Long term effects of arterialization of the portal vein stump in dogs with Eck's fistula

This study investigates the possibility of avoiding the sequelae of Eck's fistula in dogs by preserving the hepatic blood flow with an autologous vein graft inserted between the infrarenal aorta and the transected stump of the portal vein as its entrance into the liver. Ten dogs with such experimental preparation were observed for signs of encephalopathy; the patency of the grafts was assessed by periodic arteriograms. The signs of encephalopathy and general deterioration usually observed in dogs with Eck's fistula were prevented; however, marked dilation of the intrahepatic branches of the portal vein leading sometimes to spontaneous rupture of the liver or to thrombosis of the venous graft was observed. Thus, this technique does not appear to be a satisfactory long term solution for preventing the deleterious effects of Eck's fistula in dogs.

Plain film findings of hydropneumoperitoneum

Abdominal radiographs of 11 patients with hydropneumoperitoneum were reviewed. The centrally located air collection was noted in nine of the 11 patients. In the other two patients with a large amount of fluid in the pelvis, the air bubble was located in the upper abdomen. In two patients, the edge of the centrally located large air bubble was ringed by a number of small bubbles. The falciform ligament was demonstrated in five. Air-fluid levels were seen in the upper abdomen in six patients in whom upright films of the abdomen were obtained. Hydropneumoperitoneum should be suspected in supine abdominal radiographs when one recognizes a large air collection with or without surrounding small air bubbles.

Variation in falciform ligament with pheumoperitoneum

The anatomic variation in length, thickness and course of the falciform ligament was studied on abdominal radiographs of 21 patients with pneumoperitoneum. In adults, considerable variation was found: the length ranged from 6 to 14 cm (mean 9.9 cm) and thickness from 1 to 11 mm (mean 6mm). In contrast, children displayed a uniformly thin ligament. Familiarity with anatomic variation of the falciform ligament aids prompt recognition of pneumoperitoneum in seriously ill patients.

Bezoar of the esophagus

An esophageal bezoar occurring in a young patient without esophageal abnormality is described. The history of severe progressive dysphagia following forceful vomiting and presence of a gastric ulcer suggest that the esophageal bezoar might have originated in the stomach.

How and when to use barium for diagnosis of small bowel obstruction

The diagnosis of intestinal obstruction is readily made when a patient presents with typical history and signs, and when plain films of the abdomen display characteristic findings. Some patients, however, constitute diagnostic problems because abdominal roentgenograms are still equivocal, even after repetition in four hours. In the unclear case, use of a barium meal will safely, promptly, and routinely prove or disprove small bowel obstruction. Intestinal obstruction in which the initial abdominal films tend to be either unrevealing or equivocal include high obstructions, including the superior mesenteric artery syndrome; presence of strangulation; partial small bowel obstruction; and fluid-filled proximal bowel. In intestinal obstruction, characteristic roentgenographic findings with use of barium meal are normal to rather rapid transit time to the point of obstruction; homogenous dilution of barium in dilated proximal loops; and inhomogenous, scattered, and fragmented collections of barium in the distal, collapsed loops.

Intestinal atony in progressive systemic sclerosis (Scleroderma)

A 27-year-old woman with a long history of scleroderma developed megacolon and severe fecal vomiting as a result of intestinal atony. Evacuation of fecal impaction with water-soluble contrast enema resulted in prompt relief of fecal vomiting and gradual return of bowel function.

Intramural hematoma (incomplete perforation) of the esophagus associated with esophageal dilatation

Five cases of intramural hematoma of the esophagus complicating esophageal dilatation are presented along with a review of the literature. In all 5 patients, this complication developed during dilatation for benign stricture. The esophagram in each patient demonstrated double columns of contrast material separated by a radiolucent stripe, characteristic of incomplete tear of the esophagus. All 5 responded to conservative management without complication.

Circumferential web of the upper esophagus

Two patients with circumferential webs of the upper esophagus are presented. Both patients had a long history of intermittent dysphagia, particularly with solid food. The clinical, endoscopic, and radiologic features of these webs are discussed.

New technique for pelvic venography during ascending phlebography

A technique of pelvic venography making it possible to obtain satisfactory opacification of the iliofemoral segment of the pelvic veins consistently during ascending phlebography is described. The main features are the compression of the inferior vena cava with a compression band and balloon, and the use of a large amount of contrast material.

