Evaluation Of Bloody Stool In Children By High Frequency Ultrasonography

Part I:The role of high frequency ultrasound in diagnosis of primary enterogenous diseases with bloody stool in childrenObjective:To evaluate the role of high frequency ultrasound in the diagnosis of primary enterogenous diseases with bloody stool in children.Materials and Methods:The clinical and ultrasonic data of 166 pediatric patients who had bloody stool and diagnosed as intestinal abnormalities by surgery or follow-up examinations in our hospital were analyzed retrospectively. They all accepted abdominal ultrasonography examination before therapy. Ninety-four were boys and seventy-two were girls with a mean age of 5.51 years(range,5 days-13years). US was performed with various scanners. The children must keep quiet during examination, the crying child should oral chloral hydrate to sleep before examination. And sometimes drinking some water was also necessary to avoid the influence of the gas in intestinal tract. A supine position was adopted for the examination. Color Doppler ultrasound was performed with optimized color Doppler parameters. On the films, note was made of any associated relevant abnormal findings such as lesions、bowel wall and peristalsis. ileus etc. All images and clinic data recorded were saved in PACS system, and ensured that the information was complete and accurate. The SPSS program(version 13.0, SPSS, Chicago, IL,USA)was used for statistical analysis. Chi-square test was adopted and there were statistically significant differences if P value was less than 0.05.Result:The coincident rate between abdominal ultrasonic diagnosis and confirmed diagnosis results was 83.73%(139/166), while the rate of missed diagnosis and the misdiagnosis rate were 13.25%(22/166),3.01%(5/166)respectively. Those diseases that caused bloody stool included intussusceptions(66 cases)、intestinal duplication(32 cases)、intestinal malrotation(23 cases)、Meckel’s diverticulum(20 cases)、gastrointestinal polyps(22cases、intestinal foreign bodies (3 cases).The characteristic US features of intussusception included a hypoechoic outer rim of homogeneous thickness with a central hyperechoic core on a transverse plane which was called "multiple concentric rings" sign and a hyperechoic tubular center covered on each side by a hyperechoic tubular center covered on each side by a hypoechoic rim on a longitudinal plane which was called sleeve sign. In those cases with intussusceptions, the length、location and color signal of the lesion may affect the successful rate of air enema reduction.32 cases were confirmed to be digestive duplication and 26 cases were diagnosed by ultrasound which included 6 cases in duodenum,8 cases in ileocecal junction and 12 cases in small intestines.3 were misdiagnosed and 3 cases were missed before operation. The typical sonographic images of intestinal duplication showed cystic mass with clear border and thickening wall. It was divided into two types according the imaging findings:cystic form and tubular type. The former was divided into outer intestine duplication and inner intestine duplication according to the location of the cyst. The features of inner intestine duplication included cystic mass projected into enteric cavity with gas reflect in the angle between the bowel wall and the mass. The features of outer intestine duplication showed cystic mass closed to intestinal canal with three layer structure of "strong-weak-strong", which was similar with the normal intestinal wall. 23 cases were confirmed to be intestinal malrotation and 1 case was missed by ultrasonography. The Intestinal malrotation showed red and blue spiral flow signal in color Dopple flowing image. Midgut volvulus cases showed typically clockwise whirlpool sign. In the 20 cases with Meckel’s diverticulum,13 cases were diagnosed,2 cases were misdiagnosed and 5 cases were missed. Meckel’s diverticulum had a thick wall and mostly located around belly button or right next abdomens. Ultrasonography found 12 intestinal polyps included 1 case in small bowel,2 cases in ileocecal junction,4 cases in colon and 5 cases in colon sigmoideum and rectum.10 case were missed. Intestinal polyps showed irregular morphology and medium nodules with clear boundary. The small cysts were visible inside and the nodules was attached to the bowel wall by fine pedicle. Three foreign bodies were found in those patients and two cases were discovered by ultrasound examination.Conclusion:High frequency ultrasound has high value in the diagnosis of primary enterogenic diseases with bloody stool in children. Different causes shows characteristic ultrasonic features. Ultrasound is safe and simple, which is easily accepted by children and parents. But sonography is highly operator dependent method and correct interpretation of sonographic findings needs adequate experience.Part Ⅱ The role of high frequency ultrasound in the diagnosis of abdominal type Henoch-Schonlein purpuraObjective:To explore the role of high frequency ultrasound in the diagnosis of abdominal type Henoch-Schonlein purpura in children.Materials and methods:45 children admitted to our hospital with the gastrointestinal symptoms were diagnosed to be Henoch-Schonlein purpura by the following clinical and laboratory tests. They all accepted abdominal ultrasonography (US) examination before therapy. Twenty-nine (64.44%) were boys and sixteen(35.56%) were girls with a mean age of 6.89years(range,9months-12 years). US was performed with various scanners, Color Doppler ultrasound was performed with optimized color Doppler parameters. The children must keep quiet during examination, the crying child should oral chloral hydrate to sleep before examination. A supine position was adopted for the examination. Color Doppler ultrasound was performed with optimized color Doppler parameters. On the films. Note was also made of any associated relevant findings. All images and clinic data recorded were saved in PACS system, and ensured that the information was complete and accurate.Result:In all cases, US examinations detected a located and segmental thickening of bowel wall and of variable severity. The thickness of the involved intestinal wall was: 5～8mm(11cases,24.44%),8～10mm(26cases,57.58%), more than 10mm(8cases,17.78%). The intestinal wall infiltrated mostly with internal stratifications、lack of peristalsis. Lesions were multiple (13 cases,28.89%) or focal (32 cases,71.11%),29 cases located in the upper left of the abdomen; 16 cases located in the right lower quadrant. In CDFI images, most of the thickening bowel wall showed abundant color flowing signal. There were also other abnormal findings in the abdomen such as mesenteric lymph nodes、intraperitoneal fluid and change of mesenteric echo. There was no case companied with intussusception. Conclusion:Abdominal type Henoch-Schonlein purpura shows characteristic ultrasonic features and the color Doppler ultrasound is helpful for the early diagnosis and inspecting curative effect. It is safe、simple and easily accepted by children and parents.