RESUMEN
Appendicitis and diverticulitis of the colon are the two main causes of febrile acute abdomen in adults. Diagnosis from imaging (ultrasound and CT) is usually easy. However, an imaging procedure which is not suitable for the clinical situation and an examination performed with the wrong protocol are sources of error and must be avoided. Anatomical variants, inflammatory cancers, complicated forms (perforation, secondary occlusion of the small intestine, peripheral abscesses, fistulae, pylephlebitis, liver abscesses) and associated signs related to a peritoneal inflammatory reaction (reflex ileus, reactive ileitis or salpingitis) can also lead to a wrong diagnosis.
Asunto(s)
Apendicitis/diagnóstico por imagen , Enfermedades del Colon/diagnóstico por imagen , Diverticulitis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Diagnóstico Diferencial , Errores Diagnósticos , Humanos , UltrasonografíaRESUMEN
This case report describes a 77-year-old male, who presented to the emergency room with symptoms of an acute proximal small bowel obstruction. Abdominal CT scan with multi-planar reconstructions led to the diagnosis of an intestinal obstruction due to impaction of a large gallstone in the second portion of the duodenum. The CT scan demonstrated a large cholecysto-duodenal fistula as the origin of the gallstone migration. Surgical treatment consisted of milking the stone down beyond the ligament of Treitz, where it was removed through a jejunal enterotomy. The postoperative course was uncomplicated. No attempt was made to repair the choledocho-duodenal fistula at the initial intervention nor subsequently, and there have been no complications due to the fistula over 36 months of follow-up observation.
Asunto(s)
Fístula Biliar/diagnóstico por imagen , Obstrucción Duodenal/etiología , Cálculos Biliares/diagnóstico por imagen , Fístula Intestinal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Fístula Biliar/complicaciones , Obstrucción Duodenal/diagnóstico por imagen , Enfermedades de la Vesícula Biliar/complicaciones , Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Cálculos Biliares/complicaciones , Humanos , Fístula Intestinal/complicaciones , Masculino , SíndromeRESUMEN
Large bowel volvulus is a rare condition that can occur in patients who present with acute abdominal pain. Radiologists should be able to recognise its appearance on multidetector CT (MDCT) images so that the correct diagnosis can be made and catastrophic consequences can be avoided. In this article, we discuss and illustrate the MDCT and three-dimensional appearance of the various forms of large bowel volvulus. As MDCT allows the precise diagnosis of topography, mechanism and severity, this technique can provide an accurate assessment of large bowel volvulus.
Asunto(s)
Enfermedades Funcionales del Colon/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador , Vólvulo Intestinal/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Medios de Contraste , Humanos , Imagenología Tridimensional , Ilustración MédicaRESUMEN
INTRODUCTION: The treatment of pseudomyxoma peritonei (PMPs) and appendiceal mucocele (AM) has changed radically. To assess the contribution of preoperative imaging to the treatment strategy and choice of approach, a surgeon and a radiologist different from the initial radiologist examined the files of all patients treated for PMP or AM in four facilities in one district from January 1, 1996, through December 31, 2008. PATIENTS AND METHODS: The study included 27 patients (20 men and seven women, mean age: 63+/-13 years). Eleven patients had an intact AM, seven synchronous PMP (malignant appendiceal lesion in two of seven), six metachronous PMP (five with peritoneal mucinous carcinomatosis and one with diffuse peritoneal adenomucinosis) and three a ruptured AM but not PMP. The incidence of mucin-secreting tumors observed (27 cases in 12 years in a region of 500 000 inhabitants) corresponds to a prevalence of approximately five cases per year per million inhabitants. Acute clinical pictures (7/27) were significantly more frequent for the malignant forms (5/7) (p<0,02). RESULTS AND DISCUSSION: The overall sensitivity of computed tomography (CT) for all the criteria studied was 93%. The predictive value for AM rupture of visualization of thick calcifications was 100%. On the other hand, rupture never occurred when the CT showed an AM under pressure, with thin walls and septa. The predictive value for PMP of "scalloping" was 100%. The diagnostic accuracy of the initial reading was 25/27 for the imaging overall and 25/25 for the CT. Preoperative visualization of the exact size of the intact AM or of diagnostic information about ruptured AM and PMP helped to select an appropriate approach in 25 of 27 cases.
