• U Nadeem DHQ Hospital, Sheikhupura
  • N Anjum Diplomat American Board of Radiology, Radiology Research Section FAHS, UOL, Lahore,
  • F Farooq Radiology Department, UOL Teaching Hospital, Lahore
  • SA Gillani Radiology Research Section, Faculty of Allied Health Science, University of Lahore
  • Qurratulain Leads University, Lahore




Acute abdominal pain, Appendicities, necrotizing enterocolitis, Crohn’s disease, Ulcer disease, IBD


Objective: In this study, our major concern is to evaluate the efficacy of ultrasonography with the help of previous literature. Ultrasonography is a major instrument to diagnose the initial abdomen pain but its sensitivity and specificity level are highly neglected in some studies. In this study, we aim to gather all the relevant data of the past decade and perform a systematic review on it. Methodology: For this study, we follow the Preferred Reporting Items guideline for conducting this systematic review analysis (PRISMA). We search electronic articles from 2011 to 2018 on PUB Med, online Willey library, and ScienceDirect and Research Gate site. Results: At the initial stage of gathering data, we found seven hundred and sixty-two articles with selected keywords.   In the first screening, we excluded 262 duplicate articles and further screen out the rest of 498 articles. At the last stage, we found 24 articles that fulfilled the inclusion criteria and had adequate data on our topic. In the summary of weighted values of data, we observed that both sensitivity and specificity of the collected data are greater than 90%. Conclusion: A complete evaluation of acute abdominal pain needs time and experience to detect the morphological association of abdominal structures and their functioning. Ultrasonography assists in quick evaluation of the intestine wall with the association of laboratory and clinical outcomes.


Download data is not yet available.


Adolph, V. R., & Bernabe, K. (2008). Polyps in children. Clinics in colon and rectal surgery, 21(4), 280-285.

Ahmad, T. M., Greer, M. L., Walters, T. D., & Navarro, O. M. (2016). Bowel sonography and MR enterography in children. American Journal of Roentgenology, 206(1), 173-181.

Apley, J., & Naish, N. (1958). Recurrent abdominal pains: a field survey of 1,000 school children. Archives of Disease in Childhood, 33(168), 165.

Baldisserotto, M., & Marchiori, E. (2000). Accuracy of noncompressive sonography of children with appendicitis according to the potential positions of the appendix. American Journal of Roentgenology, 175(5), 1387-1392.

Ballance, W. A., Dahms, B. B., Shenker, N., & Kliegman, R. M. (1990). Pathology of neonatal necrotizing enterocolitis: a ten-year experience. The Journal of Pediatrics, 117(1), S6-S13.

Barber, J. L., Maclachlan, J., Planche, K., Furman, M., Crespi, D., Bab, N., & Beal, I. (2017). There is good agreement between MR enterography and bowel ultrasound with regards to disease location and activity in paediatric inflammatory bowel disease. Clinical Radiology, 72(7), 590-597.

Battersby, C., Santhalingam, T., Costeloe, K., & Modi, N. (2018). Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review. Archives of Disease in Childhood-Fetal and Neonatal Edition, 103(2), F182-F189.

Casciani, E., De Vincentiis, C., Polettini, E., Masselli, G., Di Nardo, G., Civitelli, F., ... & Gualdi, G. F. (2014). Imaging of the small bowel: Crohn’s disease in paediatric patients. World Journal of Radiology, 6(6), 313.

Cervero, F. (1988). Neurophysiology of gastrointestinal pain. Bailliere's Clinical Gastroenterology, 2(1), 183-199.

Chaubal, N., Dighe, M., Shah, M., & Chaubal, J. (2006). Sonography of the gastrointestinal tract. Journal of Ultrasound in Medicine, 25(1), 87-97.

Chiorean, L., Schreiber-Dietrich, D., Braden, B., Cui, X. W., & Dietrich, C. F. (2014). Transabdominal ultrasound for standardized measurement of bowel wall thickness in normal children and those with Crohn’ s disease. Medical Ultrasonography, 16(4), 319-324.

Chiorean, L., Schreiber-Dietrich, D., Braden, B., Cui, X. W., Buchhorn, R., Chang, J. M., & Dietrich, C. F. (2015). Ultrasonographic imaging of inflammatory bowel disease in pediatric patients. World Journal of Gastroenterology, 21(17), 5231. 7.5231.

Chiorean, L., Schreiber-Dietrich, D., Braden, B., Cui, X. W., Buchhorn, R., Chang, J. M., & Dietrich, C. F. (2015). Ultrasonographic imaging of inflammatory bowel disease in pediatric patients. World Journal of Gastroenterology, 21(17), 5231.

