The role of abdominal ultrasound imaging in evaluating the vomiting child

Abstract

Introduction: Children are generally very suitable subjects for ultrasound (US) examinations. US is often the first investigation performed for suspected abdominal or pelvic pathology. It may precede radiographic examination and has many advantages. It is non-invasive, does not use ionizing radiation and can be performed quickly and portably, if necessary. It is generally well tolerated by babies and children. Increasingly in pediatric practice, ultrasound is used for investigating suspected disease of the hollow gastrointestinal (GI) tract. Aim: The aims of this study was to evaluate the sonographic abdominal findings in a vomiting child, to establish indications for sonography and to show the disease patterns that cause vomiting in children, that can be evaluated by ultrasound. Method: A descriptive prospective study was carried out at the Radiology Department of Kenyatta National Hospital and University Of Nairobi for duration of six months. During this study period, all children referred to Kenyatta National Hospital and University Of Nairobi Radiology Department for upper gastrointestinal tract contrast study and/or ultrasound with history of vomiting was recruited in the study. Informed consent was obtained from parents for each child participating in the study and the study scanning protocol was followed. All ultrasound examinations was done by the researcher under supervision of consultant radiologist. Data collection sheets were used to record the personal, clinical data, sonographic findings and diagnosis. The data was eventually analyzed using computer software and the results presented in form of tables, charts and graphs. Results: A total of 56 children under 12 years of age were investigated. 64.3% of the children were male. The most common sonographic finding was intussusception which was found in 32.1% and gastro-esophageal reflux (GER) in 28.6% of the patients. The male to female ratio in intussusception was 1.5:1 while gastro-esophageal reflux male to female ratio was 1.6:1. 1 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 these children with gastro-esophageal reflux presented with complications of recurrent pneumonia and failure to thrive. Gastro-esophageal reflux was more severe in patients with recurrent pneumonia compare to those that presented without complications. Discussion: The result of this study indicates that transabdominal ultrasonography was useful and highly specific in evaluating the vomiting child and can be considered a valuable first choice examination. In some diseases of the gastrointestinal system, such as hypertrophic pyloric stenosis, intussusception sonography has almost entirely substituted contrast studies. Further more ultrasound is the only diagnostic examination which can be repeated several times with high diagnostic accuracy. The technique offers several advantages in that it has low costs, it is simple and non-invasive. Conclusion: Findings in this study confirm that ultrasound is an accurate, reliable, and rapid screening method to evaluate the causes of vomiting in children. Recommendation: It is recommended that such children referred to the x-ray department should have an initial sonographic examination and thereby avoid or limit the use of ionizing radiation.