Pediatric GI Pathology

Intussusception occurs when a part of the intestine (intussusceptum) telescopes into another part (intussuscipiens) of the intestine. The condition can cause obstruction and, if untreated, progress to bowel ischemia. Intussusception is most common in the pediatric population, but is occasionally encountered in adults. The pediatric patient typically presents with acute cyclical abdominal pain and vomiting, while adults present with symptoms of bowel obstruction. The diagnosis in children is frequently clinical but may be supported by an abdominal ultrasound showing a classic target sign. Management options in children include contrast or pneumatic enema, with surgical options reserved for failure of the non-operative measures, complications such as gangrene or perforation, and treatment of underlying pathology. In adult patients, surgery is usually required.

Megacolon is a severe, abnormal dilatation of the colon, and is classified as acute or chronic. There are many etiologies of megacolon, including neuropathic and dysmotility conditions, severe infections, ischemia, and inflammatory bowel disease. Toxic megacolon is an acute form of megacolon with systemic toxicity, and carries the highest morbidity and mortality. Common symptoms include abdominal distention, pain, bloody diarrhea, or obstipation. Diagnosis depends on the underlying cause, and is usually established with a combination of the patient’s history, laboratory findings, and imaging studies. Patients with chronic megacolon may require laxatives, enemas, and bowel training. Management for acute megacolon includes supportive care, decompression, and potential surgery.

Constipation is a common complaint in children that is relatively defined for individual age groups based on the frequency and difficulty of defecation and stool consistency. The majority of constipation cases are functional or non-organic. Clinical presentation may vary, from insufficient evacuation noted by the parents, to complaints of abdominal pain, to secondary incontinence. Often, a combination of non-pharmacologic and pharmacologic management is needed for evacuating bowel content, eliminating pain upon defecation, and improving bowel habits.

Congenital duodenal obstructions are a group of inborn conditions that cause obstruction of the lumen of the duodenal segment of the small intestine, impeding the passage of food and gastric juices. The condition may have intrinsic etiologies, such as duodenal atresia (most common) and/or extrinsic etiologies, such as an annular pancreas. The hallmark of duodenal obstruction is bilious vomiting. The condition can be diagnosed through prenatal or postnatal ultrasound. Associated anomalies, including congenital heart disease, are common. Treatment includes fluid resuscitation and surgical duodenoduodenostomy.

Hypertrophic pyloric stenosis is hypertrophy and hyperplasia of the pyloric sphincter muscle. The condition is the most common cause of gastrointestinal obstruction in infants. Affected newborns typically present after the third to fifth week of life with progressive non-bilious vomiting and a firm, olive-like mass in the epigastrium. Ultrasound confirms the diagnosis based on the thickness and length of the pyloric muscle and channel diameter. Initial treatment consists of fluid resuscitation with correction of electrolyte imbalances, followed by either open or laparoscopic pyloromyotomy.

Acute abdominal pain is common in the pediatric population. Abdominal pain is usually associated with fever, vomiting of bile, bloody diarrhea, rigidity and tenderness in the abdomen. The etiology and differential diagnosis depends on the age of the child. For instance, Infants and toddlers will have congenital anomalies, school aged children may have gastroenteritis and other infectious causes. Appendicitis is the most common cause behind onset of acute abdominal pain in children.

Pediatric colic is a very common symptom that occurs in infants during the first few months of life, and tends to disappear by the fourth month.  Its causes are poorly understood and there are various theories explaining it as a reaction to food allergies, parental stress, gastrointestinal immaturity, maternal smoking and other factors. This article gives an overview of the condition with its epidemiology, etiology, symptom, diagnosis and differential diagnosis, and treatment.

Appendicitis is considered a serious surgical emergency in medicine, therefore early diagnosis and management is important to a successful outcome and preventing serious complications as gangrene and perforation. This article will describe the incidence of appendicitis the younger children, and how can be diagnosed and managed.

Pediatric gastrointestinal disturbances are common, often simple to manage and yet, unfortunately, life threatening in some instances. Sometimes, seemingly innocuous vomiting can be a harbinger of a serious underlying disease. This article expounds on various patho-physiological aspects of pediatric vomiting and diarrhea, and expatiates on the rapid aggressive treatment of accompanying dehydration.

Meconium originates from the Greek word “mekonion” which stands for poppy. The nomenclature attests to the tarry, black appearance of meconium which resembles raw opium preparation. Meconium ileus implies the presence of an intestinal obstruction in-utero or in neonatal period secondary to abnormally thick meconium. This article expatiates on patho-physiological aspects of meconium ileus and expounds on clinical features of the same. The article concludes with treatment, complications and prognosis of meconium ileus.

Pediatric allergic proctocolitis is considered an IgE-mediated allergic reaction to dietary proteins; most commonly is Cow’s milk protein, which represents about 50-65% of the cases. It's a frequent, significant cause of infant colitis. This article explains the main clinic-patho-physiological aspects of the disease.