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T1136 Head MRI Findings in Pediatric Patients with Aspiration
T1136
Management of Splenic Pseudoaneurysm Formation in a Child with Hereditary Pancreatitis Yonathan Fuchs, Ninfa Candela, Chris Sung, Toba A. Weinstein, Jeremiah J. Levine
Head MRI Findings in Pediatric Patients with Aspiration Aaron R. Pitzele, Kevin Preston, Chang Ho, Gregory Wilson, Mary Edwards-Brown, Steven J. Steiner
Splenic artery pseudoaneurysm (SAP) formation is an uncommon complication of pancreatitis. There are no known reports of SAP in the pediatric population or in patients with hereditary pancreatitis. We report a case in a child with hereditary pancreatitis that was successfully managed via transcatheter coil embolization of the splenic artery. A 5 year old male was referred with an elevated amylase and lipase, 200 and 188 u/L respectively, abdominal pain, and poor weight gain (BMI < 5%). Serology and pancreatic ultrasound confirmed the diagnosis of pancreatitis. The child had persistently elevated pancreatic enzymes and abdominal discomfort despite supportive therapy. Genetic testing revealed 2 mutations consistent with the diagnosis of hereditary pancreatitis: an R122H mutation in the PRSS1 gene and a SPINK1 gene mutation. Three months after presentation a CT scan was obtained secondary to severe abdominal pain, guarding, and fever. The study revealed an ill defined pancreas with heterogeneous enhancement. A CT angiogram confirmed the presence of a small splenic pseudoaneurysm. The area was selectively catheterized and embolized via the deployment of three coils in the distal splenic artery (Fig). Discussion: SAP is felt to be the result of weakening of the blood vessel wall by pancreatic enzymes. The lesion is typically first seen on CT. Direct catheter angiography serves to confirm the diagnosis and provide a means of therapy since embolization of the pseudoaneurysm can be accomplished during this procedure. Selective embolizaton with coils just distal and proximal to the lesion effectively excludes the aneurysm from circulation and enables thrombosis. Although SAP formation is seen in adults with chronic pancreatitis, there are no reports in patients with hereditary pancreatitis. This is the first report describing the use of transcatheter coil embolization in the management of a child with SAP.
Background: Although the location of the swallowing center has been thought to be in the brainstem, there is increasing evidence that white matter volume in the motor cortex may play an important role in swallowing function. Very limited head MRI data exist in pediatric patients with aspiration. Aim: To describe abnormalities in head MRI studies in pediatric patients with aspiration. Methods: We retrospectively identified children who had undergone fluoroscopic swallow study and were found to have tracheal aspiration. Of these patients, all who underwent head MRI were identified. Head MRI studies were re-reviewed by neuroradiologists, who measured white matter volume loss, documented the presence and size of the corpus callosum, and categorized findings such as ischemia, bleeding, hydrocephalus, and migrational/anatomic abnormalities. White matter volume was measured as the ratio of the width of white matter compared to the greatest width of the hemisphere in the axial plane at the level of the centrum semiovale. White matter volume loss was considered normal (>50%), borderline (46-50%), mild (41-45%), moderate (36-40%), or severe (<35%). In addition, patient histories were obtained on chromosomal, syndromic, metabolic, and gestational abnormalities. Results: 192 patients were identified. White matter volume loss was found in 153 (80%) patients (Table 1), and the corpus callosum was abnormal in 99 (52%) patients. A large proportion of the patients had a syndrome or chromosomal anomaly, and a smaller percentage had a prenatal or postnatal brain injury (Table 2). Conclusions: White matter volume loss was frequently observed in the head MRI studies of pediatric patients with aspiration. Head MRI should be considered in pediatric patients with aspiration or other swallowing dysfunction. Table 1: White Matter Volume Loss in Pediatric Patients with Aspiration
Table 2: Characteristics of Pediatric Patients with Aspiration
T1135 Results of a Structured Treatment Plan in Functional Constipation, a Practice Based Report Sudipta Misra, Nitin Kumar
T1137
