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Yoshida S, Hiyama K, Kirino I, Fukui Y, Terashima H. Ascending colon stenosis caused by repeated diverticulitis that clinically mimicked advanced colon cancer: A case report. Int J Surg Case Rep 2022; 95:107184. [PMID: 35576753 PMCID: PMC9118484 DOI: 10.1016/j.ijscr.2022.107184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/08/2022] [Accepted: 05/08/2022] [Indexed: 11/03/2022] Open
Abstract
Introduction Presentation of case Discussion Conclusion Most cases of large bowel obstruction (LBO) are caused by cancer. Right-sided LBO of the colon due to chronic diverticulitis is rare. Definitive interval surgery leads to better outcomes and reduces perioperative complications.
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Bowel ultrasonography in acute abdomen: Beyond acute appendicitis. RADIOLOGIA 2021. [DOI: 10.1016/j.rxeng.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Vizuete Del Río J, Martín Benítez G, Ripollés González T, Merino Bonilla JA, San-Miguel T. Bowel ultrasonography in acute abdomen: beyond acute appendicitis. RADIOLOGIA 2021; 63:193-205. [PMID: 33551121 DOI: 10.1016/j.rx.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/03/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022]
Abstract
Acute abdomen is a common reason for consultation in the emergency department. A broad spectrum of entities, including diverse diseases of the gastrointestinal tract, can cause acute abdomen. Although computed tomography is the technique most widely used to evaluate acute abdomen in the emergency department, abdominal ultrasound is often performed first and allows bowel disease to be suspected. This article describes the ultrasound features of diverse bowel diseases that can cause acute abdomen, such as acute diverticulitis, bowel obstruction, gastrointestinal perforation, bowel ischemia, intraabdominal fat necrosis, and miscellaneous processes such as endometriosis, foreign bodies, or vasculitis. Radiologists must be familiar with the different features of abnormal bowel that can be detected incidentally in patients without clinical suspicion of bowel disease. This article focuses on ultrasonographic signs of bowel disease; other articles in this series cover the ultrasonographic signs of acute appendicitis, inflammatory bowel disease, and infectious diseases.
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Affiliation(s)
- J Vizuete Del Río
- Servicio de Radiodiagnóstico, Hospital Universitari Doctor Peset, Valencia, España
| | - G Martín Benítez
- Servicio de Radiodiagnóstico, Hospital Universitari Doctor Peset, Valencia, España
| | - T Ripollés González
- Servicio de Radiodiagnóstico, Hospital Universitari Doctor Peset, Valencia, España
| | - J A Merino Bonilla
- Servicio de Radiodiagnóstico, Hospital Santiago Apóstol, Miranda de Ebro, España.
| | - T San-Miguel
- Departamento de Anatomía Patológica, Facultad de Medicina, Universidad de Valencia, Valencia, España
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Miller AS, Boyce K, Box B, Clarke MD, Duff SE, Foley NM, Guy RJ, Massey LH, Ramsay G, Slade DAJ, Stephenson JA, Tozer PJ, Wright D. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery. Colorectal Dis 2021; 23:476-547. [PMID: 33470518 PMCID: PMC9291558 DOI: 10.1111/codi.15503] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
AIM There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence-based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. METHODS Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology-based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence-based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. RESULTS All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence-based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.
