximal jejunal atresia.

Malrotation with midgut volvulus occurs when abnormally rotated and fixated small bowel twists about the superior mesenteric artery. This often presents with bilious vomiting in the first month of life and requires emergent surgical repair. Abdominal radiographs may be normal or show distention of the stomach and proximal duodenum with some distal bowel gas seen. An upper GI fluoroscopy exam (UGI) demonstrates a spiral/corkscrew sign or abrupt beaking with small bowel malrotation. Duodenal atresia is usually the result of incomplete recanalization of the duodenum. This presents at birth with abdominal distention and bilious or non-bilious vomiting depending on the segment of duodenum affected. Treatment is surgical resection of the atresia and reanastomosis. Classically on radiograph there is a double bubble sign, which may be seen on an antenatal ultrasound. Duodenal web results from an incomplete diaphragm/web within the lumen which causes intermittent complete or partial obstruction. There may be mild symptoms, or it may present similarly to duodenal atresia. It usually presents after the first week of life but may present in any age. Treatment is usually surgical or endoscopic resection. Abdomen radiographs may show mild proximal dilation or a double bubble sign distal bowel gas. UGI classically shows a windsock sign or duodenal dimple sign. Annular pancreas results from incomplete rotation of the ventral pancreatic bud leading to pancreatic tissue encasing the descending duodenum. The presentation and age of onset varies, in neonates and children it causes similar symptoms of duodenal obstruction. Cross-sectional imaging shows the duct draining the pancreatic head encircling the duodenum. Symptomatic cases of annular pancreas are usually treated surgically to alleviate obstructive symptoms. Jejunal atresia results from a vascular injury in utero causing one or more areas of stenosis/atresia. Proximal jejunal atresia presents with abdominal distention and bilious emesis. Abdominal radiographs classically show a triple bubble sign. Treatment is surgical resection of the involved segments of bowel. Read More

Authors:  Burger Matthew , Lindsay Aaron

Keywords:  Bowel obstruction, Neonatal

Joshi Hena,  Alazraki Adina,  Rostad Bradley

Final Pr. ID: Poster #: EDU-024

Ulcerative colitis (UC) and Crohn disease are chronic, immune-mediated, inflammatory disorders of the gastrointestinal tract collectively referred to as inflammatory bowel disease (IBD). As many of 20-25% of patients with IBD initially present in childhood or adolescence, and the incidence of pediatric IBD is increasing. IBD primarily affects the bowel, but other organs can be involved. Nearly one-third of patients will have at least one extra-intestinal manifestation. Some extra-intestinal manifestations, such as that between UC and primary sclerosing cholangitis (PSC), are well-established. Others are less understood and may mimic more common pathology, particularly infection. Therefore, pediatric radiologists must become familiar with these extra-intestinal manifestations and consider the diagnosis of IBD as the etiology for their pathology. Read More

Authors:  Joshi Hena , Alazraki Adina , Rostad Bradley

Keywords:  inflammatory bowel disease, ulcerative colitis, Crohn disease

Rajderkar Dhanashree,  Sharma Priya,  Verma Nupur

Final Pr. ID: Poster #: EDU-133

GI Emergencies and congenital malformation in the neonate are variable in their presentation and can be seen from the hypo-pharynx to the anus. The pediatric radiologist often plays a key role in diagnosis and planning of early surgical management. Read More

Authors:  Rajderkar Dhanashree , Sharma Priya , Verma Nupur

Keywords:  Congenital, GI malformations, Newborn bowel obstruction, New born GI emergencies, GI congenital emergencies

Chaker Salama,  Reid Janet,  Lopez-rippe Julian

Final Pr. ID: Poster #: EDU-041

The purpose of this educational exhibit is to present a systematic 4-sequence hanging protocol and search pattern as an effective method to initially review a pediatric MR enterography (MRE) study prior to thorough interpretation. By analyzing frequently referenced sequences in MRE reports with positive inflammatory bowel disease findings, we identified novel 4-sequence hanging protocol: coronal T2-weighted HASTE (for anatomic orientation), axial fat-saturated fluid-sensitive sequence (for bowel wall thickening/edema), axial diffusion-weighted high b-value sequences (for bowel inflammation and complications), and coronal gradient-recall echo T1-weighted post-contrast (for enhancement). This structured 4-sequence hanging protocol highlights the most pertinent findings and allows for rapid first-pass evaluation to orient novice readers. The exhibit provides an efficient framework for radiology trainees to streamline review of pediatric MREs before proceeding to full detailed interpretation. Read More

Authors:  Chaker Salama , Reid Janet , Lopez-rippe Julian

Keywords:  inflammatory bowel disease, magnetic resonance enterography, hanging protocol

