COMPARISON OF ULTRASOUND WITH CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FOR PEDIATRIC VASCULAR AND AVASCULAR HERNIA

Abstract

Background: Paediatric hernias often mimic acute abdominal emergencies, and prompt recognition of vascular compromise is crucial to avoid bowel ischaemia, strangulation and necrosis. There is a lack of evidence comparing the diagnostic performances of high-resolution ultrasonography (HRUS) with Doppler and contrast-enhanced computed tomography (CECT) in differentiating vascular from avascular paediatric hernia.

Objective: To compare the diagnostic accuracy of HRUS with CECT for the detection of vascular and avascular paediatric hernia in relation to intraoperative diagnosis as the gold standard.

Methodology: In this prospective observational study, 66 paediatric patients aged 0–14 years with clinically suspected hernias were recruited at Jinnah Hospital for four months. HRUS with colour Doppler and clinically indicated CECT were performed using standardized paediatric protocols. Imaging findings were compared with the study reference diagnosis, including operative findings when available, and paired results were analysed using McNemar’s exact test in SPSS.

Results: Among 66 patients, 44 (66.7%) were male. CECT identified vascular compromise in 28 patients (42.4%), while abnormal Doppler flow was recorded in 27 patients (40.9%). Abnormal Doppler flow was strongly associated with CECT-detected vascular compromise: compromise was present in 25 of 27 patients (92.6%) with abnormal flow but in only 3 of 39 patients (7.7%) with normal flow (Pearson chi-square = 47.081, p < 0.001). Ultrasound and CECT agreed with the study reference diagnosis in 62.1% and 78.8% of cases, respectively; the paired difference was statistically significant (McNemar exact p = 0.013).

Conclusion: CECT showed greater agreement with the study reference diagnosis and provided direct assessment of bowel-wall enhancement and vascular compromise. Doppler ultrasound remained a valuable radiation-free first-line examination, and abnormal flow was strongly associated with CECT-detected compromise. CECT should be reserved for equivocal or complicated cases in a stepwise paediatric imaging pathway.