Congenital and Neonatal Gastrointestinal Diseases

Abstract

Congenital and neonatal gastrointestinal diseases include a wide variety of congenital anomalies based on the embryologic or developmental defects. Most congenital gastrointestinal tract anomalies are detected in the newborn period and a delay in diagnosis may cause a significant increase in the morbidity. Multiple imaging modalities are required to determine the correct diagnosis and appropriate surgical approach. Moreover it is important to avoid unnecessary radiation exposure to the neonates and inconvenient radiologic examinations resulting in delay of surgical correction. Other associated anomalies in certain gastrointestinal tract anomalies should be diagnosed by radiologic evaluation preoperatively as well. Plain abdominal radiography is useful as the first-line study to evaluate the neonates with suspected congenital anomalies. Neonates with radiographic findings of complete high gastrointestinal obstruction (to the level of the proximal jejunum) usually need little or no further radiologic evaluation. Incomplete high gastrointestinal or low intestinal obstructions need further additional optimal imaging procedures. The upper gastrointestinal series is the study of choice for the diagnosis of incomplete high gastrointestinal obstruction and should determine the location and cause of the obstruction. Contrast enema examination provides a specific diagnosis when low intestinal obstruction is suspected on the basis of clinical and radiographic findings. The use of ultrasonography (US) is increasing because it is easily performed as a quick bedside screening procedure with noninvasiveness, portability, and convenience in ill neonates. Furthermore its contribution, especially in the diagnosis of midgut volvulus and other kinds of neonatal intestinal obstruction, is noted. Computed tomography and magnetic resonance imaging are not commonly preferred as the first-line study because of invasiveness or inconvenience.