대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제81권4호
  • /
  • Pages.770-793
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  • 2020
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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신생아 위장관 응급 질환: 알아야 할 영상의학적 소견

Gastrointestinal Emergencies in Neonates: What We Should Know

  • 조현혜 (이화여자대학교 의과대학 이대목동병원 영상의학과) ;
  • 이소미 (경북대학교 의과대학 경북대학교병원 영상의학과) ;
  • 유선경 (충남대학교 의과대학 충남대학교병원 영상의학과)
  • Hyun-Hae Cho (Department of Radiology, Ewha Womans University Mokdong Hospital) ;
  • So Mi Lee (Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital) ;
  • Sun Kyoung You (Department of Radiology, Chungnam National University School of Medicine, Chungnam National University Hospital)
  • 투고 : 2020.03.31
  • 심사 : 2020.05.23
  • 발행 : 2020.07.01
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⟨ 이전 논문 다음 논문 ⟩

초록

신생아 위장관 응급 질환은 소화관을 따라 어디에서나 발생하는 다양한 장애를 포함한다. 이러한 질환들의 경우 대부분 후천성 질환이 아닌 선천성 기형에 의한 것이나 산전 검사에서 확인되지 않은 경우도 많아 이에 대한 산후 평가가 필요하게 된다. 이 시기의 신생아의 경우 성인과 달리 전산화단층촬영(computed tomography; 이하 CT)과 자기공명영상(magnetic resonance imaging; 이하 MRI)이 제한적인 경우가 많아 초기 복부 방사선 촬영에서의 진단이 중요하게 되어 복부 방사선 촬영에서 보일 수 있는 소견들에 대해 숙지하는 것이 필요하다. 또한 추가적으로 진단에 사용될 수 있는 복부 초음파, 투시 검사의 소견, 적응증에 대해 이해하는 것이 진단과 이에 따른 적절한 처치를 위해 중요하다. 이에 이 논문에서는 신생아 위장관 응급 질환에서 나타날 수 있는 다양한 영상 소견에 대해 기술하고 정리하였다.

Newborn gastrointestinal tract emergency diseases include various disorders that occur anywhere along the digestive tract. Most of them are congenital malformations, not acquired diseases. Many of them cannot be confirmed on prenatal examination, and consequently, postnatal evaluation is required. Unlike adults, in newborn babies, detailed evaluations with computed tomography (CT) and magnetic resonance imaging (MRI) are often limited, so making the diagnosis based on early abdominal radiography is most important. Therefore, it is necessary to be familiar with the radiologic findings that may be seen on imaging studies. In addition, it is important to understand abdominal ultrasound and fluoroscopy findings, which can be used in addition to simple radiography and indications that can be used for further diagnosis and appropriate treatment. Therefore, this study describes and organizes the various imaging findings that may occur in neonatal gastrointestinal emergencies.

