Bontrager, Kenneth L. 2018.

Textbook of Radiographic Positioning and Related

Anatomy. Eight Edition. Saint Louis: Mosby.

Frank, Eugene D, Long, Bruce W, and Smith, Barbara J. 2016. Merrill’s Atlas of
Radiographic Positioning and Procedure. Thirteenth Edition. Volume Two.
Mosby: United Sates of America.

McNally Peter R. 2010. Radiology Secrets Plus E-book. Edisi 4. Penerbit Elsevier Healty
Sciences :Canada
Rasad, Sjahriar. 2009. Radiologi Diagnostik. Edisi kedua, cetakan ke-9. Badan Penerbit
FKUI : Jakarta.
Syaifuddin, B.A.C 2010. Anatomi Fisiologi untuk siswa perawat. Edisi ke-4. Penerbit
Buku Kedokteran. EGC : Jakarta.
Bradley, P.F. 2011, Pediatric Critical Care, 4th Edition, Saunders-Elsevier, Philadelphia.
Brunner dan Suddarth. 2000. Keperawatan Medical Bedah Edisi 8 Volume 1.
Jakarta: EGC.
. Price Sylvia A, Wilson Lorraine M. Patofisiologi: Konsep Klinis Proses-Proses
Penyakit. Jakarta: EGC; 2009
Aru W, Sudoyo. 2009. Buku Ajar Ilmu Penyakit Dalam, jilid II, edisi V. Jakarta:
Interna Publishing..

https://surgery.ucsf.edu/conditions--procedures/colostomy-(pediatric).aspx

https://www.acr.org/-/media/ACR/Files/Practice-Parameters/FluourConEnema-
Ped.pdf

. https://pubs.rsna.org/doi/full/10.1148/rg.2015150033
A fistula (a term derived from the Latin word for pipe) is an abnormal
connection between 2 epithelialized surfaces that usually involves
the gut and another hollow organ, such as the bladder, urethra,
vagina, or other regions of the gastrointestinal (GI) tract. Fistulas
may also form between the gut and the skin or between the gut and
an abscess cavity. Rarely, fistulas arise between a vessel and the
gut, resulting in profound GI bleeding, which is a surgical
emergency. https://emedicine.medscape.com/article/179444-overview David E
Stein, MD Professor and Alma Dea Morani Chair of Surgery,
Director, Mini-Medical School Program, Drexel University College of
Medicine

David E Stein, MD is a member of the following medical

societies: American College of Surgeons, American Society of Colon
and Rectal Surgeons, Association for Surgical Education, Crohn's
and Colitis Foundation of America, Pennsylvania Medical

1
Society, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

The length of the large intestine in children

determined by computed tomography scan.
Mirjalili SA, et al. Clin Anat. 2017.

Mirjalili. 2017. “The Length Of The Large Intestine In

Children Determined By Computed Tomography
Scan.”http://www.ncbi.nlm.nih.gov./m/pubmed/28631339
diakses pada tanggal

Abstract
Little information is available on the length of the normal large intestine
and its component parts in children. This information would be useful for
procedures such as colonoscopy. The aim of this study was to investigate
the length of the large intestine and its component parts in New Zealand
children. Archival deidentified pediatric supine abdominopelvic computed
tomography (CT) scans were retrospectively analyzed. After exclusion
criteria, a total of 112 scans (57 males and 55 females) were included in
the study and divided into three age groups: 0-2 years (n = 33), 4-6 years
(n = 40), and 9-11 years of age (n = 39). The length of the large bowel
increased from a mean of 52 cm in children aged <2 years to 73 cm at 4-6
years and 95 cm at 9-11 years. In all age groups, the transverse colon
was the longest segment, contributing ∼30% of the total length of the large
bowel. In comparison to total large bowel length, the mean proportional
length of the rectum (9-12%), sigmoid colon (23-27%), descending colon
(19-22%), transverse colon (27-32%), and ascending colon (14-17%)
varied little between the three age groups. There were no significant
differences between males and females in all age groups. The cecum was
located in the right upper quadrant in 27% of children aged 0-2 years but
in the right lower quadrant in all 9-11 year olds. These data provide useful
information on the length of the large intestine and its component parts in
living children, which are particularly relevant to pediatric colonoscopy and
surgery. Clin. Anat. 30:887-893, 2017.

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© 2017 Wiley Periodicals, Inc. 12-15-2019 waktu 10.55

https://pubs.rsna.org/doi/full/10.1148/rg.2015150033

Barium enema studies continue to provide important and unique information to

clinicians in an era of more advanced cross-sectional imaging. In this online
presentation, foundational knowledge of appropriate technique, indications, and
important anatomic landmarks are discussed. The reader can review the
differential diagnoses for extraluminal and intraluminal masses, the typical
appearance and complications of inflammatory bowel disease and diverticulitis,
and common surgical procedures with associated postoperative complications.
Deviation from normal anatomy, such as loss of haustral markings, prominence of
the presacral space, and malrotation, can be a harbinger for a true pathologic
condition, and correct identification is important.

