Background: The plain abdominal x-ray is one of the commonly requested investigations in the children emergency room, paediatric surgical ward and neonatal wards. The short interval required to carry out this investig...Background: The plain abdominal x-ray is one of the commonly requested investigations in the children emergency room, paediatric surgical ward and neonatal wards. The short interval required to carry out this investigative procedure and obtain results makes it the first imaging modality used to unravel the different causes of acute abdominal conditions in children. The safety of abdominal x-ray in children makes it attractive for use in paediatric surgical practice as part of routine work-up for undifferentiated acute abdominal conditions and also to diagnose specific causes of acute abdomen in children. Setting: Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State. Objectives: Evaluation of the role of plain abdominal x-ray in diagnosing common acute abdominal conditions in children. Materials and method: Patients admitted to the children emergency room, paediatric surgical wards, children’s ward and neonatal ward who had plain abdominal x-ray as part of their diagnostic work-up were included in the study. They were studied prospectively between March 2011 and April 2021. Results: Three Hundred and Ninety-nine patients who had plain abdominal x-rays as part of their diagnostic work-up were studied. Males were 240 while females were 159, a male to female ratio of 1.5:1. The patients were aged between 1 day to 16 years. Differential diagnoses made with plain abdominal x-ray were intestinal obstruction in 298, perforated viscus 69 patients, intra-abdominal masses 13 patients and location of intra-abdominal foreign body 14. Intestinal obstruction cases in which plain abdominal x-ray played a role in their diagnosis and management included the following: intussusception 66, neonatal sepsis 60, malrotation 48, intestinal atresia 42, anorectal malformation 32, hirschsprung’s disease in 30 cases, pyloric stenosis 24, obstructed hernia 22, post-operative adhesions 16 and intestinal helminthiasis 12. Perforated viscus accounted for 69 indications. Out of these indications, perforated gut in intussusception 19, perforated typhoid ileitis was responsible in 13 cases, gut perforation in blunt abdominal trauma 8, perforation in strangulated hernia 11 cases, perforated gut in malrotation 7, ceacal perforation in hirschsprugs disease 6 and colonic perforation in necrotizing enterocolitis 5 cases. Conclusion: Plain abdominal x-ray remains a role to play in the differential diagnosis and management of common paediatric acute abdominal conditions.展开更多
Colonic volvulus is a relatively uncommon cause of large bowel obstruction usually involving mobile,intraperitoneal,colonic segments.Congenital or acquired anatomic variation may be associated with an increased risk o...Colonic volvulus is a relatively uncommon cause of large bowel obstruction usually involving mobile,intraperitoneal,colonic segments.Congenital or acquired anatomic variation may be associated with an increased risk of colonic volvulus which can occasionally involve retro-peritoneal segments.We report a case of 54-year-old female who presented to our Institution to perform a plain abdominal film series for acute onset of cramping abdominal pain.Both the upright and supine films showed signs of acute colonic obstruction which was thought to be due to an internal hernia of the transverse colon into the lesser sac.The patient was therefore submitted to a multi-detector contrast-enhanced computed tomography(CT).CT findings were initially thought to be consistent with the presumed diagnosis of internal hernia but further evaluation and coronal reformatting clearly depicted the presence of a colonic volvulus possibly resulting from a retro-gastric colon.At surgery,a volvulus of the ascending colon was found and a right hemi-colectomy had to be performed.However,a non rotated midgut with a right-sided duodeno-jejunal flexure and a left sided colon was also found at laparotomy and over-looked in the pre-operative CT.Retrospective evaluation of CT images was therefore performed and a number of CT signs of intestinal malrotation could be identified.展开更多
目的通过深度残差神经网络(ResNet38)对腹部立位平片进行学习,从中检出小肠梗阻。方法本研究使用的训练集和测试集数据来源于西安交通大学第一附属医院及陕西省核工业二一五医院,独立验证集数据来源于陕西省核工业二一五医院。由2名经...目的通过深度残差神经网络(ResNet38)对腹部立位平片进行学习,从中检出小肠梗阻。方法本研究使用的训练集和测试集数据来源于西安交通大学第一附属医院及陕西省核工业二一五医院,独立验证集数据来源于陕西省核工业二一五医院。由2名经验丰富的影像科诊断医师依据腹部立位平片小肠梗阻的4种征象分别对来源于2家医院的3298张腹部立位平片进行分类,意见不一致时讨论达到共识,其中小肠梗阻569例(17.3%),非小肠梗阻2729例(82.7%)。对2组数据采用完全随机分组的方法组成训练集2305张和测试集993张(训练集∶测试集=2.3∶1),其中训练集小肠梗阻405例(17.6%),非小肠梗阻1900例(82.4%);测试集小肠梗阻164例(16.5%),非小肠梗阻829例(83.5%)。训练集和测试集小肠梗阻的诊断均以有丰富经验的影像科医师的评判为标准。验证集共861张腹部立位平片,其中小肠梗阻99例(11.5%),非小肠梗阻762例(88.5%),以手术结果及临床诊断为金标准。本研究使用ImageNet 2012年大规模视觉识别挑战赛数据集(ILSVRC2012)对深度残差神经网络(ResNet38)进行预训练;用训练集数据对深度残差神经网络(ResNet38)再训练建立诊断模型;测试集主要用于学习算法过程中,调整算法的参数来修正网络,从而使得网络模型效能更优。结果本研究开发的小肠梗阻诊断模型在测试集上敏感性为84.1%,特异性为65.0%,受试者工作特征曲线(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)为0.83(95%CI为0.82~0.92);在验证集上的敏感性为89.9%,特异性为68.0%,ROC曲线下面积为0.87(95%CI为0.82~0.92),AUC为0.87。结论对深度残差神经网络进行有限的数据训练,可以获得一个有效的用于在腹部立位平片上检出小肠梗阻的诊断模型。展开更多