Saguintaah Magali,  Taleb Arrada Ikram,  Prodhomme Olivier,  Bolivar Perrin Julie,  David Stephanie,  Sevette Nancy,  Couture Alain,  Baud Catherine

Final Pr. ID: Poster #: EDU-067

To review the imaging appearances of neonatal bowel obstruction, focusing on the sonographic findings.
To describe the etiologies and the indication for other imaging modalities Read More

Authors:  Saguintaah Magali , Taleb Arrada Ikram , Prodhomme Olivier , Bolivar Perrin Julie , David Stephanie , Sevette Nancy , Couture Alain , Baud Catherine

Keywords:  neonatal bowel obstruction, ultrasonography

Chopra Mark,  Watson Tom,  Olsen Øystein

Final Pr. ID: Poster #: CR-023

The incidence of paediatric inflammatory bowel disease (pIBD) is increasing. MR enterography (MRE) is increasingly recognised as the gold standard imaging technique for the small bowel in IBD. The advantages of MRE include the lack of ionising radiation and greater soft tissue definition. It also allows functional information from diffusion sequences and is used for IBD diagnosis, monitoring of disease activity and complications such as abscess, stricture or fistula. Extra-intestinal manifestations can also be identified.

Younger children often need a general anaesthetic (GA) in order to undergo MRI. Excellent distension of the small bowel loops on MRE is essential to aid accurate assessment. As the child cannot drink a large volume of fluid prior to anaesthetic induction, fluid distension is facilitated through insertion of a nasojejunal tube and instillation of fluid via the tube whilst under GA. We present our institutional practice from a large paediatric hospital for performing MR enterography under GA in young children.

A retrospective study of our Radiology Information Service (RIS) was undertaken to identify children under the age of 10 years who underwent MRE under GA between 2010-2015. The anaesthetic charts of these children were obtained and the anaesthetic duration / complications were recorded. The imaging was reviewed to evaluate the MRI quality, degree of distension and report finding. The MR protocol and sequence optimisation will also be discussed.


12 patients were included in the study, aged from 23 months to 10 years.The length of GA time ranged from 110-185 minutes (average 142 minutes) and no significant adverse effects were described. The mean fluoroscopy radiation dosage for NJ insertion was low (8 micrograys) and the success rate was high (91%).
All completed studies were reviewed and oral contrast reached the terminal ileum in 100%. Bowel distension was rated as good or excellent in all cases.

Our institutional experience has shown that MRE under GA with nasojejunal tube enteroclysis is feasible and can safely produce high quality, diagnostic imaging in the young paediatric patient.
Read More

Authors:  Chopra Mark , Watson Tom , Olsen Øystein

Keywords:  MR enterography, Inflammatory bowel disease, general anaesthesia, enteroclysis

Hendi Aditi,  Harty Mary,  Grissom Leslie

Final Pr. ID: Poster #: CR-050

Pediatric colonic volvulus is very rare with 40% mortality, making diagnosis time-sensitive. Surgeons rely on imaging confirmation, but sensitivity of plain film is low and contrast enema is contraindicated in patients with acute abdomen. Alternatively, CT is a safe, sensitive modality and aids in pre-operative planning. We identified 11 patients over 10 years with colonic volvulus, of which 5 are chosen to describe the role of CT in work-up.

Case 1: A 12 yo male with Prune-Belly Syndrome and prior abdominal surgery presents with a day of abdominal distention. Radiography was initially concerning for small bowel obstruction. He deteriorated and the next day CT showed necrotic, distended colon in the midline. Exploratory laparotomy 24 hours after presentation revealed volvulus and necrosis of the mid transverse colon, and partial colectomy was performed.

Case 2: A 17 yo female with cerebral palsy, mental retardation and prior abdominal surgery presents with a day of abdominal distension. Radiography was concerning for volvulus. Barium enema confirmed cecal volvulus but did not decompress the bowel. Rectal tube trial was also unsuccessful. Exploratory laparotomy 2 hours after presentation revealed 720° cecal volvulus and ileocecectomy was performed.

Case 3: A 4 yo female with chronic constipation presented with 12 hours of severe abdominal pain. Radiography was initially concerning for small bowel obstruction, but CT showed transverse colonic volvulus. Four hours after presentation, the transverse colonic volvulus was detorsed and bowel was preserved during laparotomy.

Case 4: A 10 yo male with chronic constipation presented with severe abdominal pain. Radiography was nonspecific but CT showed fecal impaction and cecal volvulus. Exploratory laparotomy six hours after presentation confirmed cecal volvulus, which was detorsed and partial cecectomy was performed.

