Bowel Obstruction in Children; Ultrasound or Abdominal X-ray?

Background: Early diagnosis of intestinal obstruction is critical for preventing subsequent complications. In this study, we compare the accuracy of plain abdominal X-ray and ultrasound imaging among children with intestinal obstruction, in terms of the diagnosis of obstruction and its underlying causes.Methods: This analytical cross-sectional study was performed at Akbar Children’s Hospital of Mashhad, Iran, in 2019-2021. Children with clinical manifestations of bowel obstruction underwent abdominal ultrasound examination and plain abdominal X-ray imaging, and the diagnostic findings were compared with the final definite diagnosis. Radiologic signs of obstruction were bubble signs in obstructions until the jejunum, and sausage-shaped air-filled bowel in obstructions of the rest of the bowel. The ultrasound signs were fluid-filled dilated loops, tubular or sausage-shaped dilated bowels, parallel valvulae conniventes (stack of coins), the to-and-fro motion, and the cause of the obstruction.Results: Overall, 60 children with a mean age of 3.05 ± 0.87 years were studied. Post-operative adhesion was the most common cause of obstruction (28%). Plain radiography revealed a normal pattern in 15% of cases, bubble sign and/or decreased abdominal gas pattern in 15% of patients (high-level obstruction), and sausage-shaped pattern of low-level obstruction in 70% of cases, with 72% accuracy. The sonographic signs of bowel obstruction were seen in all patients, with 96.6% accuracy. The cause of obstruction could be determined in 91% of patients, with 91.6% accuracy.Conclusion: Plain abdominal X-ray had a normal pattern in 15% of bowel obstructions while sonography revealed all obstructions with 91.6% accuracy. Therefore, ultrasound imaging can be used as the preferred imaging modality to diagnose gastrointestinal tract obstructions.