The double-contrast barium enema study is most often used as a screening

examination for colonic malignancy. As a radiologist, it is important to be
accurate in the diagnosis and to recognize when to recommend additional follow-
up. The appearance at double-contrast barium enema examination of colonic
polyps, diverticulum, strictures, and annular lesions (Fig 1), as well as common
mimics of pathologic findings, such as hemorrhoids and lymphoid tissue, is also
described. Approximately 50% of polyps larger than 1 cm will progress to
adenocarcinoma. As such, it is important to recognize the suspicious features of a
colonic polyp and syndromes that predispose the patient to malignancy.
Nonmalignant entities causing extraluminal narrowing with the “apple core”
appearance are discussed, such as endometrial implants, adenopathy, and
inflammatory strictures. Inflammatory bowel disease also has a predictable
appearance at double-contrast barium enema examination, with inflammatory
polyps, fissures, and fistulas.
https://pubs.rsna.org/doi/full/10.1148/rg.2018170111

3
 Colostomy closure in pediatric age group A
comparative study between Single and double
layer anestomosis
http://iqjmc.uobaghdad.edu.iq/index.php/19JFacMedBaghdad36/article/view/1401

 Bilal Hamid Abdul-GafoorTeaching Hospital /Baghdad

 Hussain Malik Al-DabbaghTeaching Hospital /Baghdad

DOI: https://doi.org/10.32007/14019-12

Keywords: Colostomy closure

Abstract

This prospective study involved one hundred patients with colostomies admitted at
the Central Pediatric Teaching Hospital for colostomy closure over the period of two
years (Jan.2000-
Jan2002).
Patients were divided in to two groups according to the technique of colostomy
closure. In the first group, the closure was done by single layer of interrupted non-
absorbable suture material; in the  second group closure was done by double layer
suturing technique. All patients were prepared by the same conventional method
including fluid diet for three days
followed by two days washing enemas before operation with antimicrobial
prophylaxis agents. Of these one hundred patients;(48) presented as cases of
Hirschsprung`s disease, (50) were cases of ano-rectal malformations, and (2) were
cases of traumatic colonic perforation. According to the type of the colostomy; there
were (62) loop colostomy, and (38) double-barreled colostomy. According to the site
of the colostomy; there were (84) patients with right transverse colostomy, (2) with
left descending colostomy, (12) with sigmoidostomy, and (2) with cecostomy. Sixteen
patients developed complications following colostomy closure; these were (wound
infection, fecal fistula, small bowel obstruction, and other systemic infections).
We advise single layer bowel anastomosis for the following reasons:
1-operative time (anesthetic time) theoretically shorter with single layer closure.
2-less tissue handling (less trauma) with single layer closure.
3-less narrowing effect (as less suture material) on the already small bowel lumen.

4
Too many
sutures and too many knots leading to comprise blood supply with double layer
closure.
4-more cost benefit with single layer closure.

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 Closure of colostomy.
P H Beck and H B Conklin
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1343896/

Copyright and License information Disclaimer

This article has been cited by other articles in PMC.

Abstract
We analyzed the records of 77 cases of loop colostomy closure in Vietnam War
Casualties. All records were complete from the date of injury to discharge
following colostomy closure. Simple of the loop colostomy was performed in 44
patients and resection of the stoma and reanastomosis of bowel segments was
performed in 33 patients. Average operating time for simple closure of the loop
was 70 minutes compared to 115 minutes for resection and anastomosis.
Nasogastric suction was used less frequently and for a shorter time with simple
loop closure. The total postoperative complication rate was 9% with simple loop
closure as compared to 24% for resection and anastomosis. Simple closure of the
loop described in this report is technically easier and as safe as resection of the
stoma and reanastomosis.

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The use of low osmolality water soluble (LOWS) contrast
media in the pediatric gastro-intestinal tract. A report of
115 examinations.
Ratcliffe JF.

Abstract
There are dangers in the use of either barium sulphate suspensions or the
conventional hypertonic water soluble contrast media in the gastrointestinal tract of
"at risk" babies and children. These dangers can be avoided by the use of low
osmolality water soluble (LOWS) contrast media. This paper reports the satisfactory
use of three such contrast media, ioxaglate (Hexabrix), iohexol (Omnipaque) and
iopamidol (Niopam) in 115 examinations of the gastrointestinal tracts of 89 babies
and children. Morbidity from the inhalation or extravasation of contrast medium was
negligible. It is proposed that LOWS contrast media should be used more widely in
the gastro-intestinal investigation of all "at risk" babies and children.
https://www.ncbi.nlm.nih.gov/pubmed/3945499

Ada bahaya dalam penggunaan suspensi barium sulfat atau media kontras larut air
hipertonik konvensional dalam saluran pencernaan bayi dan anak "berisiko".
Bahaya-bahaya ini dapat dihindari dengan menggunakan media kontras yang larut
dalam air osmolalitas rendah (RENDAH). Makalah ini melaporkan penggunaan yang
memuaskan dari tiga media kontras tersebut, ioxaglate (Hexabrix), iohexol
(Omnipaque) dan iopamidol (Niopam) dalam 115 pemeriksaan saluran pencernaan
pada 89 bayi dan anak-anak. Morbiditas dari inhalasi atau ekstravasasi media
kontras diabaikan. Diusulkan bahwa media kontras RENDAH harus digunakan lebih
luas dalam penyelidikan gastro-intestinal dari semua bayi dan anak-anak "berisiko".

