DIFFERENTIAL DIAGNOSTIC TECHNIQUE FOR CHRONIC INFLAMMATORY INTESTINAL DISEASES IN CHILDREN Russian patent published in 2015 - IPC A61B8/08 A61B8/06 

FIELD: medicine.

SUBSTANCE: technique involves transabdominal ultrasonography of jejumum and colon in longitudinal and transversal projections. The transabdominal ultrasonography is native with the patient positioned on his/her back. Visualising all the jejuneal segment involves taking intestinal loops without haustra as reference points. haustra are used as reference points for visualising the colon. pulsed Doppler velocimetry is conducted to determine a blood flow velocity in mesenterial arterial branches. A transperineal examination of the anorectal area is performed in the patient placed on his/her left side with bended knees. A sensor is placed into an anal pit directly and displaced from pubic to sacrum while scanning in two projections - longitudinal and longitudinal-oblique. The reference points are sacrum, symphysis, and anal canal. The state of a distal portion of rectal ampulla is assessed. The derived values are compared to the normal criteria. If observing any changes in the jejunum: wall thickening more than 2 mm, higher echogenicity, intestinal lumen narrowing; if observing any changes in the colon: haustra flatness, contour roughness, wall thickening more than 2.5 mm, mucosal thickness more than 1 mm, submucosal thickness more than 0.5 mm, the absence of clear layer differentiation, higher submucosal echogenicity, intestinal lumen narrowing, higher blood flow velocity in the mesenterial arterial branches more than 7.0 cm/sec; changes in adjoining organs: higher echogenicity of the greater omentum, envelopment of the jejuneal and colonic loops involved into the inflammatory process with the omentum, lengthening of the mesenterial, para-aortic lymph nodes more than 10 mm, free abdominal fluid, the changes in the anorectal area: rectal ampulla wall thickening more than 2.5 mm, higher echogenicity of perineal subcutaneous fat, anorectal fistulas and paraproctitis testify to the presence of colonic and jejuneal wall hyperplasia in the involved portions, mesenterial, para-aortic lymph node hyperplasia, reactive changes of the greater omentum, as well as the presence of a perineal inflammation, and Crohn's disease is diagnosed. The changes in the colon only: haustra flatness, smooth contours, wall thickening more than 2.5 mm, mucosal thickness more than 1 mm, submucosal thickness more than 0.5 mm, reduced clear differentiation, lower submucosal echogenicity, no intestinal lumen narrowing, higher blood flow velocity in the mesenterial arterial branches more than 7.0 cm/sec; changes in the adjoining organs: lengthened mesenterial and para-aortic lymph nodes more than 10 mm, no reactive changes of omentum, rectal ampulla wall thickening more than 2.5 mm without involving the perineal region testifies to colonic wall hyperplasia and mesenterial, para-aortic lymph nodes and enables diagnosing non-specific ulcerative colitis.

EFFECT: technique enables performing the early differential diagnosis of chronic inflammatory intestinal diseases by using the accurate qualitative and quantitative ultrasonic criteria.

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