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Suzuki T, Sugiki D, Matsumoto A, Akao T, Matsumoto H. Ascending colon injury and ileal perforation due to blunt abdominal trauma: A case report. Radiol Case Rep 2024; 19:1776-1780. [PMID: 38390424 PMCID: PMC10883779 DOI: 10.1016/j.radcr.2024.01.090] [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: 08/10/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
A rare case of an ascending colon injury and ileal perforation in a 34-year-old male patient due to blunt abdominal trauma caused by a road traffic accident is reported in this study. This paper reports the clinical and imaging findings of seat belt syndrome. The seat belt syndrome primarily involves soft tissue injury; however, lacerations of the colon, small intestine, and mesentery have rarely been reported in the literature. However intestinal injuries, including bowel perforation and mesenteric injuries due to seat belt syndrome, must not be underestimated because they usually require emergency laparotomy because of accompanying peritonitis and hemorrhaging, and can be lethal if left untreated. Therefore, when an ascending mesocolon hematoma and free gas in the peritoneal cavity are present, gastrointestinal perforation due to seat belt syndrome should be suspected. In this case, gastrointestinal perforation was suspected based on the computed tomography findings, and emergency surgery was performed; the patient's course was uneventful without any postoperative complications. Early diagnosis and management are essential to prevent associated morbidity and mortality.
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Affiliation(s)
- Toshiyuki Suzuki
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, Japan
- Department of Emergency and Critical Care Medicine, Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Daisuke Sugiki
- Department of Emergency and Critical Care Medicine, Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Akiyo Matsumoto
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, Japan
| | - Takahiko Akao
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, Japan
| | - Hiroshi Matsumoto
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, Japan
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2
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Intraperitoneal Barium From Gastrointestinal Perforations: Reassessment of the Prognosis and Long-Term Effects. AJR Am J Roentgenol 2021; 217:117-123. [PMID: 33955775 DOI: 10.2214/ajr.20.23526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE. The purpose of this study was to reassess the outcome and potential consequences of intraperitoneal barium leakage during radiologic evaluation of the gastrointestinal tract. MATERIALS AND METHODS. This retrospective study included 18 patients who had significant intraperitoneal leakage of barium from gastrointestinal perforations that were not suspected or diagnosed before the radiologic procedures. This complication occurred during a barium enema examination in nine patients, an upper gastrointestinal study in seven, and a small bowel series in two patients. All patients underwent urgent laparotomy for repair of perforation, with vigorous peritoneal lavage and antibiotic therapy. RESULTS. All patients had an uneventful recovery and were followed for 4-17 years (mean, 8.5 years). Radiographs obtained during this interval showed that a significant amount of residual barium was retained in the abdominal cavity. Six patients had a total of 10 subsequent abdominal operations for unrelated conditions, and some had developed barium granulomas and peritoneal adhesions. However, none of the patients in this series experienced intestinal obstruction or any clinical symptoms related to barium deposits in the abdominal cavity. CONCLUSION. Intraperitoneal leakage of barium is a rare complication of radiologic gastrointestinal examinations, and this series of 18 cases reflects 3 decades of experience at two major medical centers. The presented data indicate that the commonly held and perpetuated concept about the high rate of morbidity and mortality of this complication would not be valid in the modern era of medical and surgical management.
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3
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Bautz B, Schneider JI. High-Risk Chief Complaints I: Chest Pain-The Big Three (an Update). Emerg Med Clin North Am 2020; 38:453-498. [PMID: 32336336 DOI: 10.1016/j.emc.2020.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Nontraumatic chest pain is a frequent concern of emergency department patients, with causes that range from benign to immediately life threatening. Identifying those patients who require immediate/urgent intervention remains challenging and is a high-risk area for emergency medicine physicians where incorrect or delayed diagnosis may lead to significant morbidity and mortality. This article focuses on the 3 most prevalent diagnoses associated with adverse outcomes in patients presenting with nontraumatic chest pain, acute coronary syndrome, thoracic aortic dissection, and pulmonary embolism. Important aspects of clinical evaluation, diagnostic testing, treatment, and disposition and other less common causes of lethal chest pain are also discussed.
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Affiliation(s)
- Benjamin Bautz
- Department of Emergency Medicine, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, USA
| | - Jeffrey I Schneider
- Department of Emergency Medicine, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, USA; Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA.
