Gastrointestinal Emergencies in the Neonate

  • Teresa Berrocal
  • Manuel ParrónEmail author
  • Gloria del Pozo
Part of the Medical Radiology book series (MEDRAD)


Gastrointestinal emergencies in the neonate often necessitate one or more radiological assessments to assist in the diagnosis and successful management. This chapter systematically reviews the aetiology, investigative pathways and the specific imaging findings of intestinal pathologies presenting in the neonatal period.


Contrast Enema Duodenal Obstruction Duodenal Atresia Plain Abdominal Radiograph Colonic Atresia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Allison JW, Johnson JF III, Barr LL et al (1995) Induction of gastroduodenal prolapse by antral heterotopic pancreas. Pediatr Radiol 25:50–51CrossRefPubMedGoogle Scholar
  2. Amat VS, Núñez Núñez R, Enríquez Zarabozo E et al (2011) Small left colon syndrome: a review of our experience. Cir Pediatr 24(3):156–160PubMedGoogle Scholar
  3. Applegate KE (2009) Evidence-based diagnosis of malrotation and volvulus. Pediatr Radiol 39(Suppl 2):S161–S163CrossRefPubMedGoogle Scholar
  4. Arnold M, Moore SW, Sidler D et al (2010) Long-term outcome of surgically managed necrotizing enterocolitis in a developing country. Pediatr Surg Int 26:355–360CrossRefPubMedGoogle Scholar
  5. Babcock DS (2002) Sonography of the acute abdomen in the pediatric patient. J Ultrasound Med 21:887–899PubMedGoogle Scholar
  6. Babyn P, Peled N, Manson D et al (1995) Radiologic features of gastric outlet obstruction in infants after long-term prostaglandin administration. Pediatr Radiol 25:41–43CrossRefPubMedGoogle Scholar
  7. Berrocal T, Lamas M, Gutiérrez J et al (1999) Congenital anomalies of the small intestine, colon and rectum. Radiographics 19:1219–1236CrossRefPubMedGoogle Scholar
  8. Buonomo C (1997) Neonatal gastrointestinal emergencies. Radiol Clin North Am 35:845–864PubMedGoogle Scholar
  9. Buonomo C (1999) The radiology of necrotizing enterocolitis. Radiol Clin North Am 37:1187–1198CrossRefPubMedGoogle Scholar
  10. Burge D, Drewett M (2004) Meconium plug obstruction. Pediatr Surg Int 20:108–110CrossRefPubMedGoogle Scholar
  11. Clark P, Ruess L (2005) Counterclockwise barber-pole sign on CT: SMA/SMV variance without midgut malrotation. Pediatr Radiol 35:1125–1127CrossRefPubMedGoogle Scholar
  12. Couture A (2008) Bowel obstruction in neonates and children. In: Couture A, Baud C, Ferran JL et al (eds) Gastrointestinal tract sonography in fetuses and children, Medical radiology. Diagnostic imaging. Springer, Berlin/Heidelberg, pp 131–251CrossRefGoogle Scholar
  13. Cowles AR, Berdon WE, Holt PD et al (2006) Neonatal intestinal obstruction simulating meconium ileus in infants with long segment intestinal aganglionosis: radiographic findings that prompt the need for rectal biopsy. Pediatr Radiol 36:1–5CrossRefGoogle Scholar
  14. Dalla Vecchia LK, Grosfeld JL, West KW et al (1998) Intestinal atresia and stenosis. Arch Surg 133:490–497CrossRefPubMedGoogle Scholar
  15. Daneman A (2009) Malrotation: the balance of evidence. Pediatr Radiol 39(Suppl 2):S164–S166CrossRefPubMedGoogle Scholar
  16. Dilli D, Oguz S, Erol R et al (2011) Does abdominal sonography provide additional information over abdominal plain radiography for diagnosis of necrotizing enterocolitis in neonates? Pediatr Surg Int 27:321–327CrossRefPubMedGoogle Scholar
  17. Doodnath R, Puri P (2010) A systematic review and meta-analysis of Hirschsprung’s disease presenting after childhood. Pediatr Surg Int 26:1107–1110CrossRefPubMedGoogle Scholar
