eMedicine Specialties > Radiology > Pediatrics

Ileal Atresia: Follow-up

Author: Ricardo Riego de Dios, MD, Staff Physician, Department of Diagnostic Radiology, Naval Hospital Jacksonville, Naval Air Station
Coauthor(s): Ellen M Chung, MD, Chief, Pediatric Radiology Section, Department of Radiologic Pathology, Armed Forces Institute of Pathology
Contributor Information and Disclosures

Updated: Feb 25, 2009

Intervention

Special Concerns

  • Use of barium or of undiluted, hypertonic water-soluble contrast agents in the performance of a diagnostic enema study can cause untoward complications. Barium should be avoided in the newborn for a number of reasons.
    • The main reason is the potential for spilling contrast material into the peritoneal cavity. Bowel adjacent to the atretic bowel is at risk of perforation and can be necrotic. On occasion, initial plain images do not demonstrate the perforation. Barium in the peritoneal cavity is not absorbed. Ensuing inflammatory response can lead to formation of granulomata and adhesions.
    • In addition, barium can become inspissated in the colon, leading to obstruction. Patients at risk are those with Hirschsprung disease, cystic fibrosis, ileus, and blind loops of bowel.
    • Use of undiluted, high-osmolality contrast agents in infants can cause fluid shifts resulting in life-threatening serum electrolyte imbalances.
  • It is important to minimize radiation exposure in children.
    • Important steps to include effective immobilization and limiting field size to the area of interest.
    • Gonadal shielding should be used whenever possible.
    • During fluoroscopic procedures, examination time should be kept to a minimum. Pulsed fluoroscopy further decreases radiation exposure to the patient.
 


More on Ileal Atresia

Overview: Ileal Atresia
Imaging: Ileal Atresia
Follow-up: Ileal Atresia
Multimedia: Ileal Atresia
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Grosfeld JL, Clatworthy HW. The nature of ileal atresia due to intrauterine intussusception. Arch Surg. Jun 1970;100(6):714-7. [Medline].

  2. Hernanz-Schulman M. Imaging of neonatal gastrointestinal obstruction. Radiol Clin North Am. Nov 1999;37(6):1163-86, vi-vii. [Medline].

  3. DeLorimier AA, Fonkalsrud EW, Hays DM. Congenital atresia and stenosis of the jejunum and ileum. Surgery. May 1969;65(5):819-27. [Medline].

  4. Walker WA. Congenital anomalies. In: Walker WA, Hamilton JR, Watkins JB, Durie PR, Walker-Smith JA, eds. Pediatric gastrointestinal disease. 3rd ed. London: BC Decker;. 2000: 556-61.

  5. Okada PJ, Hicks B. Neonatal surgical emergencies. Clin Peditr Emerg Med. 2002;3(1):3-13.

  6. Belknap WM, McEnvoy C. Developmental disorders of gastrointestinal function. In: Principles and Practice of Pediatrics. 1994: 414-23.

  7. Martin LW, Zerella JT. Jejunoileal atresia: a proposed classification. J Pediatr Surg. Jun 1976;11(3):399-403. [Medline].

  8. Seashore JH, Collins FS, Markowitz RI, Seashore MR. Familial apple peel jejunal atresia: surgical, genetic, and radiographic aspects. Pediatrics. Oct 1987;80(4):540-4. [Medline].

  9. Stringer DA, Babyn PS. Congenital and developmental anomalies of the small bowel. In: Stringer DA, Babyn PS. Pediatric Gastrointestinal Imaging. 2nd ed. London: BC Decker;. 2000: 338-42.

  10. Piper HG, Alesbury J, Waterford SD, Zurakowski D, Jaksic T. Intestinal atresias: factors affecting clinical outcomes. J Pediatr Surg. Jul 2008;43(7):1244-8. [Medline].

  11. De Grazia E, Di Pace MR, Caruso AM, Catalano P, Cimador M. Different types of intestinal atresia in identical twins. J Pediatr Surg. Dec 2008;43(12):2301-4. [Medline].

  12. Hirata I, Iwata M, Nagasaka M, Katada K. [X-ray examination of small intestine--conventional enteroclysis and CT enterography]. Nippon Rinsho. Jul 2008;66(7):1259-67. [Medline].

  13. Cohen MD. Choosing contrast media for the evaluation of the gastrointestinal tract of neonates and infants. Radiology. Feb 1987;162(2):447-56. [Medline].

  14. American College of Radiology. Manual on Contrast Media. ACR Practice Guideline. Version 6. 2008. Available at http://www.acr.org/SecondaryMainMenuCategories/quality_safety/contrast_manual.aspx. Accessed February 25, 2009.