High incidence of treatment resistant constipation has been reported. We present results of a structured treatment plan in functional constipation. Methods: In this retrospective study, charts of children treated for functional constipation at a subspecialty clinic were reviewed. These children were treated according to a protocol consisting of keeping a stool log, high fiber diet, adequate fluid intake, behavioral modification,use of anticonstipation agents for cleanout and maintenance phases (1 point for each to grade compliance) and follow up visits. Clinical data was recorded in a pre-printed data sheet. A packet with details of the treatment plan was given to the care givers and phone calls were encouraged. Children with organic causes of constipation were excluded. This study was approved by the Peoria Area Institutional Review Board of UICOMP. Results: Out of 204 children, 151 (74%) met Rome III criteria for constipation. 31 (15.2%) did not follow up after the first visit. Among the remaining 173 children, (mean age 68.8 months, range 1-196 months, 86 males) who followed up, 160 showed satisfactory improvement on a mean follow up time of 5.31 months (range 0.5 to 24 months. Children with soiling (n= 91) had an increased incidence of treatment failure (11 out of 13, p= 0.018) irrespective of presence of behavioral /psychological disorders (n= 17), stress factors (n= 11), difficult potty training (n= 44), age at potty training (n=106, mean = 31.5 months, range 12 to 74 months), holding back behavior (n=57), stool in rectal vault (n= 74), BMI above 85th centile (n= 31), compliance level (mean = 3.5, range 1-5), type of laxative and dose of polyethylene glycol 3350 (mean dose in 144 children 0.8 gm/kg/day) and mean duration of constipation (33.3 months, range 2-175 months). All the non responders with soiling had soft stools. Conclusion: Children and care givers who participated in the structured treatment plan did well except for those with non retentive fecal incontinence. Children lost on follow up (15.2%) may account for the reported high incidence of treatment failure in the literature. More than 25% of children were deemed clinically constipated though they did not meet the Rome III criteria.
The Effect of Daycare Attendance On Infant and Toddler's Growth Pnina Zmiri, Lisa Rubin, Hannah Akons, Ron Shaoul Introduction: many Israeli infants attend daycare centers from a very young age. This may be associated with recurrent infections, nutritional changes and significant stress in infants and toddlers due to the separation from their parents and the need for integration with peers. We hypothesized that growth may be negatively affected in children attending daycare centers. We therefore studied the association between daycare attendance and changes in the height, weight and weight/ height ratio over a 6 months period. Methods: Data was retrieved from 3 maternal and child health care centers in the Haifa area representing an average socioeconomic status. Parents were asked to fill a short questionnaire regarding the infant, the daycare and some demographic data. Results: One hundred and seventy infants participated in the study. The research group consisted of 85 infants that started daycare center prior to the age of 18 months, while the control group consisted of 85 infants who started daycare after this age. The main findings of the study showed that the research group had significantly shorter stature 3 months after the enrollment to the daycare compared to the control group (mean height percentiles of 56.9 versus 66.3, respectively, p=0.024,). This trend was even worse after 6 months (mean height percentiles of 52.3 versus 63.7, p= 0.022). Later age of enrollment to the daycare center was significantly associated (p=0.009) with height percentile deceleration. We did not find significant effects of daycare attendance on weight or weight/height ratio. Conclusions: The mechanism for this observation is possibly stress related growth hormone suppression. Our findings reinforce the importance of monitoring infant/toddler weight and height growth velocities, especially when he/she is introduced to daycare attendance T1138 6-OH Melatonin Sulfate Excretion in Children with Functional Gastrointestinal Disorders Genevieve Mailhot, Cindy Gauthier, Anita Franco, Alain Moreau, Christophe Faure Background and aim: Functional gastrointestinal disorders (FGID) are defined as recurrent symptoms unexplained by structural or biochemical anomalies and affect 15% of school-aged children. The pathophysiology of abdominal pain related to FGID is not clearly understood
