MULTIDISCIPLINARY EVALUATION OF THE DISTENDED ABDOMEN IN CRITICALLY ILL INFANTS AND CHILDREN - THE ROLE OF BEDSIDE SONOGRAPHY

Abdominal distention and metabolic acidosis are common in critically i ll infants and children, and can be manifestations of an intra-abdomin al catastrophe. This series demonstrates the value of bedside sonograp hy (US) in this difficult assessment. Eight infants and children prese nted with the above situation. Seven were immediately post-cardiopulmo nary resuscitation and none had antecedent histories of abdominal pain or bilious vomiting. Abdominal radiographs could not rule out intra-a bdominal pathology such as ischemic bowel. Review of all laboratory an d radiological data showed US to be a discerning modality for acute bo wel pathology. A characteristic pattern of echogenic ascites, thickene d bowel wall, dilated, fluid-filled bowel lumen, and lack of peristals is was seen in those children with gangrenous bowel. Sonographic exami nation accurately predicted the status of the bowel in all patients. F our patients survived: two had segmental ileal necrosis, one had local ized gangrene of the jejunum (twice), and one had necrotic bowel from a closed-loop obstruction. The four who died had malrotation with volv ulus (two), superior mesenteric venous thrombosis, and one was immunoc ompromised with pulmonary aspiration. We conclude that bedside US can be extremely valuable as an adjunct in assessing the abdomen and diagn osing gangrenous bowel in critically ill infants and children.