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Affiliation(s)
- Andrew S. Miller
- Leicester Royal InfirmaryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Benjamin Box
- Northumbria Healthcare Foundation NHS TrustNorth ShieldsUK
| | | | - Sarah E. Duff
- Manchester University NHS Foundation TrustManchesterUK
| | | | | | | | | | | | | | - Phil J. Tozer
- St Mark’s Hospital and Imperial College LondonHarrowUK
| | - Danette Wright
- Western Sydney Local Health DistrictSydneyNew South WalesAustralia
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García J, Lorente Martínez E, Ripollés González T, Martínez Pérez M, Vizuete del Río J. Infiltrating endometriosis: Diagnostic keys in abdominal ultrasonography. RADIOLOGIA 2021. [DOI: 10.1016/j.rxeng.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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García JS, Martínez EL, González TR, Pérez MJM, Río JVD. Infiltrating endometriosis: diagnostic keys in abdominal ultrasonography. RADIOLOGIA 2020; 63:32-41. [PMID: 33190922 DOI: 10.1016/j.rx.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/20/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Endometriosis is the presence of endometrial tissue outside the uterus. Endometriosis of the bowel and urinary tract are types of extragenital endometriosis that manifest with nonspecific symptoms, but their detection involves specific therapeutic strategies. Although the characteristics of the disease on transvaginal ultrasonography and on magnetic resonance imaging have been described in many publications, few references describe its characteristics on abdominal ultrasonography. This paper illustrates the findings for infiltrating endometriosis involving the bowel and urinary tract on abdominal ultrasonography and shows the usefulness of this technique for identifying signs of the disease that have been described with other techniques. Knowledge of infiltrating endometriosis and its ultrasonographic features will enable radiologists to suggest its diagnosis and to include it in the differential diagnosis of pelvic pain in women of child-bearing age. CONCLUSION Abdominal ultrasonography is a useful tool in the diagnosis of extragenital endometriosis. Familiarity with the ultrasonographic appearance of this entity facilitates the diagnostic orientation and management of patients with pelvic pain.
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Affiliation(s)
- J Salvador García
- Servicio de Radiodiagnóstico, Hospital Universitario Doctor Peset, Valencia, España.
| | - E Lorente Martínez
- Servicio de Radiodiagnóstico, Hospital Universitario Doctor Peset, Valencia, España
| | - T Ripollés González
- Servicio de Radiodiagnóstico, Hospital Universitario Doctor Peset, Valencia, España
| | - M J Martínez Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario Doctor Peset, Valencia, España
| | - J Vizuete Del Río
- Servicio de Radiodiagnóstico, Hospital Universitario Doctor Peset, Valencia, España
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Martínez Pérez MJ, Blanc García E, Merino Bonilla JA. Bowel ultrasound: examination techniques and normal and pathologic patterns. RADIOLOGIA 2020; 62:517-527. [PMID: 33127091 DOI: 10.1016/j.rx.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
Ultrasound is being increasingly used to study the digestive tract because it has certain advantages over other techniques such as endoscopy, CT enterography, and MR enterography. Ultrasound can be used to evaluate the bowel wall and the elements that surround it without the need for contrast agents; its ability to evaluate the elasticity and peristalsis of these structures is increasing interest in its use. This article describes the techniques and modalities of bowel ultrasound, as well as the normal features of the bowel wall and contiguous structures. It uses a practical approach to review the main pathological findings and their interpretation, and the different patterns of presentation, which will help orient the diagnosis.
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Affiliation(s)
- M J Martínez Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario Doctor Peset, Valencia, España.
| | - E Blanc García
- Servicio de Radiodiagnóstico, Hospital Universitario Doctor Peset, Valencia, España
| | - J A Merino Bonilla
- Servicio de Radiodiagnóstico, Hospital Santiago Apóstol, Miranda de Ebro, Burgos, España
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Tursi A, Scarpignato C, Strate LL, Lanas A, Kruis W, Lahat A, Danese S. Colonic diverticular disease. Nat Rev Dis Primers 2020; 6:20. [PMID: 32218442 PMCID: PMC7486966 DOI: 10.1038/s41572-020-0153-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
Diverticula are outpouchings of the intestinal wall and are common anatomical alterations detected in the human colon. Colonic diverticulosis (the presence of diverticula in the colon; referred to as diverticulosis) remains asymptomatic in most individuals but ~25% of individuals will develop symptomatic diverticulosis, termed colonic diverticular disease (also known as diverticular disease). Diverticular disease can range in severity from symptomatic uncomplicated diverticular disease (SUDD) to symptomatic disease with complications such as acute diverticulitis or diverticular haemorrhage. Since the early 2000s, a greater understanding of the pathophysiology of diverticulosis and diverticular disease, which encompasses genetic alterations, chronic low-grade inflammation and gut dysbiosis, has led to improvements in diagnosis and management. Diagnosis of diverticular disease relies on imaging approaches, such as ultrasonography, CT and MRI, as biomarkers alone are insufficient to establish a diagnosis despite their role in determining disease severity and progression as well as in differential diagnosis. Treatments for diverticular disease include dietary fibre, pharmacological treatments such as antibiotics (rifaximin), anti-inflammatory drugs (mesalazine) and probiotics, alone or in combination, and eventually surgery. Despite being effective in treating primary disease, their effectiveness in primary and secondary prevention of complications is still uncertain.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, Azienda Sanitaria Locale Barletta-Andria-Trani, Andria, Italy.
