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Congenital Anomalies of the Small Intestine, Colon, and Rectum¹

¹ From the Servicio de Radiodiagnóstico, Hospital Infantil "La Paz," Paseo de la Castellana 261, 28046 Madrid, Spain. Presented as a scientific exhibit at the 1997 RSNA scientific assembly. Received June 23, 1998; revision requested July 27 and received September 15; accepted September 16. Address reprint requests to T.B.

View larger version (113K): [in a new window]   Figure 1a.   Jejunal atresia. (a) Supine radiograph in a neonate with associated esophageal atresia shows three dilated loops of bowel. st = stomach. (b) Upright radiograph obtained in a different patient shows air-fluid levels in the stomach and the first part of the small bowel. No distal gas is seen.

View larger version (114K): [in a new window]   Figure 1b.   Jejunal atresia. (a) Supine radiograph in a neonate with associated esophageal atresia shows three dilated loops of bowel. st = stomach. (b) Upright radiograph obtained in a different patient shows air-fluid levels in the stomach and the first part of the small bowel. No distal gas is seen.

View larger version (157K): [in a new window]   Figure 2.   Gross specimen demonstrates apple peel small bowel. Note the distention of the proximal small bowel (white arrowheads), the shortening of the dorsal mesentery (arrow), and the distal spiraled segment of the small bowel (black arrowheads).

View larger version (125K): [in a new window]   Figure 3a.   Ileal atresia. (a) Upright radiograph shows multiple air-fluid levels occupying the entire abdominal cavity. (b) Image from a barium enema study shows numerous dilated, air-filled loops of bowel and a small, unused colon (functional microcolon).

View larger version (153K): [in a new window]   Figure 3b.   Ileal atresia. (a) Upright radiograph shows multiple air-fluid levels occupying the entire abdominal cavity. (b) Image from a barium enema study shows numerous dilated, air-filled loops of bowel and a small, unused colon (functional microcolon).

View larger version (148K): [in a new window]   Figure 4a.   Colonic atresia. (a) Radiograph shows distended loops of bowel similar to those seen in low small bowel obstruction. (b) Image from a barium enema study demonstrates microcolon with complete obstruction to the retrograde flow of barium in the transverse portion of the colon.

View larger version (127K): [in a new window]   Figure 4b.   Colonic atresia. (a) Radiograph shows distended loops of bowel similar to those seen in low small bowel obstruction. (b) Image from a barium enema study demonstrates microcolon with complete obstruction to the retrograde flow of barium in the transverse portion of the colon.

View larger version (148K): [in a new window]   Figure 5a.   Meconium ileus. (a) Abdominal scout radiograph shows marked distention of the small bowel and a "soap bubble" appearance in the right side of the abdomen (arrows), a finding suggestive of mottled air and feces. (b) US image shows dilated, fluid-filled intestinal loops containing echogenic material (calcified meconium) (arrows). Associated ileal atresia was seen at surgery. (c) Gross specimen shows marked distention of the small bowel loops.

View larger version (142K): [in a new window]   Figure 5b.   Meconium ileus. (a) Abdominal scout radiograph shows marked distention of the small bowel and a "soap bubble" appearance in the right side of the abdomen (arrows), a finding suggestive of mottled air and feces. (b) US image shows dilated, fluid-filled intestinal loops containing echogenic material (calcified meconium) (arrows). Associated ileal atresia was seen at surgery. (c) Gross specimen shows marked distention of the small bowel loops.

View larger version (136K): [in a new window]   Figure 5c.   Meconium ileus. (a) Abdominal scout radiograph shows marked distention of the small bowel and a "soap bubble" appearance in the right side of the abdomen (arrows), a finding suggestive of mottled air and feces. (b) US image shows dilated, fluid-filled intestinal loops containing echogenic material (calcified meconium) (arrows). Associated ileal atresia was seen at surgery. (c) Gross specimen shows marked distention of the small bowel loops.

View larger version (102K): [in a new window]   Figure 6.   Meconium peritonitis in a male neonate with cystic fibrosis. Abdominal radiograph shows linear and flocculent areas of calcification within the peritoneal cavity (arrows) and scattered areas of calcification in the scrotum (arrowheads).

View larger version (134K): [in a new window]   Figure 7a.   Hirschsprung disease in a 6-month-old infant with a history of chronic constipation. (a, b) Frontal (a) and lateral (b) images from a barium enema study show the proximal sigmoid colon and descending colon as greatly dilated compared with the distal colon and rectum.

View larger version (115K): [in a new window]   Figure 7b.   Hirschsprung disease in a 6-month-old infant with a history of chronic constipation. (a, b) Frontal (a) and lateral (b) images from a barium enema study show the proximal sigmoid colon and descending colon as greatly dilated compared with the distal colon and rectum.

View larger version (100K): [in a new window]   Figure 8a.   Total colonic aganglionosis. (a, b) Frontal (a) and lateral (b) images from a barium enema study show irregularity in the caliber of the colon with fewer redundant flexures than normal. (c) Gross specimen demonstrates total colonic aganglionosis.

View larger version (109K): [in a new window]   Figure 8b.   Total colonic aganglionosis. (a, b) Frontal (a) and lateral (b) images from a barium enema study show irregularity in the caliber of the colon with fewer redundant flexures than normal. (c) Gross specimen demonstrates total colonic aganglionosis.

