The Application Research Of Sonography In The Diagnosis Of Children Pathogeny Of Hematochezia

ObjectivePediatric hematochezia can occur at any age, bleeding complicatedreasons, in addition to the digestive tract disease itself, may also be localmanifestations of systemic disease. First, systemic diseases caused bybleeding:the blood system diseases:One:such as leukemia, hemophilia,pernicious anemia, idiopathic thrombocytopenic purpura, except the skin,subcutaneous tissue, joints, mucosal bleeding, can also be associated withgastrointestinal and urinary bleeding.Two the infectious diseases: such asneonatal sepsis, intestinal typhoid, paratyphoid, dysentery, enteritis and so on.In addition to digestive tract bleeding, also have systemic symptom.ThreeVitamin deficiency: such as vitamin K dependent coagulation factor deficiencyinduced by neonatal spontaneous hemorrhage, vitamin C deficiency causesscurvy.Four such as food allergy, allergic to milk protein allergy caused byenteritis, blood in the stool, or allergic purpura, in addition to the typical limbshemorrhagic maculopapular rash and paroxysmal abdominal pain, sometimeswith large or a small amount of blood in the stool.Five Severe metabolicdisorders: such as uremia, due to diarrhea stool caused by urea stimulatesintestinal mucosa. Liver cirrhosis due to coagulation dysfunction caused byblood in the stool, and metabolic acidosis caused by stomach bleeding.Six drug:application of analgesics often cause gastrointestinal bleeding, with the mostcommon aspirin, indomethacin, naproxen, followed by.Second gastrointestinalbleeding caused by local lesions: One esophageal diseases: such as portalhypertension caused by esophageal varices, esophagitis, esophagealdiverticulum, hiatal hernia and Mallory-Weiss syndrome.Twogastric.duodenal,biliary,tract diseases: such as primary gastric, duodenal ulcer, various causes of stress ulcer, gastric cancer, acute gastritis, gastric mucosaprolapse and biliary tract bleeding.Three Small intestinal diseases:intussusception, intestinal duplication, Meckel’s diverticulum, hemangioma,intestinal polyps, Crohn’s disease, acute hemorrhagic necrotizing enteritis,intestinal tumor and strangulated intestinal obstruction.Four the colon, rectum,anus diseases: ulcerative colitis, familial polyposis, rectum polyp, hemangioma,hemorrhoids, anal fissure and prolapse of the anus. According to the pediatrichematochezia color can be divided into the tarry stool, dark red, bright red bloodstool, stool and so on the jam sample, and the length of stay in the intestinalcavity. As for small intestinal bleeding, according to the quantity and the speedof hemorrhage, with tarry or brown. The terminal ileum and right colonhemorrhage, multiple dark red. Bleeding rectum or anus is bright red, not mixedwith the stool.The clinical symptoms of the disease caused by the variation ofhematochezia, especially for the atypical clinical symptoms in children, so theoperation of fully confirmed case is not much, need the help of auxiliaryexamination and make a diagnosis and differential diagnosis. Ultrasoundexamination is an important auxiliary examination method, simple, practical,safe, noninvasive, high detection rate and no radiation, has high value fordiagnosis of diseases in children with hematochezia. In recent years, along withthe resolution of ultrasonic image enhancement, ultrasound in the diagnosis ofpediatric hematochezia disease plays a role that can not be ignored, worthpursuing and widely used.Materials and MethodsOne clinical data83patients in our hospital from2010August to2012October weredifferent degrees of hematochezia in children, male51cases, female32cases,age2~12years old, the average age of2years and6months, among them43cases had abdominal distension, abdominal pain, vomiting, bloody stools, fever;12patients had abdominal pain, vomiting, bloody stool, abdominal mass;5cases of children with abdominal pain, and pain around the navel, fever, haveblack and even blood, and repeated attacks, positive fecal occult blood test;23cases of painless chronic blood in the stool.Equipment and MethodOne: The instrument adopts Philips HDI5000and Philips iU22color ultrasound, conventional high frequency probe, frequency