| | - Carmelo Scarpignato
- Faculty of Health Sciences, LUdeS Lugano Campus, Lugano, Switzerland
- United Campus of Malta, Birkirkara, Msida, Malta
| | - Lisa L Strate
- Division of Gastroenterology, Department of Medicine, Harborview Medical Center, University of Washington Medical School, Seattle, WA, USA
| | - Angel Lanas
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, University of Zaragoza, IIS Aragón (CIBERehd), Zaragoza, Spain
| | | | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center - IRCCS -, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Abu-Zidan FM, Cevik AA. Diagnostic point-of-care ultrasound (POCUS) for gastrointestinal pathology: state of the art from basics to advanced. World J Emerg Surg 2018; 13:47. [PMID: 30356808 PMCID: PMC6190544 DOI: 10.1186/s13017-018-0209-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023] Open
Abstract
The use of point-of-care ultrasound (POCUS) by non-radiologists has dramatically increased. POCUS is completely different from the routine radiological studies. POCUS is a Physiological, On spot, extension of the Clinical examination, that is Unique, and Safe. This review aims to lay the basic principles of using POCUS in diagnosing intestinal pathologies so as to encourage acute care physicians to learn and master this important tool. It will be a useful primer for clinicians who want to introduce POCUS into their clinical practice. It will cover the basic physics, technical aspects, and simple applications including detection of free fluid, free intraperitoneal air, and bowel obstruction followed by specific POCUS findings of the most common intestinal pathologies encountered by acute care physicians including acute appendicitis, epiploic appendagitis, acute diverticulitis, pseudomembranous colitis, intestinal tuberculosis, Crohn’s disease, and colonic tumours. Deep understanding of the basic physics of ultrasound and its artefacts is the first step in mastering POCUS. This helps reaching an accurate POCUS diagnosis and avoiding its pitfalls. With increased skills, detailed and accurate POCUS findings of specific intestinal pathologies can be achieved and properly correlated with the clinical picture. We have personally experienced and enjoyed this approach to a stage that an ultrasound machine is always accompanying us in our clinical on calls and rounds.
