DIAGNOSTICA PER IMMAGINI NELLE MALATTIE INFIAMMATORIE CRONICHE DELL'INTESTINO NELL'ETA PEDIATRICA

: Chronic inflammatory bowel disease (CIBD) in children is represented mainly by ulcerative colitis (UC) and Crohn's disease (CD). Infectious forms, Behcet's disease and eosinophilic gastroenteritis are not included in this study. UC and CD are difficult to diagnose and to treat, and require a multispecialistic approach including pediatric gastroenterologists, surgeons, radiologists, endoscopists and pathologists. Progress in diagnostic techniques--i.e., nuclear medicine procedures, conventional, duplex and color-Doppler US, and endoscopy--has increased our knowledge of these diseases and it has made their diagnosis easier, opening new therapeutic perspectives. In our paper, after mentioning the major clinical and radiologic features of CIBD, we report on the patients hospitalized in the Gaslini Institute from 1984 to 1994. Thirty-six patients (age range: 3,9 to 14 years) were examined with several imaging techniques--i.e., plain radiography, US, contrast studies and CT--according to the clinical presentation and behavior of the disease. X-ray studies played the leading role in imaging mucosal disease spread (double contrast studies) and monitoring "surgical" complications (plain radiography). These techniques, which were always combined with US and, in some cases, CT, are also a major tool to study extraluminal CIBD spread--i.e., fistulas, pseudotumors, lymph nodes, abscesses and mesenteric changes. Color-Doppler US may play a critical role in the differential diagnosis of these and other small and large bowel pathologic conditions. The most typical CD patterns in bowel disease are listed in the paper, to give a contribution to the differential diagnosis of the chronic abdominal pain syndrome which is a very common condition in children.