文摘Background: The plain abdominal x-ray is one of the commonly requested investigations in the children emergency room, paediatric surgical ward and neonatal wards. The short interval required to carry out this investigative procedure and obtain results makes it the first imaging modality used to unravel the different causes of acute abdominal conditions in children. The safety of abdominal x-ray in children makes it attractive for use in paediatric surgical practice as part of routine work-up for undifferentiated acute abdominal conditions and also to diagnose specific causes of acute abdomen in children. Setting: Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State. Objectives: Evaluation of the role of plain abdominal x-ray in diagnosing common acute abdominal conditions in children. Materials and method: Patients admitted to the children emergency room, paediatric surgical wards, children’s ward and neonatal ward who had plain abdominal x-ray as part of their diagnostic work-up were included in the study. They were studied prospectively between March 2011 and April 2021. Results: Three Hundred and Ninety-nine patients who had plain abdominal x-rays as part of their diagnostic work-up were studied. Males were 240 while females were 159, a male to female ratio of 1.5:1. The patients were aged between 1 day to 16 years. Differential diagnoses made with plain abdominal x-ray were intestinal obstruction in 298, perforated viscus 69 patients, intra-abdominal masses 13 patients and location of intra-abdominal foreign body 14. Intestinal obstruction cases in which plain abdominal x-ray played a role in their diagnosis and management included the following: intussusception 66, neonatal sepsis 60, malrotation 48, intestinal atresia 42, anorectal malformation 32, hirschsprung’s disease in 30 cases, pyloric stenosis 24, obstructed hernia 22, post-operative adhesions 16 and intestinal helminthiasis 12. Perforated viscus accounted for 69 indications. Out of these indications, perforated gut in intussusception 19, perforated typhoid ileitis was responsible in 13 cases, gut perforation in blunt abdominal trauma 8, perforation in strangulated hernia 11 cases, perforated gut in malrotation 7, ceacal perforation in hirschsprugs disease 6 and colonic perforation in necrotizing enterocolitis 5 cases. Conclusion: Plain abdominal x-ray remains a role to play in the differential diagnosis and management of common paediatric acute abdominal conditions.
文摘Colonic volvulus is a relatively uncommon cause of large bowel obstruction usually involving mobile,intraperitoneal,colonic segments.Congenital or acquired anatomic variation may be associated with an increased risk of colonic volvulus which can occasionally involve retro-peritoneal segments.We report a case of 54-year-old female who presented to our Institution to perform a plain abdominal film series for acute onset of cramping abdominal pain.Both the upright and supine films showed signs of acute colonic obstruction which was thought to be due to an internal hernia of the transverse colon into the lesser sac.The patient was therefore submitted to a multi-detector contrast-enhanced computed tomography(CT).CT findings were initially thought to be consistent with the presumed diagnosis of internal hernia but further evaluation and coronal reformatting clearly depicted the presence of a colonic volvulus possibly resulting from a retro-gastric colon.At surgery,a volvulus of the ascending colon was found and a right hemi-colectomy had to be performed.However,a non rotated midgut with a right-sided duodeno-jejunal flexure and a left sided colon was also found at laparotomy and over-looked in the pre-operative CT.Retrospective evaluation of CT images was therefore performed and a number of CT signs of intestinal malrotation could be identified.
文摘目的通过深度残差神经网络(ResNet38)对腹部立位平片进行学习,从中检出小肠梗阻。方法本研究使用的训练集和测试集数据来源于西安交通大学第一附属医院及陕西省核工业二一五医院,独立验证集数据来源于陕西省核工业二一五医院。由2名经验丰富的影像科诊断医师依据腹部立位平片小肠梗阻的4种征象分别对来源于2家医院的3298张腹部立位平片进行分类,意见不一致时讨论达到共识,其中小肠梗阻569例(17.3%),非小肠梗阻2729例(82.7%)。对2组数据采用完全随机分组的方法组成训练集2305张和测试集993张(训练集∶测试集=2.3∶1),其中训练集小肠梗阻405例(17.6%),非小肠梗阻1900例(82.4%);测试集小肠梗阻164例(16.5%),非小肠梗阻829例(83.5%)。训练集和测试集小肠梗阻的诊断均以有丰富经验的影像科医师的评判为标准。验证集共861张腹部立位平片,其中小肠梗阻99例(11.5%),非小肠梗阻762例(88.5%),以手术结果及临床诊断为金标准。本研究使用ImageNet 2012年大规模视觉识别挑战赛数据集(ILSVRC2012)对深度残差神经网络(ResNet38)进行预训练;用训练集数据对深度残差神经网络(ResNet38)再训练建立诊断模型;测试集主要用于学习算法过程中,调整算法的参数来修正网络,从而使得网络模型效能更优。结果本研究开发的小肠梗阻诊断模型在测试集上敏感性为84.1%,特异性为65.0%,受试者工作特征曲线(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)为0.83(95%CI为0.82~0.92);在验证集上的敏感性为89.9%,特异性为68.0%,ROC曲线下面积为0.87(95%CI为0.82~0.92),AUC为0.87。结论对深度残差神经网络进行有限的数据训练,可以获得一个有效的用于在腹部立位平片上检出小肠梗阻的诊断模型。
