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Sonographic rectal enema (“hydrocolon”) for diagnosing large bowel pathologies in infancy – pictorial review to demonstrate feasibility and value

Eszter Nagy
Eszter Nagy
, 
Sebastian Tschauner
Sebastian Tschauner
 e 
Michael Riccabona
Michael Riccabona
   | 28 feb 2023
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Article Category: Pictorial essay
Pubblicato online: 28 feb 2023
Pagine: 23 - 27
Ricevuto: 05 set 2022
Accettato: 18 nov 2022
DOI: https://doi.org/10.15557/JoU.2023.0004
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© 2023 Eszter Nagy, Sebastian Tschauner, Michael Riccabona, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Typical appearance of fluid-filled bowel loops after US enema in a 5-day-old girl born in the 37th week of pregnancy and presenting with intestinal transport problems, suspected malrotation, and suspicion of necrotizing enterocolitis. “Hydrocolon” was applied to rule out ileocecal intussusception in an atypical position
Typical appearance of fluid-filled bowel loops after US enema in a 5-day-old girl born in the 37th week of pregnancy and presenting with intestinal transport problems, suspected malrotation, and suspicion of necrotizing enterocolitis. “Hydrocolon” was applied to rule out ileocecal intussusception in an atypical position

Fig. 2

Preterm baby girl (born at a gestational age of 24 weeks) with failure to pass meconium. Abdominal US showed dilated bowel loops with hyperechogenic meconium balls (green stars). To further specify the diagnosis, a complementary “hydrocolon” procedure was performed. A feeding tube was inserted (A, arrowheads), and saline was instilled under US monitoring (A–D). A small-sized left colon was found without any wall disturbances or meconium filling (arrowheads on B and D). The saline enema could reach the meconium-filled loops, which ruled out atresia. The bowel loops oral to the meconium plugs showed a marked dilatation (blue stars on C, D). The findings were consistent with meconium ileus and unused microcolon
Preterm baby girl (born at a gestational age of 24 weeks) with failure to pass meconium. Abdominal US showed dilated bowel loops with hyperechogenic meconium balls (green stars). To further specify the diagnosis, a complementary “hydrocolon” procedure was performed. A feeding tube was inserted (A, arrowheads), and saline was instilled under US monitoring (A–D). A small-sized left colon was found without any wall disturbances or meconium filling (arrowheads on B and D). The saline enema could reach the meconium-filled loops, which ruled out atresia. The bowel loops oral to the meconium plugs showed a marked dilatation (blue stars on C, D). The findings were consistent with meconium ileus and unused microcolon

Fig. 3

Case of a 9-month-old infant with abdominal distension and currant jelly stool. In the initial examination, large ileocecal intussusception was diagnosed, and the patient underwent pneumatic reduction. The follow-up examination on the next day showed typical “doughnut” (A) and “pseudokidney” (B) signs indicating a recurrence, though a differentiation between ileoileal and ileocecal intussusception was not conclusive. US-guided saline enema was administered, revealing ileocecal recurrence, which was gently released by this US enema (C–E). At the end of the intervention, the ileocecal valve was still thickened (F). This case demonstrates how a diagnostic “hydrocolon” procedure can be switched to a therapeutic hydrostatic reduction, and repeated fluoroscopic decompression can be spared
Case of a 9-month-old infant with abdominal distension and currant jelly stool. In the initial examination, large ileocecal intussusception was diagnosed, and the patient underwent pneumatic reduction. The follow-up examination on the next day showed typical “doughnut” (A) and “pseudokidney” (B) signs indicating a recurrence, though a differentiation between ileoileal and ileocecal intussusception was not conclusive. US-guided saline enema was administered, revealing ileocecal recurrence, which was gently released by this US enema (C–E). At the end of the intervention, the ileocecal valve was still thickened (F). This case demonstrates how a diagnostic “hydrocolon” procedure can be switched to a therapeutic hydrostatic reduction, and repeated fluoroscopic decompression can be spared

Fig. 4

3-year-old girl presenting with hematochezia. Baseline sonography (A) showed a pedunculated hypoechoic mass in the left lower abdomen. US enema proved its intraluminal localization and unambiguously established the diagnosis of a colonic polyp (B, C). Saline enema also helped to rule out further polyps in the large bowel
3-year-old girl presenting with hematochezia. Baseline sonography (A) showed a pedunculated hypoechoic mass in the left lower abdomen. US enema proved its intraluminal localization and unambiguously established the diagnosis of a colonic polyp (B, C). Saline enema also helped to rule out further polyps in the large bowel

Fig. 5

3-year-old boy presenting with hematochezia. Baseline sonography (A, C, E) showed collapsed thickened bowel loops (A: arrowheads, E: star) with marked hyperemia of the bowel wall (C, D). After US enema, the fluid-filled bowel loops enabled a closer evaluation of bowel wall structures (B, D, F). Further diagnostic work-up confirmed the suspected diagnosis of very early onset inflammatory bowel disease
3-year-old boy presenting with hematochezia. Baseline sonography (A, C, E) showed collapsed thickened bowel loops (A: arrowheads, E: star) with marked hyperemia of the bowel wall (C, D). After US enema, the fluid-filled bowel loops enabled a closer evaluation of bowel wall structures (B, D, F). Further diagnostic work-up confirmed the suspected diagnosis of very early onset inflammatory bowel disease

Fig. 6

2-month-old preterm girl (born in the 34th week of pregnancy was presented with vomiting and distended abdomen after she was successfully treated conservatively for necrotizing enterocolitis three weeks before. The stool was normal. On baseline sonography, a wall-thickened bowel loop was found in the middle to the left upper abdomen, with a constant circumscribed narrowing of the intraluminal bowel diameter (A). The finding was suspicious for a focal obstruction. Complementary “hydrocolon” (B–D) confirmed the suspected pathology by highlighting a subtotal short-segment colonic stenosis in the descending colon with regional thickening of the bowel wall
2-month-old preterm girl (born in the 34th week of pregnancy was presented with vomiting and distended abdomen after she was successfully treated conservatively for necrotizing enterocolitis three weeks before. The stool was normal. On baseline sonography, a wall-thickened bowel loop was found in the middle to the left upper abdomen, with a constant circumscribed narrowing of the intraluminal bowel diameter (A). The finding was suspicious for a focal obstruction. Complementary “hydrocolon” (B–D) confirmed the suspected pathology by highlighting a subtotal short-segment colonic stenosis in the descending colon with regional thickening of the bowel wall
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Inglese
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Medicine, Basic Medical Science, other
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