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Shariff F, Bogach J, Guidolin K, Nadler A. Malignant Bowel Obstruction Management Over Time: Are We Doing Anything New? A Current Narrative Review. Ann Surg Oncol 2021; 29:1995-2005. [PMID: 34664143 DOI: 10.1245/s10434-021-10922-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/30/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Malignant bowel obstruction from peritoneal carcinomatosis affects a significant proportion of luminal gastrointestinal and ovarian oncology patients, and portends poor long-term survival. The management approach for these patients includes a range of medical therapies and surgical options; however, how to select an optimal treatment strategy remains enigmatic. The goal of this narrative review was to summarize the latest evidence around multimodal malignant bowel obstruction treatment and to establish if and where progress has been made. METHODS A targeted literature search examining articles focused on the management of malignant bowel obstruction from peritoneal carcinomatosis was performed. Following data extraction, a narrative review approach was selected to describe evidence and guidelines for surgical prognostic factors, imaging, tube decompression, medical management, nutrition, and quality of life. RESULTS Outcomes in the literature to date are summarized for various malignant bowel obstruction treatment strategies, including surgical and non-surgical approaches, as well as a discussion of the role of total parenteral nutrition and chemotherapy in holistic malignant bowel obstruction management. CONCLUSION There has been little change in survival outcomes in malignant bowel obstruction in over more than a decade and there remains a paucity of high-level evidence to direct treatment decision making. Healthcare providers treating patients with malignant bowel obstruction should work to establish consensus guidelines, where feasible, to support medical providers in ensuring compassionate care during this often terminal event for this unique patient group.
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Affiliation(s)
- Farhana Shariff
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Jessica Bogach
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Keegan Guidolin
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ashlie Nadler
- Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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A diagnostic dilemma: Pedunculated mesenteric lipodystrophy mimicking Meckel’s diverticulum. A case report and literature review. Int J Surg Case Rep 2020; 72:183-187. [PMID: 32544826 PMCID: PMC7298552 DOI: 10.1016/j.ijscr.2020.05.083] [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: 03/26/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 12/04/2022] Open
Abstract
Mesenteric lipodystrophy is a rare fibroinflammatory disease of unknown origin. The detection of mesenteric lipodystrophy is challenging and requires early clinical suspicion. Clinical and imaging findings can mimick other pathological conditions affecting the mesenteric fat tissue. Contrast enhanced CT is the most accurate imaging technique for diagnosing mesenteric lipodystrophy.
Introduction Mesenteric lipodystrophy is a rare fibroinflammatory disease of unknown origin with clinical and radiological non specific findings. Presentation of the case The case of a 42-years-old man affected by a pedunculated mesenteric lipodystrophy mimicking Meckel’s diverticulum is reported. Clinical, imaging and histological findings are discussed. Discussion Mesenteric lipodystrophy affects the mesenteric fat of the abdomen with a typical diffuse thickening of the mesentery, nodular thickening of the mesenteric root and presence of mass-like lesions. Ultrasound (US) and Multiphasic Computed Tomography (CT) represent the main imaging tools used for diagnosis. Clinical and imaging findings can mimick other pathological conditions affecting the mesenteric fat tissue. Contrast enhanced CT is the most accurate imaging technique for diagnosing mesenteric lipodystrophy due to the high panoramicity and accuracy with multiplanar imaging. Multiphasic technique helps to characterize the lesion and to recognize vascular anatomy. Oral administration of iodinated contrast medium may help to assess the relationship with bowel loops. All these diagnostic elements are crucial for the surgical timing and approach. Conclusions Due to the heterogeneous mesenteric involvement, the nonspecific CT findings and the high number of diseases for differential diagnosis, the detection of mesenteric lipodystrophy is challenging and requires early clinical suspicion. An histological examination is always necessary.
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Lebedev AG, Levitskiy VD, Rogal MM, Yartsev PA, Petrov DI. [Minimally invasive treatment of rare forms of mechanical intestinal obstruction]. Khirurgiia (Mosk) 2018:24-29. [PMID: 30199048 DOI: 10.17116/hirurgia201808224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To develop medical algorithms for reduction of morbidity and mortality in rare forms of mechanical intestinal obstruction. MATERIAL AND METHODS 17 patients with mechanical intestinal obstruction have been operated in Sklifosovsky Research Institute for Emergency Care for the period 2010 - 2016. There were 13 women and 4 men aged 56 (44,5-74,5) years on the average. Phytobezoar was detected in 7 patients (41.2%), tumor in 7 patients (41.2%) and gallstone ileus in 3 patients (17.6%). RESULTS There were no complications in group 1. In group 2 postoperative complications occurred in 3 patients: gastrocnemius vein thrombosis followed by successful medication (Clavien-Dindo type II), abdominal abscess drained under ultrasonic control (Clavien-Dindo type IIIa) and 1 (8.3%) death (Clavien-Dindo type V). Postoperative mortality in group 2 was 8.3%. CONCLUSION Despite small sample size and no statistically reliable results the advantages of minimally invasive access are obvious. However, further trials are required to ensure the reliability of the results.
