Diseases of the Peritoneum, Mesentery, and Omentum


Diseases involving the peritoneum, mesentery and omentum are numerous; they include among others, effusions and abscesses, consequences of intestinal malrotation and tumors. Many will be discovered during the work-up acute abdominal symptoms.

Ultrasound (US) will be the initial and preferred imaging method performed in order to evaluate peritoneal diseases in children, especially for the assessment of collections and tumors. It may also be used to guide drainage. Unfortunately, US does not provide global assessment of the abdominal and pelvic anatomy; cross sectional imaging will be necessary in complex or extensive diseases.

CT enables a much better evaluation of the peritoneal cavity and allows clearer differentiation between intra-, retro- and extra-peritoneal diseases. The main other advantages of CT are its availability, lack of operator dependency and the short duration of the examination. As usual its use should be customized and cautiously adapted to the child and to the clinical indication. Newer equipment reduces dramatically the amount of ionizing radiation.

MR imaging is and should be increasingly used to evaluate peritoneal diseases. Lack of ionizing radiation is a big advantage over CT. Yet, the technique may have a lower spatial resolution than CT, depending on the sequences employed. Newer sequences might reduce the time of acquisition of the images. The need for Gadolinium chelates injection is considered by many as a limiting factor as well.

Finally, an opacification of the upper GI tract could be of interest in selected cases of intestinal obstruction in relation with suspected malrotation.

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