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Affiliation(s)
- Fikri M Abu-Zidan
- 1Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, 17666 United Arab Emirates
| | - Arif Alper Cevik
- 2Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, 17666 United Arab Emirates
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Gong XH, Zhuang ZG, Zhu J, Feng Q, Xu JR, Qian LJ. Differentiation of cancerous and inflammatory colorectal perforations using multi-detector computed tomography. Abdom Radiol (NY) 2017; 42:2233-2242. [PMID: 28401282 DOI: 10.1007/s00261-017-1134-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine reliable CT features to distinguish cancerous from inflammatory colorectal perforations. MATERIALS AND METHODS A total of 43 patients with surgically and pathologically confirmed colorectal perforation caused by either colorectal cancer (n =27) or an inflammatory conditions (n = 16) were identified. Two radiologists independently assessed the contrast-enhanced CT features for locations of perforation, mural configurations, soft-tissue alterations, lymphadenopathy, and metastases. Intergroup comparisons for univariate analysis were performed using Fisher's exact test or chi-square test for categorical data and Mann-Whitney test for numeric data. Stepwise logistic regression analysis was conducted with features that were found significant under the univariate analysis. Interobserver agreement was assessed using intraclass correlation coefficient (ICC) and kappa test. RESULTS Maximal mural thickness >1.39 cm (sensitivity, 100%; specificity, 68.75%), luminal mass or shoulder formation (sensitivity, 88.89%; specificity, 68.75%), absence of diverticula (sensitivity, 96.30%; specificity, 50.00%), irregular mural thickening (sensitivity, 92.59%; specificity, 81.25%), lymphadenopathy (sensitivity, 40.74%; specificity, 93.75%), and metastases (sensitivity, 25.93%; specificity, 100%) were significantly frequent in cancerous perforations. The maximal mural thickness (P = 0.0493, odds ratio = 439.83) and irregular mural thickening (P = 0.0343, odds ratio = 4.69) were identified as the highly distinguished identifiers. CONCLUSIONS The CT manifestations of cancerous and inflammatory colorectal perforations overlap. Definitive diagnosis is not always possible with imaging alone. The maximal mural thickness >1.39 cm and irregular configuration of the thickened bowel wall were the two highly statistically significant CT features that may help order the difference between the two entities.
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Affiliation(s)
- Xu Hua Gong
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Zhi Guo Zhuang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Jiong Zhu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Qi Feng
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Jian Rong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China
| | - Li Jun Qian
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd. Pudong, Shanghai, 200127, People's Republic of China.
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López E, Ripolles T, Martinez MJ, Bartumeus P, Blay J, López A. Positive Predictive Value of Abdominal Sonography in the Diagnosis of Ischemic Colitis. Ultrasound Int Open 2015; 1:E41-5. [PMID: 27689152 DOI: 10.1055/s-0035-1559775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/27/2015] [Indexed: 01/06/2023] Open
Abstract
AIM The aim was to prospectively evaluate the positive predictive value of ultrasound in the diagnosis of ischemic colitis, with colonoscopy as the reference standard. METHODS During a 2-year period we included consecutive patients over 50 years of age with sudden abdominal pain and/or rectal bleeding who underwent abdominal sonography in an emergency setting with a thickened segment of colon with a length of more than 10 cm. This clinical-sonographic triad was considered diagnostic for ischemic colitis. A thickened bowel location or color Doppler flow findings on ultrasound examination were evaluated but were not considered to make the diagnosis of ischemic colitis. Basic descriptive statistics were used to characterize the study patients. The positive predictive value was calculated as: number of patients with the definitive diagnosis of ischemic colitis (colonoscopic or follow-up)/number of patients with a sonographic diagnosis of ischemic colitis. RESULTS A total of 48 patients had the clinical-sonographic triad; mean age: 74.3 years (range 54-90 years). The most frequent clinical manifestation was rectal bleeding (83% of the cases) followed by abdominal pain (81%) and diarrhea (45%). A total of 42 cases of ischemic colitis were confirmed by endoscopy (n=35) and biopsy (n=34) or clinical evaluation (n=7). The positive predictive value of the clinical-sonographic diagnosis of ischemic colitis was 87.5%. Thickening of the colon wall was detected on the left side in 35 patients with ischemic colitis, on the right side in 3 and pancolitis was identified in 5 patients. CONCLUSION In an appropriate clinical setting, ultrasound has a high positive predictive value for the diagnosis of ischemic colitis.
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Affiliation(s)
- E López
- Radiology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - T Ripolles
- Radiology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - M J Martinez
- Radiology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - P Bartumeus
- Radiology, Hospital Universtiario San Juan, San Juan, Spain
| | - J Blay
- Radiology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - A López
- Gastroenterology, Hospital Universitario Dr Peset, Valencia, Spain
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