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4
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Lampridis S, Mitsos S, Hayward M, Lawrence D, Panagiotopoulos N. The insidious presentation and challenging management of esophageal perforation following diagnostic and therapeutic interventions. J Thorac Dis 2020; 12:2724-2734. [PMID: 32642181 PMCID: PMC7330325 DOI: 10.21037/jtd-19-4096] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diagnostic and therapeutic interventions on the esophagus or adjacent organs are responsible for nearly half of all esophageal perforations. If not recognized at the time of the injury, iatrogenic esophageal perforations can present insidiously and lead to delay in diagnosis, thereby increasing morbidity and mortality. Acute clinical awareness is vital for prompt diagnosis, which is usually confirmed with contrast esophagography and contrast-enhanced computed tomography. After establishment of diagnosis, treatment should be promptly initiated and include fluid-volume resuscitation, cessation of oral intake, nasogastric tube insertion, broad-spectrum antibiotics and analgesia. Primary repair, when feasible, is the treatment of choice. Additional procedures beyond primary repair, such as relief of concomitant obstruction, may be necessary if there is underlying esophageal pathology. Drainage alone can be performed for perforations of the cervical esophagus that cannot be visualized. Esophageal T-tube placement or exclusion and diversion techniques are appropriate in clinically unstable patients and in cases where primary repair is precluded either due to preexisting esophageal disease or extensive esophageal damage. Esophagectomy should be performed in patients with malignancy, end-stage benign esophageal disease or extensive esophageal damage that precludes repair. Endoscopic techniques, including stenting, clipping or vacuum therapy, can be used in select cases. Finally, nonoperative management should be reserved for patients with contained esophageal perforations, limited extraluminal soilage and no evidence of systemic inflammation.
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Affiliation(s)
- Savvas Lampridis
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Sofoklis Mitsos
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Martin Hayward
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - David Lawrence
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Nikolaos Panagiotopoulos
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
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5
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Eghbali E, Tarzamni MK, Shirmohammadi M, Javadrashid R, Fouladi DF. Diagnostic performance of 64-MDCT in detecting ERCP-proven periampullary duodenal diverticula. Radiol Med 2020; 125:339-347. [PMID: 31893332 DOI: 10.1007/s11547-019-01121-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022]
Abstract
AIM To determine the diagnostic performance of 64-slice multidetector computed tomography (64-MDCT) in detecting periampullary duodenal diverticula. MATERIALS AND METHODS Medical profiles of 120 endoscopic retrograde cholangiopancreatography (ERCP)-proven patients with (n = 100) and without (n = 20) periampullary duodenal diverticula who had undergone 64-MDCT were retrospectively reviewed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 64-MDCT in detecting periampullary duodenal diverticula were calculated. Potential factors that might influence the diagnostic performance of 64-MDCT in such patients were also examined. RESULTS Patients were 60 males and 60 females with the mean age of 68.8 ± 12.7 (27-93) years. Indications of ERCP were common bile duct stricture (n = 62) or stone (n = 41), biliary cholestasis (n = 16) and acute cholangitis (n = 1). The sensitivity, specificity, PPV, and NPV of 64-MDCT in detecting periampullary duodenal diverticula were 76%, 100%, 100%, and 45.5%, respectively. The size of diverticula was the only predictor of 64-MDCT performance, with better results observed in larger (> 20 mm) diverticula. CONCLUSION 64-MDCT is a highly specific imaging modality in detecting periampullary duodenal diverticula. The diagnostic performance of 64-MDCT increases for larger diverticula.
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Affiliation(s)
- Elham Eghbali
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Kazem Tarzamni
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Shirmohammadi
- Department of Gastroenterology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Javadrashid
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
Bowel and bladder injuries are relatively rare, but there can be serious complications of both open and minimally invasive gynecologic procedures. As with most surgical complications, timely recognition is key in minimizing serious patient morbidity and mortality. Diagnosis of such injuries requires careful attention to surgical entry and dissection techniques and employment of adjuvant diagnostic modalities. Repair of bowel and bladder may be performed robotically, laparoscopically, or using laparotomy. Repair of these injuries requires knowledge of anatomic layers and suture materials and testing to ensure that intact and safe repair has been achieved. The participation of consultants is encouraged depending on the primary surgeon's skill and expertise. Postoperative care after bowel or bladder injury requires surveillance for complications including repair site leak, abscess, and fistula formation.