is5~12MHZ, formore children with obesity and abdominal gas with routine examination is notsatisfied, in combination with the convex array probe, the frequency of1~5MHZ.Two: Examination of fasting, water deprivation for6to8hours (clinicallysuspected intussusception can be excluded). Crying is not partners of oralexamination10%chloral hydrate0.5ml/Kg, and other children sleep after acheck. Because of feces in the colon may be given interference, andultrasonography of glycerine enema repeatedly after defecation. Obese childrenor sigmoid colon and rectal examination image are not satisfied, the enemamethod transanal saline.Three: Children with conventional supine position, according to clockwise,counterclockwise two directions, from the pyloric downward, duodenum,jejunum, ileum in exploration, colon and rectum, multiple sections, muchazimuth slow sequentially scanning, segmental bowel repeated exploration, andat the same time the pressure probe, scan of the distal rectum, children shouldtake the left lateral decubitus position check.Four: When the lesion or suspicious lesions, enlarged image, carefullyobserve the lesion location, size, shape, structure, internal echo, the lesionswere CDFI and PW blood flow display, and store image.ResultsOne:83cases of children with hematochezia,a total of24cases of childrenwith Meckel’s diverticulum, a total of22cases of children with colonic polyps,a total of12cases of children with intussusception, a total of4cases of childrenwith intestinal duplication, a total of4cases of children with Necrotizingenterocolitis, a total of5cases of children with Henoch-Schonlein purpura,another12cases of children with hematochezia clinically, although there arevarying degrees of blood in the stool, but the results of ultrasonography werenegative. In these12cases,2cases of children with leukemia,3cases ofchildren with idiopathic thrombocytopenic purpura in children, therefore,clinical consider these5cases may be caused by the blood system diseases ofthe blood in the stool.4cases had to milk protein allergy history, so considerthese4cases clinical may lead to milk protein allergy caused by enteritis stool.The other3cases clinical history of IBD, so consider these3cases may be caused by enteritis stool.Two:24cases of ultrasound diagnosis of Meckel’s diverticulum in children,after confirmed by operation and pathology ultrasound findings of3cases ofmisdiagnosis, missed diagnosis in1cases, the diagnostic accuracy rate ofultrasound was83.3%.21cases of Meckel’s diverticulum in children,ultrasonography showed intraperitoneal probe and an abnormal morphology ofintestinal loop, uneven wall thickness, no obvious creep, the abnormal shape ofend intestinal loop is connected with the tube, one end is a blind end,pathological results show diverticulum see ectopic gastric mucosa or pancreatictissue or diverticulum lined with small intestinal mucosa vascular dilatation,hyperemia of intestinal wall. In the21cases of Meckel’s diverticulum inchildren, Operation and pathology in2cases of diverticulitis and infection,Ultrasonographic lesions displayed in the intestinal tract showed irregular liquiddark area, the inner acoustic difference,peripheral mesenteric echo enhancement,pathological bowel shape is circular cone, still can have pouch, nipple, lobulatedshapes. In2cases with intestinal diverticulum junction ulcer with perforation,sonographic lesions showed irregular anechoic, intestinal clearance, around theabdomen and pelvis showed a small amount of irregular liquid dark area.1casesof diverticular bleeding from the walls, chronic ulcer formation,ultrasonographic without obvious specific disease like.1cases of children sMeckel diverticulum three small bowel intussusception.1patients with intestinalobstruction,in the dilated bowel loops at the junction with the shrinking visiblecystic anechoic.Three: Ultrasound diagnosis of polyps in22cases were(by colonoscopyconfirmed), Including21patients with single polyps in children,2polyps in1cases, a total of23polyps. In this23polyps,5polyps diameter <1cm,15polypsdiameter>1cm and <3cm,3polyps larger than3cm in diameter. Compared withcolonoscopy, ultrasound missed diagnosis of2cases, a total of2polyps,2polyps