Pediatric upper gastrointestinal contrast study is a method of imaging the stomach and proximal small bowel in neonates and babies, predominantly performed to investigate potential small bowel malrotation and resultant midgut volvulus.
On this page:
Indications
The study is most often performed in neonates who present acutely unwell with bilious vomitting and clinical concern for midgut volvulus. As this is a surgical emergency requiring urgent laparotomy, the procedure may need to be performed at short notice or out of hours. An abdominal radiograph may show dilation of the stomach or double bubble sign if there is complete obstruction but volvulus cannot be excluded on appearance alone.
Less acutely the study may be performed to delinate any other cause of upper GI obstruction or congential abnormality such as duodenal atresia or pyloric stenosis (if ultrasound unavailable) 1,2.
Contraindications
pneumoperitoneum
hemodynamic instability
Procedure
Technique
Technique may vary by institution, but the following gives a general overview.
with the baby in a supine position, inject 5-10mL of water-soluable contrast into the nasogastric tube under fluoroscopic guidance, gently distending the stomach
turn the baby to a right lateral position and observe contrast traveling posteriorly into the duodenum
once the contrast reaches the horizontal duodenum turn the baby back to supine and observe the contrast passing into the jejunum noting the position of the duodenojejunal flexure
aspirate any remaining contrast from the NG tube and flush with water
Unable to process the form. Check for errors and try again.