The Value Of Ultrasound In The Diagnosis Of Neonatal Acute Abdomen

ObjectiveTo study the sonographic features of diseases associated with neonatal acute abdomen and to explore the value of ultrasound in the diagnosis and differential diagnosis of this disease.Materials and Methods1.Clinical dataA total of 127 children from the Children's Hospital of Jinan City from December 2016 to February 2018 were recruited and they were suspected of neonatal acute abdomen by ultrasound and were treated surgically.Among them,there were 87 males and 40 females,aged 1 hour to February 14 days;there were 38 premature infants and 89 full term infants.Abdominal distension in 54 cases,accounting for 42.5%,vomiting in 59 cases,accounting for 46.4%,hematochezia in 25 cases,accounting for 19.7%,defecation difficulties and non-defecation in 40 cases,accounting for 31.5%;abdominal bulging in 77 cases,accounting for 60.6%,abdominal vein exposure in 18 cases,accounting for 14.2%,abdominal muscle tension in 20 cases,accounting for 15.7%,no normal anus in 32 cases,accounting for 25.2%.2.Equipment and Inspection methodsUltrasound instrument is Philips iU22,using high-frequency probe L12-5,frequency 8 ~ 12 MHz.Extensively expose the abdomen and try to check the child under quiet conditions.When examining the stomach and duodenum,we told the mother to feed the baby with fullness,and then to take the left lateral position.Ultrasound was examined along the cardia,the corpus,the pylorus,and the duodenum.During the examination,we observed the filling of the stomach cavity,whether there was abnormal pyloric duct opening and closing,signs of retrograde motility,and whether the duodenum had effusion or not.When inspecting the small intestine and colon,the children do not need to fill the stomach.They take a supine position and the ultrasound scans the jejunum,ileum and colon successively.During the examination,we observed whether the intestine had effusion,bowel movements,intestinal wall structure,blood flow,and whether there were masses in the bowel and intestinal effusions.We focused on scanning the right lower abdomen to detect the appendix.Finally,the children may have bladder lithotomy.We scan the perineum to detect the development of the anal canal.ResultsUltrasonography diagnosed 127 cases of neonatal acute abdomen,including 37 cases of NEC,12 cases of neonatal appendicitis,19 cases of intestinal malrotation,26 cases of intestinal atresia,32 cases of anal atresia,1 case of umbilical bulging.119 cases were confirmed by surgery and 8 cases were misdiagnosed.The diagnostic rate of ultrasound was 93.7%(119/127).1.NECUltrasonography diagnosed NEC in 37 cases,36 cases were confirmed by surgery,1 case was misdiagnosed,and 1 case misdiagnosed was proved to be congenital gastric muscular defect and gastric perforation.The diagnostic rate of ultrasound was 97.3%(36/37).Of the 36 children who were confirmed by surgery to be NEC,18 cases had intestinal perforation and 9 cases had neonatal appendicitis.2.Neonatal appendicitisUltrasonography diagnosed neonatal appendicitis in 12 cases.10 cases were confirmed by surgery,including 1 case of acute simple appendicitis,1 case of acute suppurative appendicitis,3 cases of acute gangrenous appendicitis,5 cases of acute perforated appendicitis.2 cases were misdiagnosed and 2 cases misdiagnosed were confirmed as NEC and intestinal perforation.The diagnostic rate of ultrasound was 83.3%(10/12).Among them,4 cases were associated with NEC.3.Intestinal malrotationUltrasonography diagnosed intestinal malrotation in 19 cases.18 cases were confirmed by surgery,including 1 case of 270 degrees of twist,13 cases of 360 degrees of twist,1 case of 450 degrees of twist,2 cases of 540 degrees of twist,1 case of 720 degrees of twist.1 case was misdiagnosed and confirmed by surgery for ileal atresia and intussusception.The diagnostic rate of ultrasound was 94.7%(18/19).Among them,1 case was complicated with congenital gastric muscular defect and gastric perforation.4.Intestinal atresiaUltrasonography diagnosed intestinal atresia in 26 cases.22 cases were confirmed by surgery,including duodenal atresia in 1 case,colon atresia(descending colon)in 1 case,small intestine atresia in 20 cases.Among 20 cases of intestinal atresia,4 were type I,1 was type II,9 were type III,and 6 were type IV.In 9 cases of type III,there were 6 cases of type IIIa and 3 cases of type IIIb.Four cases were misdiagnosed.Misdiagnosed cases were confirmed by surgery as two cases of MP,one case of annular pancreas,and one case of colon-shaped megacolon.The diagnostic rate of ultrasound was 84.6%(22/26).Of the 22 cases confirmed by surgery,1 was associated with intestinal perforation,2 were associated with MP,and 2 were associated with intestinal malrotation.5.Congenital anal atresiaUltrasonography diagnosed congenital anal atresia in 32 cases,and 32 cases were confirmed by surgery.The diagnostic rate of ultrasound was 100%(32/32).6.Umbilical bulgingUltrasonography diagnosed one case of umbilical bulging,and one case was confirmed by surgery.The ultrasound diagnosis rate was 100%(1/1).ConclusionsUltrasonography is a real-time and dynamic process.The combination of two-dimensional ultrasound and color Doppler ultrasound can not only directly observe the situation of neonatal abdominal organs,but also can track the primary lesions that cause obstruction and perforation.It is extremely valuable for the diagnosis and differential diagnosis of neonatal acute abdomen and can be used as the preferred imaging examination method.