diameter was <1cm. The ultrasound for polyp detection rate was92%(23/25), the diameter≤1cm polyp detection rate was71%(5/7), the diameter of>1cm and <3cm (15/15) and larger than3cm in diameter (3/3) detection rate was100%.Four: Ultrasound diagnosis of intussusception after X-ray air enema orconfirmed by operation and pathology of12cases of intussusception in children, Among the8cases of patients with intussusception were located in the rightupper abdominal mass,3cases of intussusception masses were located in the leftupper quadrant of the abdomen,1cases of intussusception from left to rightlower quadrant abdominal mass. Among them, the Hui junction in6cases, backto the junction of6cases.1cases of operation and pathological findings ofintussusception, intestinal infarction,2cases of intussusception complicated byintestinal necrosis, intussusception and2cases of acute appendicitis,Intussusception and1cases of Meckel’s diverticulum. ultrasonography showed"target sign"," false renal syndrome" or " sleeve " syndrome, had the accuracyreported ultrasound diagnosis of intussusception was100%, consistent with ourresults.Five:4cases of preoperative ultrasonography were diagnosed as intestinalduplication in children, by operation and pathological results in1cases ofmisdiagnosis, in this case the children preoperative ultrasound diagnosis ofcystic intestinal duplication, postoperative pathological findings of mesentericcyst.3cases were accurately diagnosed, among them2cases lesions werelocated in the ileum（1cases of children with intussusception）. The accurate rateof the ultrasonic diagnosis was75%(3/4).Six:4cases of ultrasound with necrotizing enterocolitis was abdominalintestinal flatulence obviously;3cases of children with intestinal clearanceshows a small amount of liquid dark area;2cases showed local bowel wall andgas exploration of the strong echo;2cases showed the intestinal wall thickeningand uneven, with small bowel wall thickening, intestinal wall thickness of>3mm;1cases of children with partial bowel wall thinner, weak and peristalsis,Color Doppler showed in the intestinal wall of less blood flow, the patients inthe diagnosis of neonatal necrotizing enterocolitis and intestinal necrosis ofintestinal perforation of colon, pathological results of necrotizing enterocolitiswith perforation, local intestinal necrosis.2patients with clinical diagnosis ofnecrotizing enteritis, give no diet, anti infection and bleeding after conservativetreatment of children with the disease recovery. Another1cases of ultrasounddiagnosis of necrotizing enterocolitis, but the clinical indications and otherexaminations are not supported in necrotizing enterocolitis. The ultrasound indiagnosis of necrotizing enterocolitis in the rate of75%(3/4).Seven:5cases with a history of allergic purpura in children, the clinical symptoms were abdominal pain, vomiting and different levels of blood stool,ultrasonography showed children bowel wall thickening, the thickness of about1.0cm, intestinal peristalsis is normal,ultrasonography for abdominal typepurpura, clinical consider the5cases caused by allergic purpura hematochezia.ConclusionIN the Clinical many diseases could caused children hematochezia,diagnosis and differential diagnosis of difficult in the clinical.The lack ofsimple and effective image examination method before ultrasound application,the traditional check method mainly depends on X-ray and endoscopicexamination method. This topic through ultrasound study on83cases ofchildren with hematochezia, results show that ultrasound in meckel’sdiverticulum, colonic polyps, intussusception, intestinal duplication, necrotizingenterocolitis, allergic purpura diseases of caused by blood in the stool hasimportant diagnostic value, this has important significance for guiding clinical.But the ultrasonic of systemic disease(Such as blood system diseases、infectiousdiseases、vitamin deficiency、allergies、severe metabolic disorders、drugs) andsome of the local lesion of gastrointestinal tract(esophageal disorders、gastroduodenal diseases、 biliary tract diseases) Cause of bloody pathogeny lackof specificity, clinical needs by means of laboratory examination and endoscopicexamination methods make a diagnosis.