Asunto(s)
Adenocarcinoma Mucinoso/diagnóstico por imagen , Neoplasias del Apéndice/diagnóstico por imagen , Apéndice/diagnóstico por imagen , Mucocele/diagnóstico por imagen , Neoplasias Peritoneales/diagnóstico por imagen , Seudomixoma Peritoneal/diagnóstico por imagen , Adenocarcinoma Mucinoso/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias del Apéndice/cirugía , Apéndice/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mucocele/cirugía , Neoplasias Peritoneales/cirugía , Valor Predictivo de las Pruebas , Cuidados Preoperatorios , Seudomixoma Peritoneal/cirugía , Rotura , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos XRESUMEN
The authors describe a case of pharmaco-bezoar consisting of ingested cholestyramine which occurred post pancreaticoduodenectomy. Intestinal obstruction by a cholestyramine bezoar is a rare occurrence but is worthy of note in the post-pancreatectomy setting where there is often concomitant use of cholestyramine, proton pump inhibitors, and octreotide.
Asunto(s)
Bezoares/inducido químicamente , Resina de Colestiramina/efectos adversos , Colon Transverso , Enfermedades del Colon/etiología , Fármacos Gastrointestinales/efectos adversos , Obstrucción Intestinal/etiología , Pancreaticoduodenectomía/efectos adversos , Adenocarcinoma/cirugía , Anciano , Antiulcerosos/efectos adversos , Anticolesterolemiantes/efectos adversos , Bezoares/cirugía , Colestasis/tratamiento farmacológico , Colestasis/etiología , Resina de Colestiramina/administración & dosificación , Colectomía , Colon Transverso/cirugía , Enfermedades del Colon/cirugía , Quimioterapia Combinada , Femenino , Fármacos Gastrointestinales/administración & dosificación , Humanos , Obstrucción Intestinal/cirugía , Octreótido/efectos adversos , Omeprazol/efectos adversos , Fístula Pancreática/prevención & control , Neoplasias Pancreáticas/cirugía , Inhibidores de la Bomba de Protones/efectos adversos , Factores de Riesgo , Resultado del TratamientoAsunto(s)
Apendicitis/etiología , Hernia Femoral/complicaciones , Hernia Inguinal/complicaciones , Apendicectomía/métodos , Apendicitis/diagnóstico por imagen , Diagnóstico Diferencial , Hernia Femoral/diagnóstico por imagen , Hernia Inguinal/diagnóstico por imagen , Humanos , Laparoscopía , Tomografía Computarizada por Rayos XRESUMEN
Thickening of the gallbladder wall may result from a large spectrum of pathological conditions, intrinsic as well as extrinsic to the biliary tract, and may have different appearances. Accurate diagnosis is usually established after a correlation of imaging findings, laboratory data and clinical history. US remains the initial imaging modality for the evaluation of acute right upper quadrant pain. CT and MRI are complementary to US and have an increasing role in assessing a thickened-wall gallbladder.
Asunto(s)
Enfermedades de la Vesícula Biliar/diagnóstico , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/diagnóstico por imagen , Adenocarcinoma/diagnóstico , Adenocarcinoma/diagnóstico por imagen , Adenoma/diagnóstico , Adenoma/diagnóstico por imagen , Adenomioma/diagnóstico , Adenomioma/diagnóstico por imagen , Colecistitis Aguda/diagnóstico , Colecistitis Aguda/diagnóstico por imagen , Colecistolitiasis/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/patología , Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Neoplasias de la Vesícula Biliar/diagnóstico , Neoplasias de la Vesícula Biliar/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
We present the first case illustred in imaging of an epiploic appendage torsion inside a Spigelian hernia.
Asunto(s)
Enfermedades del Colon/complicaciones , Hernia Ventral/complicaciones , Anciano , Enfermedades del Colon/diagnóstico por imagen , Femenino , Hernia Ventral/diagnóstico por imagen , Humanos , Radiografía , Anomalía Torsional/complicaciones , Anomalía Torsional/diagnóstico por imagen , UltrasonografíaRESUMEN
Giant diverticula of the small intestine and colon are rare. Four cases treated at our institution in the last year are reported and compared to published cases; specific features and those which differentiate them from abdominal pseudocysts are described. They most commonly present a clinical tableau similar to commonplace diverticular disease. Awareness of this unusual condition and a good CT study are the keys to diagnosis. Giant diverticula may be acquired or congenital. The acquired type is simply a more spectacular version of commonplace diverticulosis while the congenital type, having a muscular wall and myenteric plexus, is more akin to intestinal duplications. Treatment is surgical and, in the case of sigmoid giant diverticula, usually requires a colon resection similar to that required for sigmoid diverticulitis.