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The value of the small bowel enema in children
Insights
Small bowel enema (SBE) is a valuable diagnostic tool in pediatric patients, especially when conventional barium follow-through studies are inconclusive or fail to visualize the terminal ileum. SBE aids in diagnosing conditions like Crohn
Area of Science:
- Pediatric Radiology
- Gastroenterology
- Diagnostic Imaging
Background:
- Conventional barium follow-through (CBFT) examinations can present diagnostic dilemmas in pediatric patients.
- Inadequate visualization of the terminal ileum is a common limitation of CBFT.
Purpose of the Study:
- To evaluate the diagnostic utility of small bowel enema (SBE) in pediatric patients.
- To determine the role of SBE in cases with diagnostic uncertainty after CBFT.
Main Methods:
- Retrospective review of 31 pediatric small bowel enema (SBE) examinations over four years.
- Analysis of SBE findings in relation to previous conventional barium follow-through (CBFT) studies.
Main Results:
- SBE confirmed Crohn's disease in 8 patients where CBFT was inconclusive or suggested mass lesions, avoiding laparotomy.
- SBE provided clear diagnoses in cases with poor terminal ileum visualization on CBFT.
- In 5 cases, SBE ruled out abnormalities suggested by CBFT.
- SBE was useful in 17 of 18 patients without prior CBFT.
Conclusions:
- Small bowel enema (SBE) is a valuable investigation in pediatric patients.
- SBE is particularly useful when adhesions or small bowel tumors are suspected.
- SBE is indicated when conventional studies fail to adequately demonstrate the terminal ileum or are non-diagnostic.
Abstract:
Thirty-one small bowel enema (SBE) examinations performed in children over a four-year period have been reviewed. Thirteen of the patients had had a recent conventional barium follow-through (CBFT) examination resulting in a diagnostic dilemma. In 4 of these 13, mass lesions had been suspected and the SBE confirmed a diagnosis of Crohn's disease and thus laparotomy was avoided. In four others, where the terminal ileum had been poorly seen on CBFT, the SBE clearly indicated Crohn's disease. In the remaining five, although the CBFT examination had suggested an abnormality, the SBE results were obviously normal. Of the other 18 patients, all without a recent CBFT study, the SBE provided useful information in 17 and was unhelpful in 1 patient. Thus, the small-bowel enema is a valuable investigation in pediatric patients particularly if adhesions or small-bowel tumors are suspected, or when a conventional study fails to demonstrate the terminal ileum adequately or is not diagnostic.