  18. Dordelmann M, Rau GA, Bartels D et al (2009) Evaluation of portal venous gas detected by ultrasound examination for diagnosis of necrotizing enterocolitis. Arch Dis Child Fetal Neonatal Ed 94:F183–F187CrossRefPubMedGoogle Scholar
  19. Douglas D (2010) Meconium pseudocyst. Pediatr Radiol 40(Suppl 1):S105CrossRefPubMedGoogle Scholar
  20. Eckoldt F, Heling KS, Woderich KS, Bollmann R, Mau HR (2003) Meconium peritonitis and pseudo-cyst formation: prenatal diagnosis and post-natal course. Prenat Diagn 23:904–908CrossRefPubMedGoogle Scholar
  21. Ellis H, Kumar R, Kostyrka B (2009) Neonatal small left colon syndrome in the offspring of diabetic mothers-an analysis of 105 children. J Pediatr Surg 44(12):2343–2346CrossRefPubMedGoogle Scholar
  22. Epelman M, Daneman A, Navarro OM et al (2007) Necrotizing enterocolitis: review of state-of the-art imaging findings with pathologic correlation. Radiographics 27:285–305CrossRefPubMedGoogle Scholar
  23. Etienne D, John A, Menias CO, Ward R, Tubbs RS, Loukas M (2012) Annular pancreas: a review of its molecular embryology, genetic basis and clinical considerations. Ann Anat 194(5):422–428CrossRefPubMedGoogle Scholar
  24. Faingold R, Daneman A, Tomlinson G et al (2005) Necrotizing enterocolitis: assessment of bowel viability with color Doppler US. Radiology 235:587–594CrossRefPubMedGoogle Scholar
  25. Fotter R, Sorantin E (1994) Diagnostic imaging in necrotizing enterocolitis. Acta Paediatr 396(Suppl):41–44CrossRefGoogle Scholar
  26. Gershon MD, Ratcliffe EM (2004) Developmental biology of the enteric nervous system: pathogenesis of Hirschsprung’s disease and other congenital dysmotilities. Semin Pediatr Surg 13:224–235CrossRefPubMedPubMedCentralGoogle Scholar
  27. Gilbertson-Dahdal DL, Dutta S, Varich LJ et al (2009) Neonatal malrotation with midgut volvulus mimicking duodenal atresia. AJR Am J Roentgenol 192:1269–1271CrossRefPubMedGoogle Scholar
  28. Godbole P, Stringer MD (2002) Bilious vomiting in the newborn: how often is it pathologic? J Pediatr Surg 37:909–911CrossRefPubMedGoogle Scholar
  29. Hajivassiliou CA (2003) Intestinal obstruction in neonatal/pediatric surgery. Semin Pediatr Surg 12:241–253CrossRefPubMedGoogle Scholar
  30. Hayakawa K, Hamanaka Y, Suzuki M et al (2003) Radiological findings in total colon aganglionosis and allied disorders. Radiat Med 21:128–134PubMedGoogle Scholar
  31. Hayden CK Jr (1996) Ultrasonography of the acute pediatric abdomen. Radiol Clin North Am 34:791–806PubMedGoogle Scholar
  32. Hernanz-Schulman M (1999) Imaging of neonatal gastrointestinal obstruction. Radiol Clin North Am 37:1163–1186CrossRefPubMedGoogle Scholar
  33. Horton KK (2005) Pathophysiology and current management of necrotizing enterocolitis. Neonatal Netw 24:37–46CrossRefPubMedGoogle Scholar
  34. Hryhorczuk AL, Lee EY (2012) Imaging evaluation of bowel obstruction in children: updates in imaging techniques and review of imaging findings. Semin Roentgenol 47(2):159–170CrossRefPubMedGoogle Scholar
  35. Jamieson DH, Dundas SE, Belushi SA et al (2004) Does the transition zone reliably delineate aganglionic bowel in Hirschsprung’s disease? Pediatr Radiol 34:811–815CrossRefPubMedGoogle Scholar
  36. Jimenez JC, Emil S, Podnos Y et al (2004) Annular pancreas in children: a recent decade’s experience. J Pediatr Surg 39:1654–1657CrossRefPubMedGoogle Scholar
  37. Juang D, Snyder CL (2012) Neonatal bowel obstruction. Surg Clin North Am 92:685–711CrossRefPubMedGoogle Scholar
  38. Kim WY, Kim WS, Kim IO et al (2005) Sonographic evaluation of neonates with early-stage necrotizing enterocolitis. Pediatr Radiol 35(11):1056–1061CrossRefPubMedGoogle Scholar
  39. Koplewitz BZ, Daneman A (1999) The lateral view: a useful adjunct in the diagnosis of malrotation. Pediatr Radiol 29:144–145CrossRefPubMedGoogle Scholar