Civitelli, F., Di Nardo, G., Oliva, S., Nuti, F., Ferrari, F., Dilillo, A., ... & Aloi, M. (2014). Ultrasonography of the colon in pediatric ulcerative colitis: a prospective, blind, comparative study with colonoscopy. The Journal of Pediatrics, 165(1), 78-84.

de Ridder, L., van Lingen, A. V., Taminiau, J. A., & Benninga, M. A. (2007). Rectal bleeding in children: endoscopic evaluation revisited. European Journal of Gastroenterology & Hepatology, 19(4), 317-320.

Di Serafino, M., Severino, R., Gullotto, C., Lisanti, F., & Scarano, E. (2017). Idiopathic renal infarction mimicking appendicitis. Case reports in emergency medicine, 2017:8087315.

Dillman, J. R., Smith, E. A., Sanchez, R., DiPietro, M. A., Dehkordy, S. F., Adler, J., ... & Davenport, M. S. (2016). Prospective cohort study of ultrasound-ultrasound and ultrasound-MR enterography agreement in the evaluation of pediatric small bowel Crohn disease. Pediatric Radiology, 46(4), 490-497.

Doniger, S. J., & Kornblith, A. (2018). Point-of-care ultrasound integrated into a staged diagnostic algorithm for pediatric appendicitis. Pediatric Emergency Care, 34(2), 109-115.

Doria, A. S. (2009). Optimizing the role of imaging in appendicitis. Pediatric Radiology, 39(2), 144-148.

Esposito, F., Di Serafino, M., Mercogliano, C., Ferrara, D., Vezzali, N., Di Nardo, G., ... & Zeccolini, M. (2019). The pediatric gastrointestinal tract: ultrasound findings in acute diseases. Journal of Ultrasound, 1-14.

Esposito, F., Mamone, R., Di Serafino, M., Mercogliano, C., Vitale, V., Vallone, G., & Oresta, P. (2017). Diagnostic imaging features of necrotizing enterocolitis: a narrative review. Quantitative Imaging in Medicine and Surgery, 7(3), 336.

Garbi-Goutel, A., Brévaut-Malaty, V., Panuel, M., Michel, F., Merrot, T., & Gire, C. (2014). Prognostic value of abdominal sonography in necrotizing enterocolitis of premature infants born before 33 weeks gestational age. Journal of Pediatric Surgery, 49(4), 508-513.

Han, T. I. (2002). Improved sonographic visualization of the appendix with a saline enema in children with suspected appendicitis. Journal of Ultrasound in Medicine, 21(5), 511-516.

He, Y., Zhong, Y., Yu, J., Cheng, C., Wang, Z., & Li, L. (2016). Ultrasonography and radiography findings predicted the need for surgery in patients with necrotising enterocolitis without pneumoperitoneum. Acta Paediatrica,105(4): e151-e155.

Hwang, J. Y. (2017). Emergency ultrasonography of the gastrointestinal tract of children. Ultrasonography, 36(3), 204.

Kim, C., Kang, B. S., Choi, H. J., Lim, T. H., Oh, J., & Chee, Y. (2015). Clinical application of real-time tele-ultrasonography in diagnosing pediatric acute appendicitis in the ED. The American Journal of Emergency Medicine, 33(10), 1354-1359.

Kokurewicz, T., Ogórek, R., Pusz, W., & Matkowski, K. (2016). Bats increase the number of cultivable airborne fungi in the “Nietoperek” bat reserve in Western Poland. Microbial Ecology, 72(1), 36-

Lam, S. H., Grippo, A., Kerwin, C., Konicki, P. J., Goodwine, D., & Lambert, M. J. (2014). Bedside ultrasonography as an adjunct to routine evaluation of acute appendicitis in the emergency department. Western Journal of Emergency Medicine, 15(7), 808.

Levine, A., Koletzko, S., Turner, D., Escher, J. C., Cucchiara, S., de Ridder, L., ... & Wilson, D. C. (2014). ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. Journal of Pediatric Gastroenterology and Nutrition, 58(6), 795-806.

Moon, S. M., Jung, H. K., Ko, K. H., Kim, Y., & Lee, K. S. (2016). Management of Clinically and Mammographically Occult Benign Papillary Lesions Diagnosed at Ultrasound‐Guided 14‐Gauge Breast Core Needle Biopsy. Journal of Ultrasound in Medicine, 35(11), 2325-2332.

Muchantef, K., Epelman, M., Darge, K., Kirpalani, H., Laje, P., & Anupindi, S. A. (2013). Sonographic and radiographic imaging features of the neonate with necrotizing enterocolitis: correlating findings with outcomes. Pediatric Radiology, 43(11), 1444-1452.

Neu, J., & Walker, W. A. (2011). Necrotizing enterocolitis. New England Journal of Medicine, 364(3), 255-264.

Palleri, E., Kaiser, S., Wester, T., Arnell, H., & Bartocci, M. (2017). Complex fluid collection on abdominal ultrasound indicates need for surgery in neonates with necrotizing enterocolitis. European Journal of Pediatric Surgery, 27(02), 161-165.

