Purpose: Acute abdominal pain is a common complaint in the pediatric emergency department. Sonography is often the first diagnostic study performed. Our routine study includes the abdominal solid organs as well as the appendix. Adding a sonographic evaluation of the cecum and terminal ileum may reveal additional pathologies, mainly acute infectious colitis - ileitis or inflammatory bowel disease. Early diagnosis improves patient care and reduces the need for additional diagnostic studies in the acute setting.
Materials and Methods: We retrospectively reviewed sonographic examinations of children who presented to our tertiary care center at Ruth Children`s Hospital Rambam, with acute abdominal pain, between February 2017 and June 2017. We included all children 8-18 years of age with abdominal pain, and excluded patients with known Inflammatory Bowel Disease (IBD). Two pediatric radiologists reviewed all studies. For each examination, the appearance of the cecum and terminal ileum, was documented and evaluated for presence of colitis or enteritis.
Results: Over all there were 722 abdominal sonographic studies done in the acute setting. We excluded 401 studies due to known IBD or lack of demonstration of the bowel. Among the 321 studies included in the cohort, 65 patients were sonographically diagnosed with acute appendicitis (20.2%), 26 patients (8.0%) with acute colitis/enteritis, and 2 patients (0.6%) were diagnosed with IBD. Findings were correlated with clinical and pathological data, yielding a positive predictive value of 78.6% for colitis-enteritis patients and of 98.2% for appendicitis.
Conclusion: Evaluation of the cecum and ileum for signs of inflammation as a part of the workup of acute abdominal pain may have an important diagnostic value. Findings may prompt further investigations, such as gastroenterological evaluation, laboratory tests or colonoscopy, leading to early detection of inflammatory bowel disease and optimal patient care.