A-507
AGA Abstracts
AGA Abstracts
T1134
Management of Splenic Pseudoaneurysm Formation in a Child with Hereditary Pancreatitis Yonathan Fuchs, Ninfa Candela, Chris Sung, Toba A. Weinstein, Jeremiah J. Levine
Head MRI Findings in Pediatric Patients with Aspiration Aaron R. Pitzele, Kevin Preston, Chang Ho, Gregory Wilson, Mary Edwards-Brown, Steven J. Steiner
Splenic artery pseudoaneurysm (SAP) formation is an uncommon complication of pancreatitis. There are no known reports of SAP in the pediatric population or in patients with hereditary pancreatitis. We report a case in a child with hereditary pancreatitis that was successfully managed via transcatheter coil embolization of the splenic artery. A 5 year old male was referred with an elevated amylase and lipase, 200 and 188 u/L respectively, abdominal pain, and poor weight gain (BMI < 5%). Serology and pancreatic ultrasound confirmed the diagnosis of pancreatitis. The child had persistently elevated pancreatic enzymes and abdominal discomfort despite supportive therapy. Genetic testing revealed 2 mutations consistent with the diagnosis of hereditary pancreatitis: an R122H mutation in the PRSS1 gene and a SPINK1 gene mutation. Three months after presentation a CT scan was obtained secondary to severe abdominal pain, guarding, and fever. The study revealed an ill defined pancreas with heterogeneous enhancement. A CT angiogram confirmed the presence of a small splenic pseudoaneurysm. The area was selectively catheterized and embolized via the deployment of three coils in the distal splenic artery (Fig). Discussion: SAP is felt to be the result of weakening of the blood vessel wall by pancreatic enzymes. The lesion is typically first seen on CT. Direct catheter angiography serves to confirm the diagnosis and provide a means of therapy since embolization of the pseudoaneurysm can be accomplished during this procedure. Selective embolizaton with coils just distal and proximal to the lesion effectively excludes the aneurysm from circulation and enables thrombosis. Although SAP formation is seen in adults with chronic pancreatitis, there are no reports in patients with hereditary pancreatitis. This is the first report describing the use of transcatheter coil embolization in the management of a child with SAP.
Background: Although the location of the swallowing center has been thought to be in the brainstem, there is increasing evidence that white matter volume in the motor cortex may play an important role in swallowing function. Very limited head MRI data exist in pediatric patients with aspiration. Aim: To describe abnormalities in head MRI studies in pediatric patients with aspiration. Methods: We retrospectively identified children who had undergone fluoroscopic swallow study and were found to have tracheal aspiration. Of these patients, all who underwent head MRI were identified. Head MRI studies were re-reviewed by neuroradiologists, who measured white matter volume loss, documented the presence and size of the corpus callosum, and categorized findings such as ischemia, bleeding, hydrocephalus, and migrational/anatomic abnormalities. White matter volume was measured as the ratio of the width of white matter compared to the greatest width of the hemisphere in the axial plane at the level of the centrum semiovale. White matter volume loss was considered normal (>50%), borderline (46-50%), mild (41-45%), moderate (36-40%), or severe (<35%). In addition, patient histories were obtained on chromosomal, syndromic, metabolic, and gestational abnormalities. Results: 192 patients were identified. White matter volume loss was found in 153 (80%) patients (Table 1), and the corpus callosum was abnormal in 99 (52%) patients. A large proportion of the patients had a syndrome or chromosomal anomaly, and a smaller percentage had a prenatal or postnatal brain injury (Table 2). Conclusions: White matter volume loss was frequently observed in the head MRI studies of pediatric patients with aspiration. Head MRI should be considered in pediatric patients with aspiration or other swallowing dysfunction. Table 1: White Matter Volume Loss in Pediatric Patients with Aspiration
Table 2: Characteristics of Pediatric Patients with Aspiration
T1135 Results of a Structured Treatment Plan in Functional Constipation, a Practice Based Report Sudipta Misra, Nitin Kumar
T1137
