When screening for bowel-related pathology in pediatric patients, upper limit values for guidance are 1.9 mm bowel wall thickness in the small bowel and colon of healthy children, with the mean thickness slightly increasing with age in the jejunum and colon, according to a study published in Pediatric Radiology.

Ultrasound is a noninvasive assessment method of imaging the bowel, which makes it suitable for screening use in children, such as inflammatory bowel disease (IBS).   For the proper interpretation of US results in cases of suspected bowel disease, knowledge regarding US findings of bowels of healthy children is needed, according to the researchers. The current study was designed to assess bowel wall thickness in different segments of the bowels of healthy children and to assess differences in bowel wall thickness between pediatric age categories (0-4 years, 5-9 years, 10-14 years, 15-19 years). To this end, investigators conducted a search in the CINAHL, Cochrane, Embase, and PubMed databases for studies describing bowel wall thickness in healthy children as measured by transabdominal US. Studies using contrast agents were excluded.  

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Of the 191 identified studies, 7 were included in the systematic review. Reported values for bowel wall thickness ranged from 0.5 mm to 1.1 mm in the jejunum, 0.6 mm to 1.9 mm in the ileum, 0.7 mm to 1.9 mm in the cecum, and 0.7 mm to 1.9 mm in the colon. No measurements in specific age categories were reported in four studies. In the studies that reported measurements, the differences in mean bowel wall thickness between children aged 0 to 4 and those 15 to 19 were 0.5 mm in the cecum, 0.3 mm in the ascending colon, 0.4 mm in the transverse colon, and 0.2 in the descending colon (all P <.01).

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Study investigators concluded that the “values for bowel wall thickness reported in this systematic review can be used as guidance when screening for bowel-related pathology. However, for the development of strict reference values of bowel wall thickness in healthy children, larger studies with strict methodology are needed.”


van Wassenaer EA, de Voogd FAE, van Rijn RR, et al. Bowel ultrasound measurements in healthy children — systematic review and meta-analysis [published online December 14, 2019]. Pediatr Radiol. doi: 10.1007/s00247-019-04567-2