Role of abdominal ultrasound in evaluation of children with suspected upper gastrointestinal disease.

Abstract

Objectives: To evaluate the sonographic abdominal findings in children with suspected upper gastrointestinal disease, establish indications for sonography and show the gastrointestinal disease patterns that can be evaluated by ultrasound. Design: A descriptive prospective study. Setting: Kenyatta National Hospital and Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi. Subjects: Fifty-six children who presented with vomiting and suspected upper gastrointestinal disease. Age range was from six days to 12 years with mean age of 1 year 5 months. Seventy-seven percent were two years and below. Study duration: Six months. Results: Of the 56 children, six were normal on sonography; 18 (32.1%) had intussusceptions, 16(28.6%) gastroesophageal reflux, seven (12.5%) pyloric stenosis, four appendicitis, three jejuno-ileal atresia and two enteric duplication cysts. All the children with pyloric stenosis were male. The male:female ratio for intussusception and GER was 1.5:1 and 1.6:1 respectively. The most common clinical presentation in children found to have intussusception was palpable abdominal mass, and few of them presented with blood-stained stool. More than 2/3 of the children with gastroesophageal reflux presented with complications of recurrent pneumonia and failure to thrive. The sonographic findings correlated with fluoroscopy for GER except in two children where sonography was found to be more sensitive. The sonographic findings correlated with surgical outcome for pyloric stenosis, intussusceptions, jejuno-ileal atresia and enteric duplication cysts. Conclusion: Transabdominal sonography has a definite role in investigating the child suspected to have upper gastrointestinal disease and should be considered as the initial imaging modality, instead of fluoroscopy, thereby avoiding or limiting the use of ionizing radiation. Findings in this study confirm that ultrasound is an accurate, reliable, and rapid screening method to evaluate the causes of upper gastrointestinal disease in children.