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Affiliation(s)
- A G Lebedev
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - V D Levitskiy
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - M M Rogal
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - P A Yartsev
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia; Russian Medical Academy of Continuing Postgraduate Education, Healthcare Ministry of the Russian Federation, Moscow, Russia
| | - D I Petrov
- Russian Medical Academy of Continuing Postgraduate Education, Healthcare Ministry of the Russian Federation, Moscow, Russia
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Stabile Ianora AA, Telegrafo M, Lucarelli NM, Lorusso V, Scardapane A, Niccoli Asabella A, Moschetta M. Comparison between CT Net enhancement and PET/CT SUV for N staging of gastric cancer: A case series. Ann Med Surg (Lond) 2017; 21:1-6. [PMID: 28751975 PMCID: PMC5519227 DOI: 10.1016/j.amsu.2017.07.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 07/09/2017] [Accepted: 07/09/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The therapeutic approach of gastric cancer strictly depends on TNM staging mainly provided by CT and PET/CT. However, the lymph node size criterion as detected by MDCT causes a poor differential diagnosis between reactive and metastatic enlarged lymph nodes with low specificity values. Our study aims to compare 320-row CT Net enhancement and fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (F-FDG PET/CT) SUV for N staging of gastric cancer. MATERIALS AND METHODS 45 patients with histologically proven gastric cancer underwent CT and F-FDG PET/CT. Two radiologists in consensus evaluated all images and calculated the CT Net enhancement and F-FDG PET/CT SUV for N staging, having the histological findings as the reference standard. CT and F-FDG PET/CT sensitivity, specificity, diagnostic accuracy, positive and negative predictive values (PPV and NPV) were evaluated and compared by using the Mc Nemar test. RESULTS The histological examination revealed nodal metastases in 29/45 cases (64%). CT Net enhancement obtained sensitivity, specificity, accuracy, PPV and NPV of 90%, 81%, 87%, 90% and 81%, respectively. F-FDG PET/CT SUV obtained sensitivity, specificity, accuracy, PPV and NPV of 66%, 88%, 73%, 90% and 58%, respectively. No statistically significant difference between the two imaging modalities was found (p = 0.1). CONCLUSION CT Net enhancement represents an accurate tool for N staging of gastric cancer and could be considered as the CT corresponding quantitative parameter of F-FDG PET/CT SUV. It could be applied in the clinical practice for differentiating reactive lymph nodes from metastatic ones improving accuracy and specificity of CT.
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Affiliation(s)
- Amato Antonio Stabile Ianora
- DIM – Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Michele Telegrafo
- DIM – Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Nicola Maria Lucarelli
- DIM – Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Valentina Lorusso
- DIM – Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Arnaldo Scardapane
- DIM – Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Artor Niccoli Asabella
- DIM – Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Marco Moschetta
- DETO – Department of Emergency and Organ Transplantations, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124, Bari, Italy
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King WC, Shuaib W, Vijayasarathi A, Fajardo CG, Cabrera WE, Costa JL. Benefits of sonography in diagnosing suspected uncomplicated acute diverticulitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:53-58. [PMID: 25542939 DOI: 10.7863/ultra.34.1.53] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Despite evidence demonstrating equivalent accuracy of sonography and computed tomography (CT) in the workup of mild/uncomplicated acute diverticulitis, CT is overwhelmingly performed as the initial diagnostic test, particularly in the acute setting. Our study evaluated potential radiation and turnaround time savings associated with performing sonography instead of CT as the initial diagnostic examination in the workup of suspected uncomplicated acute diverticulitis. METHODS We retrospectively reviewed medical records from January 2010 to December 2012 for patients presenting with clinical symptoms of acute diverticulitis. Patients were categorized as a whole and subgrouped by age (>40 and <40 years). A modified Hinchey classification (Am Surg 1999; 65:632-636) was used to stage the severity of the disease. The effective radiation dose was calculated by multiplying the dose length product from the scanner by the standard conversion coefficient (k= 0.0021 mSv/mGy × cm). The turnaround time for patients was calculated as the time the examination was ordered by the emergency department physician or staff to the time the report was finalized. RESULTS Our study included 253 patients (172 male and 81 female; mean age ± SD, 50.2 ± 11.7 years; 132 >40 years and 121 <40 years). The distribution of patients by the modified Hinchey classification was 210 (stages 0 and 1a), 26 (stages 1b and 2), 17 (stages 3 and 4), 0 (fistula), and 0 (obstruction). The estimated CT radiation dose per patient was 21 ± 5.2 mSv. Mean turnaround times for CT and sonography were 138.5 ± 76.9 and 51.3 ± 44 minutes, respectively. CONCLUSIONS Sonography is a lower-cost, faster, and radiation-free alternative that measures up to the diagnostic standards of CT for management of suspected mild or uncomplicated acute diverticulitis.
