Peds-Gastrointestinal

Transverse view of the appendix showing the appendix with intraluminal appendicolith.

Contributor: Maher M. Abulfaraj, MD, @mahermabulfaraj

Ascites with floating bowel and questionable to-and-fro peristalsis.

Contributor: Peter Gutierrez, MD, FAAP, Emory University School of Medicine/Children's Healthcare of Atlanta, @pocuspete

23 month old with ileocolic intussusception. Pseudokidney sign seen here due to oblique orientation of the linear transducer.

Contributor: Antonio Riera, MD

18 mo F sent from PMD for mass in the RUQ. POCUS shows extra renal mass consistent with neuroblastoma that was later confirmed by pathology.

Contributor: Paul Khalil, MD Nicklaus Children's Hospital

Ultrasound used to assess gastric content prior to procedural sedation. Sagittal view in the epigastric region using the curvilinear probe with the patient in the right lateral decubitus position. Probe indicator cephalad. The gastric antrum is seen in the upper right with heavily air-admixed content with dirty shadow obscuring deeper content. The liver is seen in the upper left and the aorta in the deep field.

Contributor: Matthew Moake, MD PhD

Roughly 1m male with projectile emesis. POCUS demonstrated elongated and thickened pylorus with absence of trans-pyloric flow.

Contributor: Matthew Moake, MD PhD

2+ weeks projectile vomiting. Extreme lab abnormalities including Cl 67. CG4: 7.57/67/34/60, base excess >30, lactate 3.23. The pyloric channel is elongated, thickened, and has an absence of trans-pyloric flow.

Contributor: Matthew Moake, MD PhD

2+ weeks projectile vomiting. Extreme lab abnormalities including Cl 67. CG4: 7.57/67/34/60, base excess >30, lactate 3.23. The pyloric channel is elongated, thickened, and has an absence of trans-pyloric flow.

Contributor: Matthew Moake, MD PhD

7y female with N/V and tactile fever. Benign abdominal exam. Note the small size of the intuss. In long axis you can easily track the bowel wall as it folds into itself and see it is slowly sliding in and out a small bit.

Contributor: Matthew Moake, MD PhD

3y female with 3d RLQ abd pain, emesis, fever. WBC 8.5 with 73% PMN. CRP 9. POCUS with enlarged appendix with loss of bowel wall architecture, surrounding early fluid collection, fecolith, and mural hyperemia.

Contributor: Matthew Moake, MD PhD

6y female with 2d abd pain, fever, nauesea, dysuria. OSH WBC 17.5, pyuria. Long axis view of the appendix draping down into the pelvis. Note how the regular bowel wall architecture is progressively obliterated as the appendix tracks distally into the pelvis, ending in full perforation with early abscess formation and surrounding hyperechoic fat.

Contributor: Matthew Moake, MD PhD

5 wk old male with projectile vomiting. Clips show hypertrophic pyloric stenosis in long axis.

Contributor: Paul Khalil, MD Nicklaus Children's Hospital @khalil3paul

5 wk old male with projectile vomiting. Clips show hypertrophic pyloric stenosis in long axis.

Contributor: Paul Khalil, MD Nicklaus Children's Hospital @khalil3paul

5 wk old male with projectile vomiting. Clips show hypertrophic pyloric stenosis in short axis.

Contributor: Paul Khalil, MD Nicklaus Children's Hospital @khalil3paul

4-year-old boy with severe dengue with free fluid in the abdominal cavity.

Contributor: Mg. Andres Silva Horna, Hospital Cayetano Heredia Piura-Peru

17 yo male with history of abdominal surgeries (g-tube and fundoplication) and chronic constipation who comes in with lower abdominal pain. POCUS shows stool to and fro (tanga sign).

Contributor: Paul Khalil, MD Nicklaus Children's Hospital @khalil3paul

Small bowel obstruction with to and fro peristalsis visualized.

Contributor: Peter Gutierrez, MD FAAP FACEP; Children's Healthcare of Atlanta; @pocuspete

Ileocolic intussusception measuring 4.4cm.

Contributor: Peter Gutierrez, MD FAAP FACEP; Children's Healthcare of Atlanta; @pocuspete

3 yo male presented with an episode of abdominal pain and bilious emesis in the morning. He was noted to be sleepy all day at home and passed two bloody diarrheal stools prior to arrival. Point-of-care ultrasound demonstrates ileocolic intussusception in the left upper quadrant. Transverse view demonstrate a "target sign" and longitudinal view demonstrates "sandwich sign" consistent with the diagnosis.

Contributor: Megan Musisca, MD, Boston Children's Hospital

"Fever Vomiting and Abdominal pain 9yr old

Tenderness @ McBurney’s point

USG : Aperistaltic Dilated with probe tenderness in right iliac region Diameter 6mm plus"

Contributor: Dr Vanitha Jagannath

"Fever Vomiting and Abdominal pain 9yr old

Tenderness @ McBurney’s point

USG : Aperistaltic Dilated with probe tenderness in right iliac region Diameter 6mm plus"

Contributor: Dr Vanitha Jagannath

10 y/o with abdominal pain. Normal appendix identified medial to the iliac vessels. Please see other image in series for doppler.

Contributor: Elena Chen, MD

10 y/o with abdominal pain. Normal appendix identified medial to the iliac vessels.

Contributor: Elena Chen, MD

7 y/o F with abdominal pain. Normal appendix identified.

Outer wall measured 0.48cm in long, 0.46cm in short, and 0.51cm again in a short axis.

Contributor: Russ Horowitz, MD, Lurie Children's Hospital