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https://appliedradiology.com/articles/selecting-contrast-media-for-pediatric-
fluoroscopy-a-primer

Selecting contrast media for pediatric

fluoroscopy: A primer

By Staff News Brief

What type of gastroenteric contrast media should be used for pediatric fluoroscopy? Pediatric
radiologists at Boston Children’s Hospital have prepared a comprehensive review of the enteric
contrast media they routinely use, which is intended to serve as a resource for radiology trainees or
adult radiologists who occasionally image children. Their article, published in  Pediatric Radiology,
supplements the primarily adult-based guidelines from the American College of Radiology’s Manual
on Contrast Media v10.2, and provides suggestions for the proper use of these media in children.

The authors begin with a discussion of the characteristics, technical considerations, and uses of
barium sulfate and iodinated water-soluble contrast media. Barium sulfate is an extremely versatile
gastroenteric contrast media, is well tolerated orally by most children, and is considerably less
expensive than most iodinated non-ionic contrast media. It is not absorbed or metabolized in the
gastrointestinal tract and is excreted unchanged. Because of its favorable safety profile and
versatility, barium sulfate is the most commonly used oral enteric media for fluoroscopy in children.
However, it is generally not used when there is a potential risl for a perforated viscus.

Although only one iodine-based low-osmolar contrast medium - iohexol (Omnipaque, GE

Healthcare) - has been cleared by the U.S. Food and Drug Administration (FDA) for pediatric
enteric use, the authors state that virtually any low-osmolar contrast media (LOCM) can be safely
used as enteric contrast media off label. LOCM offers the advantages of being water soluble, of
binding with organic compounds, and of having relatively low levels of toxicity.

Lead author Michael J. Callahan, MD, and colleagues describe six common types of fluoroscopy
procedures, explaining the indications for the studies and the types of contrast media used and how
they are administered. They offer several recommendations and cautions. Highlights include:

Contrast esophagram, upper gastrointestinal examinations and contrast

examination of the small bowel

These are the most commonly requested pediatric fluoroscopic gastrointestinal imaging studies,
and barium sulfate suspension is used for most of these procedures performed at Boston
Children’s. Water-soluble LOCM is used when a luminal leak or perforation is suspected. As such,
either barium sulfate solution or low iosmolar contrast media (LOCM) such as iohexol 180 should
be considered when administering enteric contrast media to premature neonates. It is the authors’
opinion that diatrizoate meglumine and diatrizoate sodium solution in whater should never be

8
administered orally to a pediatric patient because of the extreme hyperosmolarity of these media
and associated risks of aspiration pneumonitis and severe fluid shifts.

Enteric and ostomy catheter evaluations

This procedure is recommended for localization of gastrostomy, jejunostomy, gastrojejunostromy,

nasojejunostomy and ceostomy catheters. The authors perform a catheter injection of either LOCM
or barium sulfate via a syringe. LOCM is recommended in cases if an ostomy catheter may be
extraluminal or recently placed.

Modified barium swallow

At Boston Children’s both a radiologist and a speech pathologist work together to determine the
optimal way to administer barium sulfate powder mixed with liquids, semi-solid and solid food, and
to tailor the eneteric media used for these exams to each individual patient.

Diagnostic contrast enema

The majority of contrast enemas are performed in newborns to evaluate clinical and radiographic
signs of low intestinal obstruction. However, this exam is also performed for intractable
constipation, post-surgical evaluation of the colon and/or lower small intestine, and evaluation of
stricture in the setting of necrotizing enterocolitis.

The authors recommend the use of iothalamate megulumine for virtually all contrast enemas. They
note that although it has a lower iodine content than other iodinated water-soluble contrast media,
adequate visuallization is attained as a result of the large volume of contrast used. The authors do
not recommend that full-strength, undiluted diatrizoate meglumine and diatrizoate sodium solution
should ever be administered rectally to children of any age. Notably the authors rarely adminster
barium sulfate for contrast enemas at their institution.

Stomagrams

The authors use a Foley catheter advanced into the ostomy with the balloon inflated outside the
patient’s stoma. Iothalmate meglumine is administered via gravity for these studies..

Therapeutic contrast enema

For infants, the authors use equal volumes of diatrizoate meglumine and diatrizoate sodium
solution in water. They caution that infants should be well hydrated prior to the enema. For older
children and adolescents who have become obstructed due to viscous distal small bowel contents,
the authors use diatrizoate meglumine and diatrizoate sodium solution diluted with iothalmate
meglumine.

REFERENCE

1. Callahan MJ, Talmadge JM, MacDougall RD, et al. Selecting appropriate gastroenteric
contrast media for diagnostic fluoroscopic imaging in infants and children: a practical

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approach. Pediat Radiol. Published online October 10, 2016 DOI: 10.1007/s00247-016-
3709-5.

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