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7
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Rao N, Kumar S, Taylor S, Plumb A. Diagnostic pathways in Crohn's disease. Clin Radiol 2019; 74:578-591. [PMID: 31005268 DOI: 10.1016/j.crad.2019.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/14/2019] [Indexed: 12/17/2022]
Abstract
The management of Crohn's disease (CD) is shifting from a stepwise, incremental approach based on symptom control to more aggressive early combined immunosuppression in an attempt to induce remission more rapidly and avoid long-term bowel damage. Accurately defining disease activity is a major challenge, as there is often a disconnect between symptomatology and underlying disease status. The role of imaging in CD has evolved such that it now plays a central role establishing the initial diagnosis, characterising disease phenotype, activity assessment, disease surveillance, and assessing response to therapy. Furthermore, the "treat-to-target" approach is being investigated in CD, with resolution of transmural inflammation on cross-sectional imaging being the treatment goal. In this review, we summarise the principal imaging techniques available to the radiologist, the key findings, and provide some guidance on the preferred imaging option in the diagnostic pathway. We consider the relative merits and drawbacks of each imaging technique before offering a brief discussion of some current developments and research avenues in CD imaging. We discuss how imaging may be useful in a "treat-to-target" approach. Finally, we highlight some practical considerations around service configuration and delivery to optimise imaging in CD in an accurate, cost-effective manner.
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Affiliation(s)
- N Rao
- Department of Radiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - S Kumar
- Centre for Medical Imaging, University College London, London, UK
| | - S Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - A Plumb
- Centre for Medical Imaging, University College London, London, UK.
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Moon JY, Hong SS, Hwang J, Lee HK, Choi KC, Cha H, Kim HJ, Chang YW, Lee E. Differentiation between stercoral perforation and colorectal cancer perforation. ACTA ACUST UNITED AC 2019; 65:191-197. [PMID: 30892443 DOI: 10.1590/1806-9282.65.2.191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/05/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine the computed tomography (CT) signs associated with stercoral perforation and colorectal cancer perforation. MATERIALS AND METHODS From May 2003 to Feb. 2015, all surgically and pathologically confirmed patients with stercoral perforation (n=8, mean age 68.3 years) or colon cancer perforation (n=11, mean age 66.3 years) were retrospectively reviewed by two board-certified radiologists blinded to the proven diagnosis. The following CT findings were evaluated and recorded for each patient: wall thickness of the distal colon adjacent to perforation site, pattern of the colon wall thickening and enhancement, length of the thickened bowel wall, presence of fecaloma, degree of proximal colon dilatation, and pericolonic inflammation or presence of pericolonic abscess, and number of enlarged pericolonic lymph nodes. These findings were correlated with the pathologic diagnosis. RESULTS The mean thickness of the distal colonic wall adjacent to the perforation site was 13.6 mm in patients with colorectal cancer perforation and 5.1 mm with stercoral perforation, which was statistically different. There was a significant correlation between colorectal cancer perforation and eccentric wall thickening (p<0.01). CT findings of layered enhancing wall thickening (p<0.01) and the presence of fecaloma in the proximal colon (p<0.01) were significant findings for stercoral perforation. Patients with colorectal cancer displayed more pericolonic lymph nodes (mean 2.27, p<0.05). CONCLUSION Fecaloma in the proximal colon and layered enhancing wall thickening adjacent to perforation site are likely due to stercoral perforation. Eccentric bowel wall thickening at the distal portion of the perforation site with many enlarged pericolonic lymph nodes is most likely due to colorectal cancer perforation.