Case 5: A 15 yo male with Goldenhar syndrome, chronic constipation and prior abdominal surgery presents with a day of severe abdominal pain. CT showed cecal volvulus, reduction of which was unsuccessful with contrast enema. During exploratory laparotomy 12 hours after presentation, a 720° cecal volvulus was detorsed and bowel was preserved. Read More

Authors:  Hendi Aditi , Harty Mary , Grissom Leslie

Keywords:  Colonic Volvulus, CT, Large Bowel Volvulus, Pediatric

Castro Denise,  Silva Cecília,  Paranhos Isabela,  Lira Andréa,  Fonseca Josélia,  Ribeiro Rafaela

Final Pr. ID: Poster #: CR-045

A 10-year-old girl presented with 18-hour history of crampy periumbilical pain, associated with three episodes of non-bilious vomiting and anorexia over the past few days. She denied fever and had a normal bowel movement one day before admission. She had no medical history and was not on any medication. Her social development and school performance were both unremarkable. On physical examination, the abdomen was distended, tender in the periumbilical area, with normal bowel sounds and no peritoneal signs.
The abdominal radiograph showed air-fluid levels with distended small bowel loops and a large heterogeneous mass conforming to the shape of the stomach and a possible distended loop with mottled gas pattern in the mid pelvis, to the left of the midline. Six hours later, while in the hospital, the patient developed bilious vomiting and a computed tomography (CT) showed a mottled air-containing large mass within the stomach and a second smaller similar appearing mass within a segment of small bowel in the left lower quadrant, with diffuse distension of small bowel loops and multiple air-fluid levels proximal to it, in keeping with small bowel obstruction (SBO). The patient admitted to trichotillomania and trichophagia and a patch of alopecia was noted in the left parietal scalp. She was sent to the operating room where a supraumbilical vertical midline incision was made and a large obstructing trichobezoar completely filling the gastric lumen was removed through a transverse gastrotomy. The small bowel was inspected and a palpable, obstructing smaller trichobezoar was removed from the jejunum, approximately 1 meter from the pylorus.
Trichobezoars form after the ingestion of large amounts of hair, often over many years. Although trichotillomania affects about 1% of the population, only one third have trichophagia and just 1% of these individuals eat enough hair to require surgical intervention, making trichobezoars very uncommon in clinical practice. They are usually single and seen in the stomach, but in 5% of cases more then one bezoar is found. SBO occurs in fewer than 10% of patients with trichobezoar.
Plain radiographs are usually the initial imaging tool for diagnosis of SBO. CT can be helpful in determining the presence of obstruction in clinically suspected cases with equivocal plain radiographs, and determining the site and cause of obstruction, including trichobezoars. Read More

Authors:  Castro Denise , Silva Cecília , Paranhos Isabela , Lira Andréa , Fonseca Josélia , Ribeiro Rafaela

Keywords:  trichobezoar, small bowel obstruction, simultaneous, synchronous, bezoar

Seekins Jayne,  Newman Beverly

Final Pr. ID: Poster #: EDU-034

Causes of paucity of bowel gas in the neonate abdomen can vary widely. This case series will review common and uncommon causes of paucity of bowel gas on abdominal radiography in the newborn as well as further imaging strategies to achieve a rapid diagnosis. Entities range from solid organ enlargement and masses as well as diseases of bowel origin. Evaluation of the most common causes of the lack of bowel gas with x-ray, ultrasound and fluoroscopy can lead to rapid diagnosis and treatment, especially if not prenatally diagnosed. This series will also discuss the utility of post-natal CT and/or MRI in select cases. Read More

Authors:  Seekins Jayne , Newman Beverly

Keywords:  Paucity of bowel gas, Neonate, Abdomen

Groth Nicholas,  Williams Avery,  Southard Richard

Final Pr. ID: Poster #: EDU-023

PURPOSE: Trauma is a leading cause of death and disability in children ages 1-18, with abdominal trauma accounting for a significant patient population. Prompt identification of bowel and mesenteric injury in the setting of blunt trauma and penetrating injuries is important to avoid significant complications that may arise from delayed diagnosis. Spectral Dual-Energy Computed Tomography (DECT) obtains raw data at two energy spectra which by virtue of material decomposition can identify, isolate and or quantify iodine, pure calcium, and uric acid. Multiple image sets can be generated from a single scan allowing both anatomic and material-specific analysis. The use of DECT can improve detection and accurate grading of solid organ injury, aid in defining active hemorrhage, and increase visibility of altered bowel wall enhancement, ischemia, necrosis, and inflammation which provides critical information to inform the course of treatment in emergent settings. Read More

Authors:  Groth Nicholas , Williams Avery , Southard Richard

Keywords:  Dual Energy, Computed Tomography, Bowel Injury