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Affiliation(s)
- Welfur C King
- Department of Radiology, Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic (W.C.K., J.L.C.); Department of Radiology, Hospital Dr Salvador B. Gautier, Santo Domingo, Dominican Republic (W.C.K., W.S., C.G.F., W.E.C.); and Department of Radiology, Emory University Hospital, Atlanta, Georgia USA (W.S., A.V.).
| | - Waqas Shuaib
- Department of Radiology, Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic (W.C.K., J.L.C.); Department of Radiology, Hospital Dr Salvador B. Gautier, Santo Domingo, Dominican Republic (W.C.K., W.S., C.G.F., W.E.C.); and Department of Radiology, Emory University Hospital, Atlanta, Georgia USA (W.S., A.V.)
| | - Arvind Vijayasarathi
- Department of Radiology, Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic (W.C.K., J.L.C.); Department of Radiology, Hospital Dr Salvador B. Gautier, Santo Domingo, Dominican Republic (W.C.K., W.S., C.G.F., W.E.C.); and Department of Radiology, Emory University Hospital, Atlanta, Georgia USA (W.S., A.V.)
| | - Carlos G Fajardo
- Department of Radiology, Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic (W.C.K., J.L.C.); Department of Radiology, Hospital Dr Salvador B. Gautier, Santo Domingo, Dominican Republic (W.C.K., W.S., C.G.F., W.E.C.); and Department of Radiology, Emory University Hospital, Atlanta, Georgia USA (W.S., A.V.)
| | - Waldo E Cabrera
- Department of Radiology, Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic (W.C.K., J.L.C.); Department of Radiology, Hospital Dr Salvador B. Gautier, Santo Domingo, Dominican Republic (W.C.K., W.S., C.G.F., W.E.C.); and Department of Radiology, Emory University Hospital, Atlanta, Georgia USA (W.S., A.V.)
| | - Juan L Costa
- Department of Radiology, Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic (W.C.K., J.L.C.); Department of Radiology, Hospital Dr Salvador B. Gautier, Santo Domingo, Dominican Republic (W.C.K., W.S., C.G.F., W.E.C.); and Department of Radiology, Emory University Hospital, Atlanta, Georgia USA (W.S., A.V.)
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Tirumani H, Vassa R, Fasih N, Ojili V. Small bowel obstruction in the emergency department: MDCT features of common and uncommon causes. Clin Imaging 2014; 38:580-8. [DOI: 10.1016/j.clinimag.2014.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 04/02/2014] [Accepted: 04/18/2014] [Indexed: 12/11/2022]
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Pinto F, Pinto A, Russo A, Coppolino F, Bracale R, Fonio P, Macarini L, Giganti M. Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature. Crit Ultrasound J 2013; 5 Suppl 1:S2. [PMID: 23902717 PMCID: PMC3711731 DOI: 10.1186/2036-7902-5-s1-s2] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Ultrasound is a widely used technique in the diagnosis of acute appendicitis; nevertheless, its utilization still remains controversial. Methods The accuracy of the Ultrasound technique in the diagnosis of acute appendicitis in the adult patient, as shown in the literature, was searched for. Results The gold standard for the diagnosis of appendicitis still remains pathologic confirmation after appendectomy. In the published literature, graded-compression Ultrasound has shown an extremely variable diagnostic accuracy in the diagnosis of acute appendicitis (sensitivity range from 44% to 100%; specificity range from 47% to 99% ). This is due to many reasons, including lack of operator skill, increased bowel gas content, obesity, anatomic variants, and limitations to explore patients with previuos laparotomies. Conclusions Graded-compression Ultrasound still remains our first-line method in patients referred with clinically suspected acute appendicitis: nevertheless, due to variable diagnostic accuracy, individual skill is requested not only to perform a successful exam, but also in order to triage those equivocal cases that, subsequently, will have to undergo assessment by means of Computed Tomography.
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Affiliation(s)
- Fabio Pinto
- Department of Diagnostic Imaging, Marcianise Hospital, ASL Caserta (CE), Caserta, Italy.
