REVIEW Gastrointestinal pathology in neonates: new imaging strategies Stephanie Ryan & Veronica Donoghue Received: 5 January 2010 / Accepted: 24 January 2010 # Springer-Verlag 2010 Abstract The mainstay of imaging of gastrointestinal (GI) pathology in infants has always been and still is the plain radiograph of the abdomen and conventional contrast studies. In this review emphasis is placed on the situations where there are new imaging strategies and alternative modalities of imaging, including US, CT, MRI and radionuclide studies. This review will deal with GI pathology in the newborn and in the older neonate. It will also refer to any new approaches to imaging GI pathology in the premature infant. Finally the review will address how antenatal diagnosis of gastrointestinal tract abnormalities has changed the imaging strategy and management of the neonate. Keywords Gastrointestinal . US . MRI . CT . Radioisotope . Neonate . Infant Introduction The mainstay of imaging of gastrointestinal (GI) pathology in infants has always been and still is the plain radiograph of the abdomen and conventional contrast studies. In this review emphasis is placed on the situations where there are new imaging strategies and alternative modalities of imaging, including ultrasound, CT, MRI and scintigraphy, and these shall be put into context of management of neonates and the role of alternative imaging will be defined in reference to the plain film and contrast studies. This review will deal with GI pathology (excluding liver, biliary system and pancreas) in the newborn—mostly obstruction such as atresia, meconium ileus and Hirsch- sprung disease (HD)—and also duplication cysts. It will also deal with GI pathology in the older neonate such as pyloric stenosis, malrotation and volvulus and feeding difficulties. It will also refer to any new approaches to imaging GI pathology in the premature infant especially necrotising enterocolitis (NEC) and its complications. Lastly this review will address how antenatal diagnosis of GI tract abnormalities by US, MRI and amniotic fluid digestive enzyme (AFDE) assays has changed the imaging strategy and management of the neonate. Gastrointestinal pathology in the term newborn Intestinal obstruction When a baby presents with abdominal distension and failure to pass meconium, a clinical diagnosis of intestinal obstruction is made. A plain abdominal radiograph can distinguish between duodenal obstruction, jejunal atresia and more distal atresia. It is not usually possible to distinguish ileal obstruction from colonic obstruction on the plain radiograph alone. Traditionally the next investigation has been a contrast enema. An abdominal US may have a role here. With US one can distinguish dilated from collapsed loops (Fig. 1). One can often distinguish ileal loops from colon and it is also possible to distinguish the dilated fluid-filled loop proximal to an atresia from the dilated meconium-filled loop of a meconium ileus [1]. It may be possible to proceed directly to surgery for jejunal or ileal atresia or to proceed to reduction of a meconium ileus by contrast enema. S. Ryan (*) : V. Donoghue Department of Radiology, Children’ s University Hospital, Temple Street, Dublin 1, Ireland e-mail: stephanie.ryan@cuh.ie Pediatr Radiol (2010) 40:927–931 DOI 10.1007/s00247-010-1582-1