  40. Kubota A, Imura K, Yagi M et al (1999) Functional ileum in neonates: Hirschsprung’s disease-allied disorders versus meconium related ileus. Eur J Pediatr Surg 9(6):392–395CrossRefPubMedGoogle Scholar
  41. Kul S, Korkmaz HAA, Aysegul Cansu A et al (2012) Contribution of MRI to Ultrasound in the Diagnosis of Fetal Anomalies. J Magn Reson Imaging 35:882–890CrossRefPubMedGoogle Scholar
  42. Lampl B, Levin TL, Berdon WE, Cowles RA (2009) Malrotation and midgut volvulus: a historical review and current controversies in diagnosis and management. Pediatr Radiol 39(4):359–366CrossRefPubMedGoogle Scholar
  43. Lang I, Daneman A, Cutz E et al (1997) Abdominal calcification in cystic fibrosis with meconium ileus: radiologic-pathologic correlation. Pediatr Radiol 27:523–527CrossRefPubMedGoogle Scholar
  44. Laughlin DM, Friedmacher F, Puri P (2012) Total colonic aganglionosis: a systematic review and meta-analysis of long-term clinical outcome. Pediatr Surg Int 28(8):773–779CrossRefPubMedGoogle Scholar
  45. Lee NK, Kim S, Jeon TY et al (2010) Complications of congenital and developmental abnormalities of the gastrointestinal tract in adolescents and adults: evaluation with multimodality imaging. Radiographics 30:1489–1507CrossRefPubMedGoogle Scholar
  46. Lee SH, Cho YH, Kim HY et al (2012) Clinical experience of complex jejunal atresia. Pediatr Surg Int 28(11):1079–1083CrossRefPubMedGoogle Scholar
  47. Lin PW, Stoll BJ (2006) Necrotising enterocolitis. Lancet 368:1271–1283CrossRefPubMedGoogle Scholar
  48. Martinez-Ferro M, Rothenberg S, St Peter S et al (2010) Laparoscopic treatment of postnecrotizing enterocolitis colonic strictures. J Laparoendosc Adv Surg Tech A 20(5):477–480CrossRefPubMedGoogle Scholar
  49. McBride WJ, Roy S, Brudnicki A et al (2010) Correlation of complex ascites with intestinal gangrene and perforation in neonates with necrotizing enterocolitis. J Pediatr Surg 45(5):887–889CrossRefPubMedGoogle Scholar
  50. Menten R, Reding R, Godding V et al (2012) Sonographic assessment of the retroperitoneal position of the third portion of the duodenum: an indicator of normal intestinal rotation. Pediatr Radiol 42(8):941–945CrossRefPubMedGoogle Scholar
  51. Minato M, Okada T, Miyagi H et al (2012) Meconium pseudocyst with particular pathologic findings: a case report and review of the literature. J Pediatr Surg 47:E9–E12CrossRefPubMedGoogle Scholar
  52. Okoye BO, Parikh DH, Buick RG et al (2000) Pyloric atresia: five new cases, a new association, and a review of the literature with guidelines. J Pediatr Surg 35:1242–1245CrossRefPubMedGoogle Scholar
  53. Paradiso VF, Briganti V, Oriolo L et al (2011) Meconium obstruction in absence of cystic fibrosis in low birth weight infants: an emerging challenge from increasing survival. Ital J Pediatr 37:55CrossRefPubMedPubMedCentralGoogle Scholar
  54. Patil RT, Gupta R, Parelkar SV et al (2011) A rare case of duodenal atresia with apple-peel configuration of the small intestine and malrotation. Eur J Pediatr Surg 21(5):340–342CrossRefPubMedGoogle Scholar
  55. Patino MO, Munden MM (2004) Utility of the sonographic whirlpool sign in diagnosing midgut volvulus in patients with atypical clinical presentations. J Ultrasound Med 23:397–401PubMedGoogle Scholar
  56. Peled N, Dagan O, Babyn P et al (1992) Gastric-outlet obstruction induced by prostaglandin therapy in neonates. N Engl J Med 327:505–511CrossRefPubMedGoogle Scholar
  57. Pickhardt PJ, Bhalla S (2002) Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. AJR Am J Roentgenol 179(6):1429–1435CrossRefPubMedGoogle Scholar
