Accuracy of ultrasonography in detecting gastrointestinal tract obstructions in children; a prospective study in a tertiary referral hospital

Parisa Hajalioghli, Saeid Aslanabadi, Mostafa Vafaei Aghdam, Daniel Fadaei Fouladi


Aims: To examine the diagnostic accuracy of plain radiography, abdominal ultrasonography (US), and their combination in pediatric patients with suspected gastrointestinal (GI) tract obstruction.

Material and methods: A cohort of 48 patients (age, 0-14 years, 27 boys) with clinical manifestations of GI tract obstruction underwent plain radiography and abdominal US examination. The final diagnoses were based on intraoperative findings, rectal biopsies (in Hirschsprung’s disease), or adequate follow-ups.

Results: The GI tract obstruction was diagnosed in 40 patients. The sensitivity, specificity, positive predictive value and negative predictive value of plain radiography in diagnosing GI tract obstruction were 87.5%, 75.0%, 94.6%, and 54.6%, respectively. The corresponding values were 95%, 100%, 100%, and 80%, respectively when US was used alone; and 97.5%, 100%, 100% and 88.9%, respectively when radiography and US were used together. Except for two patients (one with Hirschsprung’s disease and the other with massive peritonitis), US detected the underlying causes of obstruction correctly in all patients.

Conclusions: US is a highly sensitive and specific modality in diagnosing pediatric GI tract obstructions, as well as their causes. The combination of plain radiography and US further increase the diagnostic sensitivity and negative predictive value.


ultrasonography; radiography; intestinal obstruction; pediatrics

Full Text:



Hajivassiliou CA. Intestinal obstruction in neonatal/pediatric surgery. Seminars in pediatric surgery 2003;12:241-53.

Juang D, Snyder CL. Neonatal bowel obstruction. The Surgical clinics of North America 2012;92:685-711, ix-x.

Vasavada P. Ultrasound evaluation of acute abdominal emergencies in infants and children. Radiol Clin North Am 2004;42:445-56.

Fidler JL, Guimaraes L, Einstein DM. MR imaging of the small bowel. Radiographics : a review publication of the Radiological Society of North America, Inc 2009;29:1811-25.

Hefny AF, Corr P, Abu-Zidan FM. The role of ultrasound in the management of intestinal obstruction. Journal of emergencies, trauma, and shock 2012;5:84-6.

van Randen A, Lameris W, van Es HW, et al. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol 2011;21:1535-45.

Puylaert JB. Ultrasonography of the acute abdomen: gastrointestinal conditions. Radiol Clin North Am 2003;41:1227-42, vii.

Musoke F, Kawooya MG, Kiguli-Malwadde E. Comparison between sonographic and plain radiography in the diagnosis of small bowel obstruction at Mulago Hospital, Uganda. East Afr Med J 2003;80:540-5.

Nylund K, Odegaard S, Hausken T, et al. Sonography of the small intestine. World J Gastroenterol 2009;15:1319-30.

Kimmey MB, Martin RW, Haggitt RC, Wang KY, Franklin DW, Silverstein FE. Histologic correlates of gastrointestinal ultrasound images. Gastroenterology 1989;96:433-41.

Choe J, Wortman JR, Michaels A, Sarma A, Fulwadhva UP, Sodickson AD. Beyond appendicitis: ultrasound findings of acute bowel pathology. Emerg Radiol 2019;26:307-17.

Esposito F, Di Serafino M, Mercogliano C, et al. The pediatric gastrointestinal tract: ultrasound findings in acute diseases. J Ultrasound 2019.

Garcia R, Arcement C, Hormaza L, et al. Use of the recto-sigmoid index to diagnose Hirschsprung's disease. Clin Pediatr (Phila) 2007;46:59-63.

Gollub MJ, Yoon S, Smith LM, Moskowitz CS. Does the CT whirl sign really predict small bowel volvulus?: Experience in an oncologic population. J Comput Assist Tomogr 2006;30:25-32.

Maheshwari P, Abograra A, Shamam O. Sonographic evaluation of gastrointestinal obstruction in infants: a pictorial essay. J Pediatr Surg 2009;44:2037-42.

Ogata M, Mateer JR, Condon RE. Prospective evaluation of abdominal sonography for the diagnosis of bowel obstruction. Ann Surg 1996;223:237-41.

Hucl T. Acute GI obstruction. Best practice & research Clinical gastroenterology 2013;27:691-707.

Silva AC, Pimenta M, Guimaraes LS. Small bowel obstruction: what to look for. Radiographics 2009;29:423-39.

Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emergency medicine journal : EMJ 2011;28:676-8.

Berlin SC, Goske MJ, Obuchowski N, et al. Small bowel obstruction in rats: diagnostic accuracy of sonography versus radiography. J Ultrasound Med 1998;17:497-504.

Richardson NG, Heriot AG, Kumar D, Joseph AE. Abdominal ultrasonography in the diagnosis of colonic cancer. Br J Surg 1998;85:530-3.

Ko YT, Lim JH, Lee DH, Lee HW, Lim JW. Small bowel obstruction: sonographic evaluation. Radiology 1993;188:649-53.

Schmutz GR, Benko A, Fournier L, Peron JM, Morel E, Chiche L. Small bowel obstruction: role and contribution of sonography. European radiology 1997;7:1054-8.

Ikeda H, Matsuyama S, Suzuki N, Takahashi A, Kuroiwa M, Hatakeyama S. Small bowel obstruction in children: review of 10 years experience. Acta Paediatr Jpn 1993;35:504-7.

James V, Alsani FS, Fregonas C, Seguin J, Tessaro MO. Point-of-care ultrasound in pediatric small bowel obstruction: an ED case series. The American journal of emergency medicine 2016.

Hwang JY. Emergency ultrasonography of the gastrointestinal tract of children. Ultrasonography 2017;36:204-21.

Trout AT, Towbin AJ, Fierke SR, Zhang B, Larson DB. Appendiceal diameter as a predictor of appendicitis in children: improved diagnosis with three diagnostic categories derived from a logistic predictive model. European radiology 2015;25:2231-8.

Pinto A, Pinto F, Faggian A, et al. Sources of error in emergency ultrasonography. Critical ultrasound journal 2013;5 Suppl 1:S1.

Gupta H, Dupuy DE. Advances in imaging of the acute abdomen. The Surgical clinics of North America 1997;77:1245-63.

Chen SC, Lin FY, Hsieh YS, Chen WJ. Accuracy of ultrasonography in the diagnosis of peritonitis compared with the clinical impression of the surgeon. Arch Surg 2000;135:170-3; discussion 4.

Chavhan GB, Masrani S, Thakkar H, et al. Sonography in the diagnosis of pediatric gastrointestinal obstruction. J Clin Ultrasound 2004;32:190-9.

Kandasamy D, Sharma R, Gupta AK. Bowel Imaging in Children: Part 1. Indian J Pediatr 2019.



  • There are currently no refbacks.