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Boraschi P, Giugliano L, Mercogliano G, Donati F, Romano S, Neri E. Abdominal and gastrointestinal manifestations in COVID-19 patients: Is imaging useful? World J Gastroenterol 2021; 27:4143-4159. [PMID: 34326615 PMCID: PMC8311532 DOI: 10.3748/wjg.v27.i26.4143] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) can be considered a systemic disease with a specific tropism for the vascular system, in which the alterations of the microcirculation have an important pathogenetic role. The lungs are the main organ involved in COVID-19, and severe progressive respiratory failure is the leading cause of death in the affected patients; however, many other organs can be involved with variable clinical manifestations. Concerning abdominal manifestations, the gastrointestinal tract and the hepatobiliary system are mainly affected, although the pancreas, urinary tract and spleen may also be involved. The most common gastrointestinal symptoms are loss of appetite, followed by nausea and vomiting, diarrhea and abdominal pain. Gastrointestinal imaging findings include bowel wall thickening, sometimes associated with hyperemia and mesenteric thickening, fluid-filled segments of the large bowel and rarely intestinal pneumatosis and ischemia. Hepatic involvement manifests as an increase in the enzymatic levels of alanine aminotransferase, aspartate aminotransferase, serum bilirubin and γ-glutamyl transferase with clinical manifestations in most cases mild and transient. The most frequent radiological features are hepatic steatosis, biliary sludge and gallstones. Edematous acute pancreatitis, kidney infarct and acute kidney injury from acute tubular necrosis have been described more rarely in COVID-19. Lastly, splenic involvement is characterized by splenomegaly and by the development of solitary or multifocal splenic infarcts with classic wedge-shaped or even rounded morphology, with irregular or smooth profiles. In summary, the abdominal radiological findings of COVID-19 are nonspecific and with poor pathological correlation reported in the literature. Ultrasound and particularly computed tomography with multiphasic acquisition are the diagnostic methods mainly utilized in COVID-19 patients with abdominal clinical symptoms and signs. Although radiological signs are not specific of abdominal and gastrointestinal involvement, the diagnostic imaging modalities and in particular computed tomography are helpful for the clinician in the management, evaluation of the severity and evolution of the COVID-19 patients.
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Affiliation(s)
- Piero Boraschi
- Department of Diagnostic Imaging, Second Division of Radiology, Azienda Ospedaliero-Universitaria Pisana-University of Pisa, Pisa 56124, Italy
| | - Luigi Giugliano
- Department of Radiology, University of Naples “Federico II”, Naples 80131, Italy
| | - Giuseppe Mercogliano
- Department of Radiology, University of Naples “Federico II”, Naples 80131, Italy
| | - Francescamaria Donati
- Department of Diagnostic Imaging, Second Division of Radiology, Azienda Ospedaliero-Universitaria Pisana-University of Pisa, Pisa 56124, Italy
| | - Stefania Romano
- Department of Diagnostic Imaging, Santa Maria delle Grazie Hospital, Naples 80078, Italy
| | - Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa 56126, Italy
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Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury Suggested citation: Jeffery Johns, Klaus Krogh, Gianna M. Rodriguez, Janice Eng, Emily Haller, Malorie Heinen, Rafferty Laredo, Walter Longo, Wilda Montero-Colon, Mark Korsten. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Journal of Spinal Cord Med. 2021. Doi:10.1080/10790268.2021.1883385. J Spinal Cord Med 2021; 44:442-510. [PMID: 33905316 PMCID: PMC8115581 DOI: 10.1080/10790268.2021.1883385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jeffery Johns
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Janice Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Haller
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas, USA
| | | | - Walter Longo
- Department of Surgery, Division of Gastrointestinal Surgery, Yale University, New Haven, Connecticut, USA
| | | | - Mark Korsten
- Icahn School of Medicine at Mount Sinai, Department of Internal Medicine, Division of Gastroenterology, New York, New York, USA
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Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Wilson C, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers. Top Spinal Cord Inj Rehabil 2021; 27:75-151. [PMID: 34108835 PMCID: PMC8152174 DOI: 10.46292/sci2702-75] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jeffery Johns
- Vanderbilt University Medical Center, Nashville, Tennessee USA
| | | | | | - Janice Eng
- University of British Columbia, Vancouver Canada
| | | | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas USA
| | | | | | | | - Catherine Wilson
- Diplomate, American Board of Professional Psychology (RP) Private Practice, Denver, Colorado
| | - Mark Korsten
- Icahn School of Medicine @ Mt Sinai, New York, New York USA
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Schneeweiss S, Esser M, Thaiss W, Boesmueller H, Ditt H, Nikolau K, Horger M. Improved CT-detection of acute bowel ischemia using frequency selective non-linear image blending. Acta Radiol Open 2017; 6:2058460117718224. [PMID: 28811930 PMCID: PMC5528188 DOI: 10.1177/2058460117718224] [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: 04/24/2017] [Accepted: 06/08/2017] [Indexed: 01/06/2023] Open
Abstract
