Application of bowel ultrasound in comparison to MRI: A case study
Mitesh Naik, Fariba Williams, Tom Watson, Great Ormond Street Hospital for Children NHS Foundation Trust, London
Background
Crohn’s disease (CD) is an inflammatory disorder affecting any part of the gastrointestinal tract. The incidence and prevalence of CD is rising1.
Imaging is pivotal in diagnosis and in monitoring disease activity. Although several imaging modalities are used, MR enterography is often preferred due to the high resolution of both bowel and relevant extra-intestinal sites. However, drawbacks include lack of availability, patient preparation, and examination length which may be challenging for infants. Ultrasound offers advantages of being non-invasive, generally well-tolerated and providing a dynamic assessment of the bowel.
Case Report
A 14-year-old boy of Hungarian origin with known CD, asymptomatic on maintenance treatment, was found on examination at a routine appointment to have an 8-10 cm mass palpable in the right iliac fossa.
An ultrasound scan was arranged which showed presence of a grossly abnormal mass of bowel loops with at least three interloop fistulae, and markedly abnormal vascularity of surrounding mesentery. The terminal and distal ileum were thick-walled, with dilatation of the mid-ileum suggesting a stricture. An MRI small bowel study corroborated these findings.
He was commenced on biologic treatment and underwent an ileocaecal resection.
Further cases will be demonstrated in our presentation.
Discussion
This case, alongside other examples in our presentation, highlights potential advantages of using ultrasound as an adjunct to MRI in the surveillance of CD. Sonographic assessment is reliable in detecting inflammatory changes within the colon and distal ileum - with our case clearly depicting interloop bowel fistulae - and may be particularly useful to confirm equivocal or unusual findings seen in other imaging modalities.
References
- Kammemeir J, Morris M, Garick V et al. Management of Crohn’s Disease. Arch Dis Child 2015; 0:1-6.
- Ahmad T, Greer M, Walters D et al. Bowel Sonography and MR Enterography in Children. AJR 2016; 206:173–181.
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