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Imaging of Gastrointestinal Tract Perforation in the Pediatric Patient

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Imaging of Alimentary Tract Perforation

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Abstract

There are multiple etiologies of gastrointestinal perforation in children. It occurs most frequently in the newborn. The most common causes of perforation include necrotizing enterocolitis (NEC), gastric perforation, Hirschsprung’s disease, meconium ileus, imperforate anus, and neonatal small left colon syndrome. Other causes of intestinal perforation are intussusception, volvulus/malrotation, appendicitis, inflammatory bowel disease, and foreign object.

Diagnosis requires a combination of clinical, laboratory, and radiological findings.

The radiological criteria evaluated as predictors of perforation are pneumoperitoneum, intestinal distension, peritoneal fluid, air fluid levels, pneumatosis intestinalis, and gas in the portal venous system. Gas in the intestinal wall and portal venous system in infant is invariably associated with enteritis or enterocolitis, except when the gas has been introduced accidentally through an indwelling umbilical catheter. Conventional radiography is a common method for detecting intraperitoneal free air. Abdominal radiograph has to be obtained in double projection: upright and lateral radiograph films with horizontal beam. In some cases of perforation of hollow viscera, the clinical and plain film findings may be inconclusive. In such circumstances, examination with contrast material may be indicated with low osmotic pressure agents.

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Authors and Affiliations

  1. Dipartimento di Scienze Radiologiche, SOD Radiologia Pediatrica e Specialistica, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Via Conca, 71, Ancona, 60126, Italy

    Cecilia Lanza & Andrea Giovagnoni

  2. Dipartimento di Scienze Radiologiche, Scuola di Specializzazione in Radiodiagnostica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Via Conca, 71, Ancona, 60126, Italy

    Elisabetta Panfili

Authors
  1. Cecilia Lanza
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  3. Andrea Giovagnoni
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Correspondence to Cecilia Lanza .

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Editors and Affiliations

  1. Department of Radiology, “A. Cardarelli” Hospital, Naples, Italy

    Luigia Romano

  2. Dept Radiology, “A. Cardarelli” Hospital, Naples, Italy

    Antonio Pinto

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Lanza, C., Panfili, E., Giovagnoni, A. (2015). Imaging of Gastrointestinal Tract Perforation in the Pediatric Patient. In: Romano, L., Pinto, A. (eds) Imaging of Alimentary Tract Perforation. Springer, Cham. https://doi.org/10.1007/978-3-319-08192-2_13

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  • DOI: https://doi.org/10.1007/978-3-319-08192-2_13

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  • Online ISBN: 978-3-319-08192-2

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