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Mazzei MA, Cioffi Squitieri N, Guerrini S, Stabile Ianora AA, Cagini L, Macarini L, Giganti M, Volterrani L. Sigmoid diverticulitis: US findings. Crit Ultrasound J 2013; 5 Suppl 1:S5. [PMID: 23902791 PMCID: PMC3711739 DOI: 10.1186/2036-7902-5-s1-s5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acute diverticulitis (AD) results from inflammation of a colonic diverticulum. It is the most common cause of acute left lower-quadrant pain in adults and represents a common reason for acute hospitalization, as it affects over half of the population over 65 years with a prevalence that increases with age. Although 85% of colonic diverticulitis will recover with a nonoperative treatment, some patients may have complications such as abscesses, fistulas, obstruction, and /or perforation at presentation. For these reasons, different classifications were introduced through times to help clinicians to develop a correct diagnosis and guide the treatment and for the same reasons imaging is used in most cases both to realise a differential diagnosis and to guide the therapeutic management. US and CT are both usefull in diagnosis of diverticolitis, and their sensibility and specificity are similar. However CT scanning is essential for investigating complicated diverticular disease especially where there are diffuse signs and clinical suspicion of secondary peritonitis; instead in most uncomplicated cases the experienced sonographer may quickly confirm a diagnosis guided by the clinical signs. US is to be recommended in premenopausal women, and in young people to reduce dose exposure.
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Affiliation(s)
- Maria Antonietta Mazzei
- Department of Medical, Surgical and Neuro Sciences, Section of Radiological Sciences, Siena, Italy.
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Mazzei MA, Guerrini S, Cioffi Squitieri N, Cagini L, Macarini L, Coppolino F, Giganti M, Volterrani L. The role of US examination in the management of acute abdomen. Crit Ultrasound J 2013; 5 Suppl 1:S6. [PMID: 23902801 PMCID: PMC3711740 DOI: 10.1186/2036-7902-5-s1-s6] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Acute abdomen is a medical emergency, in which there is sudden and severe pain in abdomen of recent onset with accompanying signs and symptoms that focus on an abdominal involvement. It can represent a wide spectrum of conditions, ranging from a benign and self-limiting disease to a surgical emergency. Nevertheless, only one quarter of patients who have previously been classified with an acute abdomen actually receive surgical treatment, so the clinical dilemma is if the patients need surgical treatment or not and, furthermore, in which cases the surgical option needs to be urgently adopted. Due to this reason a thorough and logical approach to the diagnosis of abdominal pain is necessary. Some Authors assert that the location of pain is a useful starting point and will guide a further evaluation. However some causes are more frequent in the paediatric population (like appendicitis or adenomesenteritis) or are strictly related to the gender (i.e. gynaechologic causes). It is also important to consider special populations such as the elderly or oncologic patients, who may present with atypical symptoms of a disease. These considerations also reflect a different diagnostic approach. Today, surely the integrated imaging, and in particular the use of multidetector Computed Tomography (MDCT) has revolutionised the clinical approach to this condition, simplyfing the diagnosis but burdening the radiologists with the problems related to the clinical management. However although CT emerging as a modality of choice for evaluation of the acute abdomen, ultrasonography (US) remains the primary imaging technique in the majority of cases, especially in young and female patients, when the limitation of the radiation exposure should be mandatory, limiting the use of CT in cases of nondiagnostic US and in all cases where there is a discrepancy between the clinical symptoms and negative imaging at US.
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Affiliation(s)
- Maria Antonietta Mazzei
- Department of Medical, Surgical and Neuro Sciences, Section of Radiological Sciences, Siena, Italy.
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Angelelli G, Moschetta M, Cosmo T, Binetti F, Scardapane A, Stabile Ianora AA. CT diagnosis of the nature of bowel obstruction: morphological evaluation of the transition point. Radiol Med 2012; 117:749-58. [PMID: 22228127 DOI: 10.1007/s11547-011-0770-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 05/09/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE This study evaluated transition-point morphology for defining the nature of bowel obstructions. MATERIALS AND METHODS Computed tomography (CT) examinations of 95 patients affected by severe bowel obstruction (23 neoplastic, 72 nonneoplastic) were retrospectively reviewed. RESULTS The transition point was identified in 89 patients (94%); morphology in relation to the proximal loop was concave in 64 cases (68%), linear in five (5%) and convex in 20 (21%). Concave transition-point morphology was indicative of a nonneoplastic condition, with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy values of 89%, 100%, 100%, 74% and 92%, respectively. A linear shape had almost identical incidence among neoplastic (60%) and nonneoplastic (40%) conditions. A convex appearance correlated with neoplastic disease with sensitivity, specificity, PPV, NPV and diagnostic accuracy values of 87%, 100%, 100%, 96% and 97%, respectively. CONCLUSIONS In the case of bowel obstruction, transitionpoint detection indicates the obstruction site, whereas its morphological evaluation can contribute to defining the nature of the obstruction. A concave morphology indicates a nonneoplastic condition with a high probability; a convex morphology correlates with neoplastic disease, whereas linearity is not significant.
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Affiliation(s)
- G Angelelli
- Di.M.I.M.P., Sezione di Diagnostica per Immagini, Policlinico Universitario, Piazza Giulio Cesare 11, 70124, Bari, Italy.
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