  58. Pracros JP, Sann L, Genin G et al (1992) Ultrasound diagnosis of midgut volvulus: the “whirlpool” sign. Pediatr Radiol 22:18–20CrossRefPubMedGoogle Scholar
  59. Quedas EPS, Longuini VC, Sekiya T et al (2012) RET haplotype, not linked to the C620R activating mutation, associated with Hirschsprung disease in a novel MEN2 family. Clinics 67(S1):57–61CrossRefPubMedPubMedCentralGoogle Scholar
  60. Rubesova E (2012) Fetal bowel anomalies – US and MR assessment. Pediatr Radiol 42(Suppl 1):S101–S106CrossRefPubMedGoogle Scholar
  61. Ryan S, Donoghue V (2010) Gastrointestinal pathology in neonates: new imaging strategies. Pediatr Radiol 40:927–931CrossRefPubMedGoogle Scholar
  62. Saguintaah M, Veyrac C, Prodhomme O et al (2010) Meconium obstruction in extremely-low-birth-weight premature infant: US contribution to diagnosis and management. Pediatr Radiol 40:1091–1092, Abstract 65Google Scholar
  63. Salman AB, Karaoglanoglu N, Suma S (1999) Abdominal, scrotal, and thoracic calcifications owing to healed meconium peritonitis. J Pediatr Surg 34:1415–1416CrossRefPubMedGoogle Scholar
  64. Shimanuki Y, Aihara T, Takano H et al (1996) Clockwise whirlpool sign at color Doppler US: an objective and definite sign of midgut volvulus. Radiology 199:261–264CrossRefPubMedGoogle Scholar
  65. Shawis R, Antao B (2006) Prenatal bowel dilatation and the subsequent postnatal management. Early Hum Dev 82(5):297–303CrossRefPubMedGoogle Scholar
  66. Shew SB (2009) Surgical concerns in malrotation and midgut volvulus. Pediatr Radiol 39(Suppl 2):S167–S171CrossRefPubMedGoogle Scholar
  67. Singal AK, Ramu C, Paul S et al (2009) Preduodenal portal vein in association with midgut malrotation and duodenal web—triple anomaly? J Pediatr Surg 44:E5–E7CrossRefPubMedGoogle Scholar
  68. Strouse PJ (2004) Disorders of intestinal rotation and fixation (“malrotation”). Pediatr Radiol 34:837–851CrossRefPubMedGoogle Scholar
  69. Subbarao K (2008) Roentgenological diagnosis of alimentary tract emergencies in the new born. Indian J Radiol Imaging 18(3):198–203PubMedPubMedCentralGoogle Scholar
  70. Jo YS, Jang DG, Nam SY, Choi SK, Shin JC, Lee G (2012) Antenatal sonographic features of ileal atresia. J Obstet Gynaecol Res 38(1):215–219CrossRefPubMedGoogle Scholar
  71. Sze RW, Guillerman RP, Krauter D et al (2002) A possible new ancillary sign for diagnosing midgut volvulus: the truncated superior mesenteric artery. J Ultrasound Med 21:477–480PubMedGoogle Scholar
  72. Taylor GA (2011) CT appearance of the duodenum and mesenteric vessels in children with normal and abnormal bowel rotation. Pediatr Radiol 41(11):1378–1383CrossRefPubMedGoogle Scholar
  73. Toma P, Mengozzi E, Dell’Acqua A et al (2002) Pyloric atresia: report of two cases (one associated with epidermolysis bullosa and one associated with multiple intestinal atresias). Pediatr Radiol 32:552–555CrossRefPubMedGoogle Scholar
  74. Veyrac C, Baud C, Prodhomme O et al (2012) US assessment of neonatal bowel (necrotizing enterocolitis excluded). Pediatr Radiol 42(Suppl 1):S107–S114CrossRefPubMedGoogle Scholar
  75. Vinocur DN, Lee EY, Eisenberg RL (2012) Neonatal intestinal obstruction. AJR Am J Roentgenol 198(1):W1–W10CrossRefPubMedGoogle Scholar
  76. Yousefzadeh DK (2009) The position of the duodenojejunal junction: the wrong horse to bet on in diagnosing or excluding malrotation. Pediatr Radiol 39:S172–S177CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Teresa Berrocal
    • 1
  • Manuel Parrón
    • 1
    Email author
  • Gloria del Pozo
    • 2
  1. 1.Pediatric Radiology Section, Department of RadiologyUniversity Hospital La PazMadridSpain
  2. 2.Pediatric Radiology Section, Department of RadiologyUniversity Hospital 12 de OctubreMadridSpain

Personalised recommendations