Parra, D. A., & Navarro, O. M. (2008). Sonographic diagnosis of intestinal polyps in children. Pediatric Radiology, 38(6), 680-684.

Prithviraj, D., Sandeep, B., Suresh, A., Balaraju, V., & Mondal, S. (2015). Comparison between X-ray and Abdominal Ultrasound Findings of Necrotizing Enterocolitis, its Usefulness in Early Diagnosis, Prognosis, and to Assess, is this is the Time to Change our View of Surgeon’s Intervention According to the Bell’s Criteria. Prognosis, and to Assess, is this is the Time to Change our View of Surgeon’s Intervention According to the Bell’s Criteria, 3, 12.

Schuh, S., Chan, K., Langer, J. C., Kulik, D., Preto‐Zamperlini, M., Aswad, N. A., ... & Doria, A. S. (2015). Properties of serial ultrasound clinical diagnostic pathway in suspected appendicitis and related computed tomography use. Academic Emergency Medicine, 22(4), 406-414.

Schuh, S., Man, C., Cheng, A., Murphy, A., Mohanta, A., Moineddin, R., ... & Doria, A. S. (2011). Predictors of non-diagnostic ultrasound scanning in children with suspected appendicitis. The Journal of Pediatrics, 158(1), 112-118.

Sivitz, A. B., Cohen, S. G., & Tejani, C. (2014). Evaluation of acute appendicitis by pediatric emergency physician sonography. Annals of Emergency Medicine, 64(4), 358-364.

Staryszak, J., Stopa, J., Kucharska-Miąsik, I., Osuchowska, M., Guz, W., & Błaż, W. (2015). Usefulness of ultrasound examinations in the diagnostics of necrotizing enterocolitis. Polish Journal of Radiology, 80, 1.

Trout, A. T., Sanchez, R., Ladino-Torres, M. F., Pai, D. R., & Strouse, P. J. (2012). A critical evaluation of US for the diagnosis of pediatric acute appendicitis in a real-life setting: how can we improve the diagnostic value of sonography?. Pediatric Radiology, 42(7), 813-823.

Trout, A. T., Towbin, A. J., Fierke, S. R., Zhang, B., & Larson, D. B. (2015). Appendiceal diameter as a predictor of appendicitis in children: improved diagnosis with three diagnostic categories derived from a logistic predictive model. European Radiology, 25(8), 2231-2238.

Tsai, T. L., Marine, M. B., Wanner, M. R., Cooper, M. L., Steiner, S. J., Ouyang, F., ... & Karmazyn, B. (2017). Can ultrasound be used as the primary imaging in children with suspected Crohn disease?. Pediatric Radiology, 47(8), 917-923.

Tulin-Silver, S., Babb, J., Pinkney, L., Strubel, N., Lala, S., Milla, S. S., ... & Fefferman, N. R. (2015). The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity. Pediatric Radiology, 45(6), 820-830.

Vitale, V., Di Serafino, M., Mercogliano, C., & Vallone, G. (2016). Giant colon polyp in a child with suspected inflammatory bowel disease: US findings. Journal of Ultrasound, 19(1), 53-55.

Wang, L., Li, Y., & Liu, J. (2016). Diagnostic value and disease evaluation significance of abdominal ultrasound inspection for neonatal necrotizing enterocolitis. Pakistan Journal of Medical Sciences, 32(5), 1251.

Wyrick, D. L., Smith, S. D., Burford, J. M., & Dassinger, M. S. (2015). Surgeon-performed ultrasound: accurate, reproducible, and more efficient. Pediatric Surgery International, 31(12), 1161-1164.

Yikilmaz, A., Hall, N. J., Daneman, A., Gerstle, J. T., Navarro, O. M., Moineddin, R., ... & Pierro, A. (2014). Prospective evaluation of the impact of sonography on the management and surgical intervention of neonates with necrotizing enterocolitis. Pediatric Surgery International, 30(12), 1231-1240.

Ziech, M. L., Hummel, T. Z., Smets, A. M., Nievelstein, R. A., Lavini, C., Caan, M. W., ... & Stoker, J. (2014). Accuracy of abdominal ultrasound and MRI for detection of Crohn disease and ulcerative colitis in children. Pediatric Radiology, 44(11), 1370-1378.




How to Cite

Nadeem, U., Anjum, N., Farooq, F., Gillani, S., & Qurratulain. (2021). A SONOGRAPHIC EVALUATION OF PEDIATRIC ACUTE ABDOMINAL PAIN: A SYSTEMATIC REVIEW . Biological and Clinical Sciences Research Journal, 2021(1). https://doi.org/10.54112/bcsrj.v2021i1.60



Systematic Reviews