Background Computed tomography (CT) as a fast and reliable diagnostic technique is the imaging modality of choice for acute bowel ischemia. However, diagnostic is often difficult mainly due to low attenuation differences between ischemic and perfused segments. Purpose To compare the diagnostic efficacy of a new post-processing tool based on frequency selective non-linear blending with that of conventional linear contrast-enhanced CT (CECT) image blending for the detection of bowel ischemia. Material and Methods Twenty-seven consecutive patients (19 women; mean age = 73.7 years, age range = 50–94 years) with acute bowel ischemia were scanned using multidetector CT (120 kV; 100–200 mAs). Pre-contrast and portal venous scans (65–70 s delay) were acquired. All patients underwent surgery for acute bowel ischemia and intraoperative diagnosis as well as histologic evaluation of explanted bowel segments was considered “gold standard.” First, two radiologists read the conventional CECT images in which linear blending was adapted for optimal contrast, and second (three weeks later) the frequency selective non-linear blending (F-NLB) image. Attenuation values were compared, both in the involved and non-involved bowel segments creating ratios between unenhanced and CECT. Results The mean attenuation difference between ischemic and non-ischemic wall in the portal venous scan was 69.54 HU (reader 2 = 69.01 HU) higher for F-NLB compared with conventional CECT. Also, the attenuation ratio between contrast-enhanced and pre-contrast CT data for the non-ischemic walls showed significantly higher values for the F-NLB image (CECT: reader 1 = 2.11 (reader 2 = 3.36), F-NLB: reader 1 = 4.46 (reader 2 = 4.98)]. Sensitivity in detecting ischemic areas increased significantly for both readers using F-NLB (CECT: reader 1/2 = 53%/65% versus F-NLB: reader 1/2 = 62%/75%). Conclusion Frequency selective non-linear blending improves detection of bowel ischemia compared with conventional CECT by increasing attenuation differences between ischemic and perfused segments.
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Affiliation(s)
- Sven Schneeweiss
- Institute of Pathology, University Hospital Tuebingen, Tübingen, Germany
| | - Michael Esser
- Institute of Pathology, University Hospital Tuebingen, Tübingen, Germany
| | - Wolfgang Thaiss
- Institute of Pathology, University Hospital Tuebingen, Tübingen, Germany
| | - Hans Boesmueller
- Institute of Pathology, University Hospital Tuebingen, Tübingen, Germany
| | | | - Konstantin Nikolau
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tübingen, Germany
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Treuer R. DOLOR ABDOMINAL AGUDO EN EL ADULTO MAYOR. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Darras KE, McLaughlin PD, Kang H, Black B, Walshe T, Chang SD, Harris AC, Nicolaou S. Virtual monoenergetic reconstruction of contrast-enhanced dual energy CT at 70keV maximizes mural enhancement in acute small bowel obstruction. Eur J Radiol 2016; 85:950-6. [DOI: 10.1016/j.ejrad.2016.02.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/29/2015] [Accepted: 02/18/2016] [Indexed: 11/24/2022]
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Liang X, Li W, Zhao B, Zhang L, Cheng Y. Comparative analysis of MDCT and MRI in diagnosing chronic gallstone perforation and ileus. Eur J Radiol 2015; 84:1835-42. [DOI: 10.1016/j.ejrad.2015.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/02/2015] [Accepted: 06/10/2015] [Indexed: 12/27/2022]
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Caracela Zeballos CR, Diéguez Tapias S, Cereceda Pérez CN, Pinto Varela JM. [Laparoscopic gastric bypass: computed tomography appearance of common postoperative changes and complications]. RADIOLOGIA 2014; 56:413-9. [PMID: 24508056 DOI: 10.1016/j.rx.2013.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 07/02/2013] [Accepted: 07/26/2013] [Indexed: 01/21/2023]
Abstract
Laparoscopic Roux-en-Y bypass is being increasingly used for weight reduction in patients with morbid obesity. Unfortunately, some complications can occur after this procedure, the most frequent being intestinal obstruction (due to stenosis of the anastomosis at the distal end of the loop, internal hernias, bands, and adhesions), anastomotic leaks, and bleeding. This article provides basic knowledge about the surgical technique and its correlation with the common postoperative changes with the aim of facilitating the interpretation of CT findings and the identification of postoperative complications in these patients.
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Affiliation(s)
- C R Caracela Zeballos
- Servicio de Radiodiagnóstico, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España.
| | - S Diéguez Tapias
- Servicio de Radiodiagnóstico, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España
| | - C N Cereceda Pérez
- Servicio de Radiodiagnóstico, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España
| | - J M Pinto Varela
- Servicio de Radiodiagnóstico, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España
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Abstract
Abdominal pain in older adults is a concerning symptom common to a variety of diagnoses with high morbidity and mortality. Organizing the differential into categories based on pathology (inflammatory, obstructive, vascular, or other causes) provides a framework for the history, physical, and diagnostic studies. An organized approach and treatment and considerations specific to the geriatric population are discussed.
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Affiliation(s)
- Luna Ragsdale
- Division of Emergency Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Abstract
Abdominal angina refers to abdominal pain in which perfusion to digestive tissues has been compromised, usually due to mesenteric atherosclerosis. Pathology can progress to necrosis of vital viscera, sepsis, or even death. Practitioners need to be aware of this serious medical condition, especially in the ever-growing elderly population.
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Apport du scanner multi-détecteurs dans la prise en charge des volvulus du sigmoïde. ACTA ACUST UNITED AC 2010; 91:213-20. [DOI: 10.1016/s0221-0363(10)70026-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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