View larger version (150K): [in a new window]   Figure 8c.   Total colonic aganglionosis. (a, b) Frontal (a) and lateral (b) images from a barium enema study show irregularity in the caliber of the colon with fewer redundant flexures than normal. (c) Gross specimen demonstrates total colonic aganglionosis.

View larger version (118K): [in a new window]   Figure 9a.   Meconium plug syndrome. (a) Image from a barium enema study shows a normal-sized rectum and colon with inspissated meconium filling defects (arrows). (b) Gross specimen shows the colon (C) and the typical appearance of an evacuated plug (arrows).

View larger version (132K): [in a new window]   Figure 9b.   Meconium plug syndrome. (a) Image from a barium enema study shows a normal-sized rectum and colon with inspissated meconium filling defects (arrows). (b) Gross specimen shows the colon (C) and the typical appearance of an evacuated plug (arrows).

View larger version (18K): [in a new window]   Figure 10.   Drawings illustrate the stages of intestinal rotation. In A, the duodenum has rotated 90° counterclockwise to lie to the right of the superior mesenteric artery. The distal large bowel also rotates 90° counterclockwise. In B, the duodenum has rotated another 90° counterclockwise. In C, the duodenum has rotated its final 90° counterclockwise with the duodenojejunal flexure lying to the left of the midline. The cecum continues to rotate. In D, the normally rotated bowel is depicted. (Reprinted, with permission, from reference 1.)

View larger version (114K): [in a new window]   Figure 11a.   Nonrotation. Images from a contrast material-enhanced gastrointestinal examination show the small intestine on the right side of the abdomen and the colon and cecum on the left side. The ileum is seen crossing the midline from right to left (arrows in b).

View larger version (129K): [in a new window]   Figure 11b.   Nonrotation. Images from a contrast material-enhanced gastrointestinal examination show the small intestine on the right side of the abdomen and the colon and cecum on the left side. The ileum is seen crossing the midline from right to left (arrows in b).

View larger version (26K): [in a new window]   Figure 12.   Drawings illustrate midgut volvulus. Narrow mesenteric attachment of nonrotation (A) or incomplete rotation (B) may lead to midgut volvulus (C). (Reprinted, with permission, from reference 1.)

View larger version (85K): [in a new window]   Figure 13.   Malrotation. On an image from a barium enema study, the intestine occupies an intermediate position between that of nonrotation and the normal postnatal position. The cecum and the terminal ileum are displaced upward and medially.

View larger version (137K): [in a new window]   Figure 14.   Midgut volvulus. Image from a contrast-enhanced upper gastrointestinal series clearly demonstrates the "corkscrew" appearance of the proximal small bowel (arrows) as it twists around the superior mesenteric artery.

View larger version (156K): [in a new window]   Figure 15.   Malrotation. Abdominal CT scan shows the superior mesenteric vein (+) lying anterior to the superior mesenteric artery. The superior mesenteric vein normally lies on the right side of the superior mesenteric artery; in malrotation, it lies either in front or on the left side.

View larger version (136K): [in a new window]   Figure 16a.   Ileal duplication. (a) Image from a barium enema study shows extrinsic compression of the cecum by an extraluminal mass. (b) US image shows a cystic mass (C) that corresponds to a surgically proved duplication cyst. k = kidney.

View larger version (158K): [in a new window]   Figure 16b.   Ileal duplication. (a) Image from a barium enema study shows extrinsic compression of the cecum by an extraluminal mass. (b) US image shows a cystic mass (C) that corresponds to a surgically proved duplication cyst. k = kidney.

View larger version (168K): [in a new window]   Figure 17.   Cystic communicating duplication of the colon in a 54-year-old woman with abdominal pain. Abdominal radiograph shows a round collection of air near the ascending colon (arrows).

View larger version (136K): [in a new window]   Figures 18-20.   (18) Imperforate anus. Lateral radiograph shows an imperforate anus below the "M" line drawn through the junction of the upper two-thirds and lower one-third of the ischium (perineal surgical approach). (19) Ectopic anus. Voiding cystogram demonstrates a recto-urethral fistula (arrow). (20) Imperforate anus. Lateral voiding cystogram demonstrates an air-filled distal rectal pouch (arrows) ending blindly below the "M" line, a finding indicative of a low lesion. There is no fistula opening in the terminal bowel.

View larger version (123K): [in a new window]   Figures 18-20.   (18) Imperforate anus. Lateral radiograph shows an imperforate anus below the "M" line drawn through the junction of the upper two-thirds and lower one-third of the ischium (perineal surgical approach). (19) Ectopic anus. Voiding cystogram demonstrates a recto-urethral fistula (arrow). (20) Imperforate anus. Lateral voiding cystogram demonstrates an air-filled distal rectal pouch (arrows) ending blindly below the "M" line, a finding indicative of a low lesion. There is no fistula opening in the terminal bowel.

View larger version (124K): [in a new window]   Figures 18-20.   (18) Imperforate anus. Lateral radiograph shows an imperforate anus below the "M" line drawn through the junction of the upper two-thirds and lower one-third of the ischium (perineal surgical approach). (19) Ectopic anus. Voiding cystogram demonstrates a recto-urethral fistula (arrow). (20) Imperforate anus. Lateral voiding cystogram demonstrates an air-filled distal rectal pouch (arrows) ending blindly below the "M" line, a finding indicative of a low lesion. There is no fistula opening in the terminal bowel.