키워드

참고문헌

  1. Vinocur DN, Lee EY, Eisenberg RL. Neonatal intestinal obstruction. AJR Am J Roentgenol 2012;198:W1-W10
  2. Hernanz-Schulman M. Imaging of neonatal gastrointestinal obstruction. Radiol Clin North Am 1999;37:1163-1186, vi-vii
  3. McAlister WH, Kronemer KA. Emergency gastrointestinal radiology of the newborn. Radiol Clin North Am 1996;34:819-844
  4. Rao P. Neonatal gastrointestinal imaging. Eur J Radiol 2006;60:171-186
  5. Cumming WA, Williams JL. Neonatal gastrointestinal imaging. Clin Perinatol 1996;23:387-407
  6. Stanescu AL, Liszewski MC, Lee EY, Phillips GS. Neonatal gastrointestinal emergencies: step-by-step approach. Radiol Clin North Am 2017;55:717-739
  7. Anupindi SA, Halverson M, Khwaja A, Jeckovic M, Wang X, Bellah RD. Common and uncommon applications of bowel ultrasound with pathologic correlation in children. AJR Am J Roentgenol 2014;202:946-959
  8. Hiorns MP. Gastrointestinal tract imaging in children: current techniques. Pediatr Radiol 2011;41:42-54
  9. Solomon BD. The etiology of VACTERL association: current knowledge and hypotheses. Am J Med Genet C Semin Med Genet 2018;178:440-446
  10. Van de Putte R, Van Rooij IALM, Marcelis CLM, Guo M, Brunner HG, Addor MC, et al. Spectrum of congenital anomalies among VACTERL cases: a EUROCAT population-based study. Pediatr Res 2020;87:541-549
  11. Wu Y, Wu C. Congenital esophageal atresia associated with a tracheobronchial remnant. Korean J Thorac Cardiovasc Surg 2019;52:170-173
  12. Yoo HJ, Kim WS, Cheon JE, Yoo SY, Park KW, Jung SE, et al. Congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula: clinical and radiologic features. Pediatr Radiol 2010;40:1353-1359
  13. Newman B, Bender TM. Esophageal atresia/tracheoesophageal fistula and associated congenital esophageal stenosis. Pediatr Radiol 1997;27:530-534
  14. Strouse PJ. Disorders of intestinal rotation and fixation ("malrotation"). Pediatr Radiol 2004;34:837-851
  15. Maxfield CM, Bartz BH, Shaffer JL. A pattern-based approach to bowel obstruction in the newborn. Pediatr Radiol 2013;43:318-329
  16. Weinberger E, Winters WD, Liddell RM, Rosenbaum DM, Krauter D. Sonographic diagnosis of intestinal malrotation in infants: importance of the relative positions of the superior mesenteric vein and artery. AJR Am J Roentgenol 1992;159:825-828
  17. Karmazyn B. Duodenum between the aorta and the SMA does not exclude malrotation. Pediatr Radiol 2013;43:121-122
  18. Hameed S, Caro-Dominguez P, Daneman A, Zani-Ruttenstock E, Zani A, Navarro OM. The role of sonography in differentiating congenital intrinsic duodenal anomalies from midgut malrotation: emphasizing the new signs of duodenal and gastric wall thickening and hyperechogenicity. Pediatr Radiol 2020;50:673-683
  19. Pracros JP, Sann L, Genin G, Tran-Minh VA, Morin de Finfe CH, Foray P, et al. Ultrasound diagnosis of midgut volvulus: the "whirlpool" sign. Pediatr Radiol 1992;22:18-20
  20. Cooper J, So H, Cohen HL. Ultrasound diagnosis of midgut volvulus. J Ultrasound Med 1992;11:178
  21. Chao HC, Kong MS, Chen JY, Lin SJ, Lin JN. Sonographic features related to volvulus in neonatal intestinal malrotation. J Ultrasound Med 2000;19:371-376
  22. Sizemore AW, Rabbani KZ, Ladd A, Applegate KE. Diagnostic performance of the upper gastrointestinal series in the evaluation of children with clinically suspected malrotation. Pediatr Radiol 2008;38:518-528
  23. Applegate KE, Anderson JM, Klatte EC. Intestinal malrotation in children: a problem-solving approach to the upper gastrointestinal series. Radiographics 2006;26:1485-1500
  24. Choi KS, Choi YH, Cheon JE, Kim WS, Kim IO. Intestinal malrotation in patients with situs anomaly: implication of the relative positions of the superior mesenteric artery and vein. Eur J Radiol 2016;85:1695-1700
  25. Long FR, Kramer SS, Markowitz RI, Taylor GE, Liacouras CA. Intestinal malrotation in children: tutorial on radiographic diagnosis in difficult cases. Radiology 1996;198:775-780
  26. Newman B, Koppolu R, Murphy D, Sylvester K. Heterotaxy syndromes and abnormal bowel rotation. Pediatr Radiol 2014;44:542-551
