Congenital anomalies of the upper gastrointestinal tract

A wide spectrum of congenital anomalies may affect the upper gastrointestin al tract, including anomalies of the esophagus (eg, atresia, fistulas, webs , duplications, vascular rings), stomach (eg, congenital gastric outlet obs truction, duplications), and duodenum (eg, atresia, annular pancreas, dupli cations, malrotation). The evaluation of affected patients can require mult iple imaging modalities for diagnosis and surgical planning. Radiography is often diagnostic and specific and can usually provide important clues to h elp determine the optimal diagnostic procedure. Neonates with complete gast ric or upper intestinal obstruction do not usually require further radiolog ic evaluation after radiography: Barium studies are usually contraindicated , and complementary procedures (eg, ultrasound [US], computed tomography [C T]) are not usually helpful and may even delay surgery, resulting in death. Nevertheless, US has become important in the evaluation of the pediatric g astrointestinal tract and is being used in an increasing number of applicat ions. CT and magnetic resonance imaging are unsuitable for general screenin g bur provide superb anatomic detail and added diagnostic specificity. They are especially useful in demonstrating esophageal duplications and vascula r rings as well as associated abnormalities. However, the decision to perfo rm a given imaging examination should be considered carefully to avoid inco nvenience or unnecessary radiation exposure to the patient or delays in sur gical correction. Quality control programs should be in place to ensure saf e, effective radiologic practice through use of up-to-date equipment and go od imaging technique.