Angiographic diagnosis of leiomyomas of the small intestine

Leiomyomas of the small intestine were demonstrated by visceral angiography in a 54-year old man with recurrent episodes of severe gastrointestinal bleeding over a five-year period. Angiographic features were irregular vessels within the tumor and early opacification of prominent feeding and draining vessels.

Intestinal infarction complicating low cardiac output states

Nonocclusive mesenteric ischemia, leading into intestinal infarction, frequently complicates and causes the fatal outcome in otherwise treatable instances of low cardiac output states. Once intestinal necrosis occurs in these patients, the mortality is almost 100 per cent. A high risk group of patients in whom intestinal infarction occurs because of low cardiac output can be readily identified. A high index of suspicion for the occurrence of intestinal ischemia in these patients should facilitate recognition of the disease during its early stages. The disastrous results experienced by us and others warrant the use of more aggressive methods for the diagnosis and treatment of patients with this condition. A high index of suspicion in a recognizable group of patients observed by selective mesenteric arteriography affords a method for confirmation of the diagnosis of mesenteric vasoconstriction. Once the diagnosis is established, a patient management protocol program should be followed. Sustained infusion of papaverine into the mesenteric artery is useful in reversing mesenteric vasoconstriction. Additionally, the judicious use of celiotomy and intestinal resection, preceded and followed by the sustained infusion of papaverine into the superior mesenteric artery, offers hope for the survival of some of these patients and warrants further use.

Plain film findings in massive gastrointestinal bleeding

The admixture of blood clots and air in the lumen of the stomach or colon produces a bubbly radiolucency on plain films of the abdomen in some patients with massive gastrointestinal bleeding. In 10 patients this radiographic sign served as a clue to the site of bleeding. It is postulated that recognition of this sign on preliminary scout films may facilitate location of the bleeding vessel.

Cardiovascular involvement by invasive thymomas

We have observed 74 cases of thymoma from 1968 to 1974. Six cases of invasive (malignant) thymoma presented in an unusual fashion with signs and symptoms of cardiovascular disease and superior vena caval syndrome. The clinical, pathological, and roentgenographic features of these cases are presented. The literature concerning cardiovascular involvement by thymoma is reviewed and discussed.

Starch granulomatous peritonitis

An unusual case of recurrent starch granulomatous peritonitis that presented as a long-standing paralytic ileus is described and the literature pertaining to this unusual entity is reviewed. The roentgenographic finding of severe prolonged paralytic ileus usually developing late in the post-operative period should suggest the possibility of this disease.

Polyarteritis nodosa causing severe intestinal bleeding

Rupture of an aneurysm of the mesentergic artery caused severe intestinal hemorrhage in a 50-year-old woman with polyarteritis nodosa. Abdominal angiography not only established diagnosis of polyarteritis nodosa by demonstrating multiple visceral aneurysms but also localized the site of bleeding.

Carcinoma of the urachus

Characteristic roentgenographic and anatomical features of a mucinous adenocarcinoma of the urachus were observed in two patients. Both presented with a midline anterior abdominal mass in the supravesicular area. The tumor contained fine stippled calcification in one case. The cystogram demonstrated an irregular filling defect in the bladder dome in the other case. Ultrasonographic examination in one case was helpful in delineating the nature, size, and location of the mass in detail.

Jefferson fracture of the atlas. Report of six cases

Six cases of Jefferson fracture of the atlas are summarized. None had recognizable neurological signs that resulted from the injury when seen in the hospital. With conservative treatment, pain subsided and the fracture stabilized in a short period in all six patients. None of the patients underwent fusion of the cervical spine.

Portal vein thrombosis resulting in portal hypertension in adults

Attempting to elucidate the best way to treat adult patients with extrahepatic portal vein occlusive thrombosis, the experience with six such patients is analyzed. Portal vein thrombosis rarely occurs in adults but when it does, it frequently results in portal hypertension with its concomitant complications. Five patients had bleeding esophageal varices, two had massive refractory ascites. Their conventional liver function tests were not greatly altered. Thrombocytosis and history of thrombophlebitis were encountered in over half of the patients. Splenoportography is the best method to confirm the diagnosis preoperatively. In none of the six patients a decompressive portal systemic shunt could be performed although, it was attempted in five. Three patients survived. It appears that nonoperative management is the treatment of choice in these patients who can remain well for several years, however, when bleeding recurs gastric devascularization or even resective procedures are acceptable therapeutic alternatives.