  27. Yoon CH, Goo HW, Kim EA, Kim KS, Pi SY. Sonographic windsock sign of a duodenal web. Pediatr Radiol 2001;31:856-857
  28. Dalla Vecchia LK, Grosfeld JL, West KW, Rescorla FJ, Scherer LR, Engum SA. Intestinal atresia and stenosis: a 25-year experience with 277 cases. Arch Surg 1998;133:490-496; discussion 496-497
  29. Govaert P, Van Hecke R, Vanhaesebrouck P, Verpaele A, Derom F, Defoort P. Meconiumperitonitis: diagnose, etiologie en behandeling. Tijdschr Kindergeneeskd 1991;59:98-105
  30. Salman AB, Karaog˘lanog˘lu N, Suma S. Abdominal, scrotal, and thoracic calcifications owing to healed meconium peritonitis. J Pediatr Surg 1999;34:1415-1416
  31. Chan KW, Lee KH, Wong HY, Tsui SY, Wong YS, Pang KY, et al. Cystic meconium peritonitis with jejunoileal atresia: is it associated with unfavorable outcome? World J Clin Pediatr 2017;6:40-44
  32. Lee GS, Chandran S, Rajadurai VS. Calcified meconium pseudocyst: X-ray diagnosis of meconium peritonitis at birth. BMJ Case Rep 2015;2015:bcr2015211052
  33. Puri B. Meconium peritonitis presenting as a pseudocyst. Med J Armed Forces India 1996;52:207
  34. Wu CC. Sonographic findings of generalized meconium peritonitis presenting as neonatal ascites. J Clin Ultrasound 1988;16:48-51
  35. Cho HH, Cheon JE, Choi YH, Lee SM, Kim WS, Kim IO, et al. Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: factors that affect treatment success. Eur J Radiol 2015;84:2024-2031
  36. Nakaoka T, Nishimoto S, Tsukazaki Y, Santo K, Higashio A, Kamiyama M, et al. Ultrasound-guided hydrostatic enema for meconium obstruction in extremely low birth weight infants: a preliminary report. Pediatr Surg Int 2017;33:1019-1022
  37. Siddiqui MM, Drewett M, Burge DM. Meconium obstruction of prematurity. Arch Dis Child Fetal Neonatal Ed 2012;97:F147-150
  38. Sathe M, Houwen R. Is meconium ileus associated with worse outcomes in cystic fibrosis? J Cyst Fibros 2019;18:746
  39. Wood KE. Meconium ileus in a neonate with cystic fibrosis. N Engl J Med 2018;378:1142
  40. Alamo L, Meyrat BJ, Meuwly JY, Meuli RA, Gudinchet F. Anorectal malformations: finding the pathway out of the labyrinth. Radiographics 2013;33:491-512
  41. AbouZeid AA, Mohammad SA, Seada M, Khiamy K, Gamal R. Currarino triad: importance of preoperative magnetic resonance imaging. European J Pediatr Surg Rep 2019;7:e86-e89
  42. Lee SC, Chun YS, Jung SE, Park KW, Kim WK. Currarino triad: anorectal malformation, sacral bony abnormality, and presacral mass--a review of 11 cases. J Pediatr Surg 1997;32:58-61
  43. Niedzielski JK. Invertography versus ultrasonography and distal colostography for the determination of bowel-skin distance in children with anorectal malformations. Eur J Pediatr Surg 2005;15:262-267
  44. Han TI, Kim IO, Kim WS. Imperforate anus: US determination of the type with infracoccygeal approach. Radiology 2003;228:226-229
  45. Thomeer MG, Devos A, Lequin M, De Graaf N, Meeussen CJ, Meradji M, et al. High resolution MRI for preoperative work-up of neonates with an anorectal malformation: a direct comparison with distal pressure colostography/fistulography. Eur Radiol 2015;25:3472-3479
  46. Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med 2011;364:255-264
  47. Epelman M, Daneman A, Navarro OM, Morag I, Moore AM, Kim JH, et al. Necrotizing enterocolitis: review of state-of-the-art imaging findings with pathologic correlation. Radiographics 2007;27:285-305
  48. Wexler HA. The persistent loop sign in neonatal necrotizing enterocolitis: a new indication for surgical intervention? Radiology 1978;126:201-204
  49. Coursey CA, Hollingsworth CL, Wriston C, Beam C, Rice H, Bisset G 3rd. Radiographic predictors of disease severity in neonates and infants with necrotizing enterocolitis. AJR Am J Roentgenol 2009;193:1408-1413
  50. Silva CT, Daneman A, Navarro OM, Moore AM, Moineddin R, Gerstle JT, et al. Correlation of sonographic findings and outcome in necrotizing enterocolitis. Pediatr Radiol 2007;37:274-282
  51. Gale HI, Gee MS, Westra SJ, Nimkin K. Abdominal ultrasonography of the pediatric gastrointestinal tract. World J Radiol 2016;8:656-667