High incidence of treatment resistant constipation has been reported. We present results of a structured treatment plan in functional constipation. Methods: In this retrospective study, charts of children treated for functional constipation at a subspecialty clinic were reviewed. These children were treated according to a protocol consisting of keeping a stool log, high fiber diet, adequate fluid intake, behavioral modification,use of anticonstipation agents for cleanout and maintenance phases (1 point for each to grade compliance) and follow up visits. Clinical data was recorded in a pre-printed data sheet. A packet with details of the treatment plan was given to the care givers and phone calls were encouraged. Children with organic causes of constipation were excluded. This study was approved by the Peoria Area Institutional Review Board of UICOMP. Results: Out of 204 children, 151 (74%) met Rome III criteria for constipation. 31 (15.2%) did not follow up after the first visit. Among the remaining 173 children, (mean age 68.8 months, range 1-196 months, 86 males) who followed up, 160 showed satisfactory improvement on a mean follow up time of 5.31 months (range 0.5 to 24 months. Children with soiling (n= 91) had an increased incidence of treatment failure (11 out of 13, p= 0.018) irrespective of presence of behavioral /psychological disorders (n= 17), stress factors (n= 11), difficult potty training (n= 44), age at potty training (n=106, mean = 31.5 months, range 12 to 74 months), holding back behavior (n=57), stool in rectal vault (n= 74), BMI above 85th centile (n= 31), compliance level (mean = 3.5, range 1-5), type of laxative and dose of polyethylene glycol 3350 (mean dose in 144 children 0.8 gm/kg/day) and mean duration of constipation (33.3 months, range 2-175 months). All the non responders with soiling had soft stools. Conclusion: Children and care givers who participated in the structured treatment plan did well except for those with non retentive fecal incontinence. Children lost on follow up (15.2%) may account for the reported high incidence of treatment failure in the literature. More than 25% of children were deemed clinically constipated though they did not meet the Rome III criteria.
The Effect of Daycare Attendance On Infant and Toddler's Growth Pnina Zmiri, Lisa Rubin, Hannah Akons, Ron Shaoul Introduction: many Israeli infants attend daycare centers from a very young age. This may be associated with recurrent infections, nutritional changes and significant stress in infants and toddlers due to the separation from their parents and the need for integration with peers. We hypothesized that growth may be negatively affected in children attending daycare centers. We therefore studied the association between daycare attendance and changes in the height, weight and weight/ height ratio over a 6 months period. Methods: Data was retrieved from 3 maternal and child health care centers in the Haifa area representing an average socioeconomic status. Parents were asked to fill a short questionnaire regarding the infant, the daycare and some demographic data. Results: One hundred and seventy infants participated in the study. The research group consisted of 85 infants that started daycare center prior to the age of 18 months, while the control group consisted of 85 infants who started daycare after this age. The main findings of the study showed that the research group had significantly shorter stature 3 months after the enrollment to the daycare compared to the control group (mean height percentiles of 56.9 versus 66.3, respectively, p=0.024,). This trend was even worse after 6 months (mean height percentiles of 52.3 versus 63.7, p= 0.022). Later age of enrollment to the daycare center was significantly associated (p=0.009) with height percentile deceleration. We did not find significant effects of daycare attendance on weight or weight/height ratio. Conclusions: The mechanism for this observation is possibly stress related growth hormone suppression. Our findings reinforce the importance of monitoring infant/toddler weight and height growth velocities, especially when he/she is introduced to daycare attendance T1138 6-OH Melatonin Sulfate Excretion in Children with Functional Gastrointestinal Disorders Genevieve Mailhot, Cindy Gauthier, Anita Franco, Alain Moreau, Christophe Faure Background and aim: Functional gastrointestinal disorders (FGID) are defined as recurrent symptoms unexplained by structural or biochemical anomalies and affect 15% of school-aged children. The pathophysiology of abdominal pain related to FGID is not clearly understood
A-507
AGA Abstracts
AGA Abstracts
T1134