Congenital segmental dilatation of the colon in a newborn: a radiologic perspective of an unusual entity.

A newborn with congenital segmental dilatation of the intestine affecting the colon is presented. This rare condition, unrelated to Hirschsprung's disease, may affect any portion of the bowel and is characterized by focal dilatation of a segment of bowel flanked by normal proximal and distal bowel. While reported in the surgical literature, congenital segmental dilatation of the intestine has not been reported in the pediatric radiology literature even though pediatric radiologists may be the first to encounter imaging suggesting the diagnosis. We therefore present the characteristic imaging findings, including abdominal radiographs and images from a contrast enema, and discuss the clinical presentation, pathology findings, associations, treatment, and prognosis of congenital segmental dilatation of the intestine to increase awareness of this unusual diagnosis.

Bladder prolapse through a patent urachus presenting as an umbilical mass in the newborn: characteristic prenatal sonographic findings and the diagnostic benefit of postnatal cystography.

Bladder prolapse through a patent urachus is rare. We present a newborn with an unusual exophytic, erythematous umbilical mass. Voiding cystography readily demonstrated continuity of the bladder dome with the umbilical mass, confirming bladder prolapse through a patent urachus. The diagnosis of bladder prolapse was rapidly made in a second newborn with similar imaging and clinical findings and confirmed by cystography. We discuss the embryology of this condition including the association with a vesico-allantoic cyst in utero. Pre- and postnatal images are presented. The use of cystography in diagnosis is emphasized.

Do clinical outcomes suffer during transition to an ultrasound-first paradigm for the evaluation of acute appendicitis in children?

OBJECTIVE: The objective of our study was to examine whether the rate of complicated appendicitis and the hospital length of stay (LOS) increased during the transition to an ultrasound-first paradigm for the imaging evaluation of acute appendicitis. MATERIALS AND METHODS: All pediatric patients with surgically proven appendicitis from 2005 to 2011 were identified by searching the hospital billing database for the discharge diagnosis codes for simple appendicitis (ICD-9 [International Classification of Diseases, 9th revision] code 540.9) and complicated appendicitis (ICD-9 codes 540.0 and 540.1). Annual trends of the proportions of these patients who underwent ultrasound and CT were determined and plotted for the study period. Correlation of complicated appendicitis and median hospital LOS with calendar year was assessed using the Spearman (ρ) rank correlation test. RESULTS. Eight hundred four patients met the inclusion criteria. The percentage of patients who underwent CT only showed a moderate downward association with year (ρ = -0.32, p < 0.01), and the percentage of patients who underwent ultrasound first showed a moderate upward trend (ρ = 0.44, p < 0.01). The percentage of patients with ultrasound as the only study performed before appendectomy increased moderately over the 7-year study period (ρ = 0.33, p < 0.01). The percentage of patients with complicated appendicitis and the median hospital LOS did not increase significantly over the study duration (ρ = -0.01, p = 0.74 and ρ = -0.04, p = 0.25, respectively). CONCLUSION: The transition to an ultrasound-first pathway for the imaging workup of acute appendicitis in children occurred without evidence of a corresponding increase in the proportion of patients with complicated appendicitis or in the median hospital LOS.

Acute gastrointestinal hemorrhage in infancy from gastric duplication: imaging findings.

We report two cases of duplications, occurring along the greater curvature of the stomach, both complicated by acute gastrointestinal hemorrhage, and review the findings on various imaging studies. Special attention is directed to the plain film findings, as this may be the initial study performed in the emergency department setting.

Ingested magnets: the force within.

Foreign body ingestion is a common occurrence in children. Morbidity associated with ingestion is rare and is dependent on the type of foreign body ingested. We report a case of a 9-year-old boy who developed intestinal obstruction and perforation following ingestion of magnetic-backed earrings.

Recurrent colocolic intussusception in a child with hereditary angioneurotic edema: reduction by air enema.

The authors discuss a case of hereditary angioneurotic edema in a child presenting with recurrent episodes of colocolic intussusception, each successfully reduced by air enema. Although additional manifestations of vasogenic edema are potential risks of the procedure, these were not encountered.