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

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

Fugatt Robert,  Pasham Vishwajeeth,  Kasi Nagraj,  Mcbee Morgan

Final Pr. ID: Poster #: CR-014

While there are various intestinal polyposis syndromes, the single juvenile retention polyp (JRP) is one of the most common polypoid lesions detected in the pediatric gastrointestinal tract. Although these solitary JRPs are benign entities, they can commonly present with hematochezia. Rarely, they can serve as a nidus for infection. While intestinal polyps are fairly frequently encountered by endoscopy, they are not commonly encountered radiologically.

The subject of this case report is an 8 year old female who experienced intermittent abdominal pain and hematochezia for approximately one year before ultimately presenting with sepsis and colitis. By radiograph, CT, endoscopic sampling, histopathologic and laboratory evaluation, she was found to have sigmoid colitis secondary to a solitary JRP.

Initial abdominal radiograph showed haustral thickening, raising suspicion for colitis. Subsequent contrast enhanced abdominopelvic CT revealed a 2.8 cm peripherally enhancing, centrally hypodense polypoid lesion with internal calcification in the sigmoid colon. There was adjacent colonic wall thickening and mesenteric stranding suggesting an associated infectious or inflammatory process.

Stool studies were positive for enteropathogenic E. Coli and occult blood. The colonic lesion was endoscopically excised and shown to be a JRP. This was the presumed nidus for hematochezia and eventual bacterial translocation leading to colitis. The patient was treated with supportive and antimicrobial therapy, and ultimately improved to her baseline status.

While solitary juvenile retention polyps are non-neoplastic entities, they can often present with hematochezia and rarely serve as a nidus for colitis which may lead to sepsis. If a solitary polypoid lesion is identified in a region of intestinal inflammation, it should be considered as a potential culprit. Read More

Authors:  Fugatt Robert , Pasham Vishwajeeth , Kasi Nagraj , Mcbee Morgan

Keywords:  Juvenile Polyp, Colitis