  15. Carcopino X, Chaumoitre K, Shojai R, Akkawi R, Panuel M, Boubli L, et al. Foetal magnetic resonance imaging and echogenic bowel. Prenat Diagn. Mar 2007;27(3):272-8. [Medline].

  16. Röttgen R, Ocran K, Lochs H, Hamm B. Cinematographic techniques in the diagnostics of intestinal diseases using MRT enteroclysma. Clin Imaging. Jan-Feb 2009;33(1):25-32. [Medline].

  17. Neal MR, Seibert JJ, Vanderzalm T, Wagner CW. Neonatal ultrasonography to distinguish between meconium ileus and ileal atresia. J Ultrasound Med. Apr 1997;16(4):263-6; quiz 267-8. [Medline].

  18. ACR. American College of Radiology Manual on Contrast Media. 5th ed. Reston, Va: American College of Radiology;. 2004.

  19. Berrocal T, Lamas M, Gutiérrez J, et al. Congenital anomalies of the small intestine, colon, and rectum. Radiographics. Sep-Oct 1999;19(5):1219-36. [Medline].

  20. Buonomo C. Neonatal gastrointestinal emergencies. Radiol Clin North Am. Jul 1997;35(4):845-64. [Medline].

  21. Carty H, Brereton RJ. The distended neonate. Clin Radiol. Jul 1983;34(4):367-80. [Medline].

  22. Engrum SA, Grosfeld JL. Pediatric surgery. In: Townsend CM, Beauchamp DR, Evers MB, Mattox KL, Sabiston DC, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 16th ed. Philadelphia: WB Saunders;. 2001: 1471.

  23. Kimura K, Loening-Baucke V. Bilious vomiting in the newborn: rapid diagnosis of intestinal obstruction. Am Fam Physician. May 1 2000;61(9):2791-8. [Medline].

  24. Kuhns LR, Kanellitsas C. Use of isotonic water-soluble contrast agents for gastrointestinal examinations in infants. Radiology. Jul 1982;144(2):411. [Medline].

  25. Stringer DA. Congenital and developmental anomalies of the small bowel. In: Stringer DA, Babyn PS. Pediatric Gastrointestinal Imaging. London: BC Decker;. 1989: 255-62.

  26. Weitzman JJ, Vanderhoof RS. Jejunal atresia with agenesis of the dorsal mesentery. With "Christmas tree" deformity of the small intestine. Am J Surg. Mar 1966;111(3):443-9. [Medline].

[ CLOSE WINDOW ]

Keywords

ileal atresia, atresia of the ileum, neonatal intestinal obstruction, ileal stenosis, small intestine atresia, small intestine stenosis, atresia of the small intestine, stenosis of the small intestine, jejunal atresia, small bowel atresia, small bowel stenosis, small-bowel atresia, small-bowel stenosis, meconium peritonitis, apple peel atresia, apple-peel atresia, Christmas tree atresia, Christmas-tree atresia

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ricardo Riego de Dios, MD, Staff Physician, Department of Diagnostic Radiology, Naval Hospital Jacksonville, Naval Air Station
Ricardo Riego de Dios, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Phi Beta Kappa, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Ellen M Chung, MD, Chief, Pediatric Radiology Section, Department of Radiologic Pathology, Armed Forces Institute of Pathology
Ellen M Chung, MD is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Medical Association, American Roentgen Ray Society, Radiological Society of North America, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Medical Editor

Lori Lee Barr, MD, FACR, FAIUM, Clinical Associate Professor of Radiology, University of Texas Health Science Center in San Antonio; Clinical Assistant Professor of Radiology, University of Texas Medical Branch at Galveston; Member, Board of Directors, Austin Radiological Association; Consulting Staff, Seton Health Network, Columbia/St David's Healthcare System, Healthsouth Rehabilitation Hospital of Austin, Georgetown Hospital, St Mark's Medical Center, Cedar Park Regional Medical Center
Lori Lee Barr, MD, FACR, FAIUM is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, American Society of Pediatric Neuroradiology, Association of University Radiologists, Radiological Society of North America, Society for Pediatric Radiology, Society of Radiologists in Ultrasound, Southern Medical Association, Texas Radiological Society, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

David A Stringer, BSc, MBBS, FRCR, FRCPC, Professor, National University of Singapore; Head, Diagnostic Imaging, KK Women's and Children's Hospital, Singapore
David A Stringer, BSc, MBBS, FRCR, FRCPC is a member of the following medical societies: British Columbia Medical Association, Canadian Association of Radiologists, European Society of Paediatric Radiology, Ontario Medical Association, Radiological Society of North America, Royal College of Physicians and Surgeons of Canada, Royal College of Radiologists, and Society for Pediatric Radiology
Disclosure: Sirius d'innovation None Board membership

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.