Fluoroscopic and CT enteroclysis in children: initial experience, technical feasibility, and utility
Shanaree Brown1, Kimberly E Applegate, Kumar Sandrasegaran
1Indiana University School of Medicine, Indianapolis, IN, USA.
Insights
Fluoroscopic enteroclysis (FE) and CT enteroclysis (CTE) are safe and effective for diagnosing pediatric small bowel issues, especially Crohn disease. These imaging techniques aid in identifying partial small bowel obstruction and other pathologies in children.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Imaging
Background:
- Partial small-bowel obstruction is challenging to diagnose clinically and may be missed on routine CT scans.
- Accurate imaging is crucial for timely diagnosis and management of pediatric gastrointestinal conditions.
Purpose of the Study:
- To assess the feasibility, safety, and techniques of fluoroscopic enteroclysis (FE) and CT enteroclysis (CTE) in children.
- To review the indications and diagnostic findings of FE and CTE in pediatric patients.
Main Methods:
- Retrospective review of 112 FE and 74 CTE studies in children under 18 (2002-2007).
- Correlation of enteroclysis results with other imaging, surgical, and pathological findings.
- Analysis of patient demographics, indications, and outcomes.
Main Results:
- FE and CTE were most commonly used for Crohn disease and abdominal pain evaluation.
- No complications were reported; studies were well-tolerated.
- Common diagnoses included Crohn disease (34% FE, 28% CTE) and partial small bowel obstruction (3% FE, 10% CTE).
- CTE identified more extrinsically located abnormalities (19%) compared to FE (2%).
- Additional bowel abnormalities were noted in 11 FE and 25 CTE studies for inflammatory bowel disease patients.
Conclusions:
- Fluoroscopic enteroclysis and CT enteroclysis are safe, feasible, and accurate for diagnosing pediatric small bowel pathology.
- These imaging modalities are particularly valuable for children with small bowel Crohn disease.
- FE and CTE provide crucial diagnostic information for pediatric gastrointestinal conditions.
Background:
Partial small-bowel obstruction can be difficult to diagnose on clinical examination. These obstructions might not be detected on routine abdominal/pelvic CT.
Objective:
To evaluate the feasibility, safety, and techniques of fluoroscopic enteroclysis (FE) and CT enteroclysis (CTE), and to review their indications and findings in children.
Materials And Methods:
We retrospectively reviewed all enteroclysis studies in children younger than 18 years performed between January 2002 and March 2007. We correlated the results with other abdominal imaging and surgical and pathological findings.
Results:
The review revealed 112 FE and 74 CTE studies performed in 175 children (mean age 14 years, range 3-18 years). FE and CTE studies were performed most commonly for evaluation of known Crohn disease (FE 38%, CTE 29%) and abdominal pain (FE 26%, CTE 26%). One FE study was terminated because of patient anxiety, and one CTE study was terminated because of patient discomfort. No complications of FE or CTE were reported. The findings were normal in 54% of the FE studies and 46% of the CTE studies. The most common small bowel diagnoses were Crohn disease (FE 34%, CTE 28%) and partial small bowel obstruction (FE 3%, CTE 10%). Two FE studies (2%) and 14 CTE studies (19%) showed abnormalities outside the small bowel. In 54 patients with inflammatory bowel disease, 11 FE studies and 25 CTE studies showed additional bowel abnormalities. Overall, 14 and 21 patients had surgery as a result of the findings of FE and CTE, respectively.
Conclusion:
FE and CTE are safe, feasible, and accurate in depicting small-bowel pathology in children. These techniques can be particularly useful in children with Crohn disease involving the small bowel.
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