Traubici Benjamin, Daneman Alan, Doganay Selim, Rutten Caroline, Dekirmendjian Adriana, Zani Augusto, Faingold Ricardo
University of Toronto, Toronto, Canada.
Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada.
Pediatr Radiol. 2025 Jun;55(7):1437-1447. doi: 10.1007/s00247-025-06271-w. Epub 2025 May 29.
There is a paucity of information in the literature regarding preoperative sonography recognition of a defect in the intestinal wall due to perforation in neonates, infants, and young children.
To illustrate a group of neonates, infants, and young children, with a variety of causes of intestinal perforation, in whom the defect in the intestinal wall was correctly recognized preoperatively on sonography. Our aim is to increase the awareness of this imaging finding in this age group.
Retrospective analysis of clinical, imaging, surgical, and histologic findings in seven young children with intestinal perforation in whom the defect in the intestinal wall was recognized preoperatively on sonography and confirmed at surgery and histology.
The seven patients included five males and two females. Six were premature (22-28 weeks) and one was full term (38 weeks). All seven presented with clinical findings of an acute intestinal episode between 1 day and 15 months of age. Abdominal radiographs showed a distended abdomen with a relative paucity of bowel gas in four, and in the other three, there were multiple loops of dilated gas-filled intestine. Pneumoperitoneum was present in two. Sonography confirmed the presence of a large amount of echogenic ascites in all seven. The intestinal wall appeared variably thickened or thinned, with increased echogenicity in all. The defect of the intestinal wall, due to perforation, was located on sonography in all seven and showed communication between the intestinal intraluminal fluid content and the echogenic ascites in all seven. Tiny echogenic bubbles of gas were noted passing from the intraluminal space into the peritoneal cavity in two. Pneumoperitoneum was also noted on sonography in four. At surgery, the defect in the intestinal wall was located in the small intestine in four and in the large intestine in three.
This study illustrates seven young children in whom an intestinal defect, due to perforation, was correctly recognized on sonography preoperatively. Sonography proved more useful than the abdominal radiographs in documenting the presence of perforation. Pediatric radiologists should make the effort to search throughout the entire abdomen and pelvis for the presence of an intestinal wall defect due to perforation on sonography in neonates, infants, and young children with an acute abdominal episode, especially in the absence of pneumoperitoneum on plain radiographs and sonography. Its recognition preoperatively will facilitate a rapid diagnosis and will direct appropriate management.
关于新生儿、婴儿和幼儿因肠穿孔导致肠壁缺损的术前超声识别，文献中的信息较少。
举例说明一组因各种原因导致肠穿孔的新生儿、婴儿和幼儿，他们在术前超声检查中肠壁缺损被正确识别。我们的目的是提高对该年龄组这一影像学表现的认识。
对7例肠穿孔幼儿的临床、影像、手术和组织学检查结果进行回顾性分析，这些患儿术前超声检查发现肠壁缺损，手术和组织学检查证实。
7例患者中，5例为男性，2例为女性。6例为早产儿（22 - 28周），1例为足月儿（38周）。所有7例患者在1天至15个月龄之间均出现急性肠道疾病的临床表现。腹部X线片显示4例腹部膨隆，肠气相对较少，另外3例有多个扩张的充气肠袢。2例有气腹。超声检查证实所有7例均有大量高回声腹水。肠壁厚度不一，或增厚或变薄，回声均增强。所有7例超声检查均发现因穿孔导致的肠壁缺损，且均显示肠腔内液体与高回声腹水相通。2例可见微小的气体高回声气泡从肠腔内进入腹腔。4例超声检查也发现有气腹。手术时，4例肠壁缺损位于小肠，3例位于大肠。
本研究举例说明了7例幼儿，其因穿孔导致的肠壁缺损在术前超声检查中被正确识别。超声检查在记录穿孔存在方面比腹部X线片更有用。儿科放射科医生应努力在整个腹部和盆腔寻找因肠穿孔导致的肠壁缺损，对于患有急性腹部疾病的新生儿、婴儿和幼儿，尤其是在平片和超声检查均未发现气腹的情况下。术前识别有助于快速诊断并指导适当的治疗。