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Affiliation(s)
- Ji Yoon Moon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seong Sook Hong
- Department of Radiology, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, Korea
| | - JiYoung Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, Korea
| | - Hae Kyung Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Gyeonggi, Korea
| | - Kyo Chang Choi
- Department of Radiology, Soonchunhyang University Gumi Hospital, Gumi Gyeongsang, Korea
| | - Hwajin Cha
- Department of Radiology, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, Korea
| | - Hyun-Joo Kim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, Korea
| | - Yun-Woo Chang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, Korea
| | - EunJi Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, Korea
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9
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Aiolfi A, Inaba K, Recinos G, Khor D, Benjamin ER, Lam L, Strumwasser A, Asti E, Bonavina L, Demetriades D. Non-iatrogenic esophageal injury: a retrospective analysis from the National Trauma Data Bank. World J Emerg Surg 2017; 12:19. [PMID: 28465715 PMCID: PMC5408440 DOI: 10.1186/s13017-017-0131-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 04/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic, non-iatrogenic esophageal injuries, despite their rarity, are associated with significant morbidity and mortality. The optimal management of these esophageal perforations remains largely debated. To date, only a few small case series are available with contrasting results. The purpose of this study was to examine a large contemporary experience with traumatic esophageal injury management and to analyze risk factors associated with mortality. METHODS This National Trauma Data Bank (NTDB) database study included patients with non-iatrogenic esophageal injuries. Variables abstracted were demographics, comorbidities, mechanism of injury, Abbreviated Injury Scale (AIS), esophageal Organ Injury Scale (OIS), Injury Severity Score (ISS), level of injury, vital signs, and treatment. Multivariate analysis was used to identify independent predictors for mortality and overall complications. RESULTS A total of 944 patients with non-iatrogenic esophageal injury were included in the final analysis. The cervical segment of the esophagus was injured in 331 (35%) patients. The unadjusted 24-h mortality (8.2 vs. 14%, p = 0.008), 30-day mortality (4.2 vs. 9.3%, p = 0.005), and overall mortality (7.9 vs. 13.5%, p = 0.009) were significantly lower in the group of patients with a cervical injury. The overall complication rate was also lower in the cervical group (19.8 vs. 27.1%, p = 0.024). Multilogistic regression analysis identified age >50, thoracic injury, high-grade esophageal injury (OIS IV-V), hypotension on admission, and GCS <9 as independent risk factors associated with increased mortality. Treatment within the first 24 h was found to be protective (OR 0.284; 95% CI, 0.148-0.546; p < 0.001). Injury to the thoracic esophagus was also an independent risk factor for overall complications (OR 1.637; 95% CI, 1.06-2.53; p = 0.026). CONCLUSIONS Despite improvements in surgical technique and critical care support, the overall mortality for traumatic esophageal injury remains high. The presence of a thoracic esophageal injury and extensive esophageal damage are the major independent risk factors for mortality. Early surgical treatment, within the first 24 h of admission, is associated with improved survival. TRIAL REGISTRATION iStar, HS-16-00883.
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Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 1, 20097 Milan, Italy
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, Los Angeles, CA 90033 USA
| | - Gustavo Recinos
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, Los Angeles, CA 90033 USA
| | - Desmond Khor
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, Los Angeles, CA 90033 USA
| | - Elizabeth R. Benjamin
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, Los Angeles, CA 90033 USA
| | - Lydia Lam
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, Los Angeles, CA 90033 USA
| | - Aaron Strumwasser
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, Los Angeles, CA 90033 USA
| | - Emanuele Asti
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 1, 20097 Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 1, 20097 Milan, Italy
| | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, Los Angeles, CA 90033 USA
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10
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Herb B, Meltzer J, Lim CA. Dysphagia in a Teenager With Neck Trauma. Clin Pediatr (Phila) 2017; 56:301-304. [PMID: 27107007 DOI: 10.1177/0009922816645523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brandon Herb
- 1 Albert Einstein College of Medicine, Bronx, NY, USA
| | - James Meltzer
- 1 Albert Einstein College of Medicine, Bronx, NY, USA.,2 Jacobi Medical Center, Bronx, NY, USA
| | - C Anthoney Lim
- 1 Albert Einstein College of Medicine, Bronx, NY, USA.,2 Jacobi Medical Center, Bronx, NY, USA
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11
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Federle MP, Jaffe TA, Davis PL, Al-Hawary MM, Levine MS. Contrast media for fluoroscopic examinations of the GI and GU tracts: current challenges and recommendations. Abdom Radiol (NY) 2017; 42:90-100. [PMID: 27503380 DOI: 10.1007/s00261-016-0861-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
One of the significant challenges facing radiologists who perform and interpret studies of the gastrointestinal and genitourinary systems have been periodic interruptions in the availability of barium and iodinated contrast media specially formulated for gastrointestinal (GI) and genitourinary (GU) studies. These interruptions are due to the US Food and Drug Administration's recent requirement for more stringent documentation of the safety and efficacy of contrast media and the consolidation among contrast manufacturers. Therefore, radiologists may be required to recommend an alternative means of evaluation, such as computed tomography, magnetic resonance, or endoscopy, or they may need to substitute a different formulation of a contrast agent not specifically developed for GI or GU use, for example the utilization of an agent designed and marketed for vascular use. This article reviews the current status of fluoroscopic contrast media, and provides suggestions and recommendations for the optimal and alternative use of contrast media formulations.
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Affiliation(s)
- Michael P Federle
- Stanford University Medical Center, 300 Pasteur Drive, Rm H1330, Stanford, CA, 94305, USA.
| | - Tracy A Jaffe
- Duke University Medical Center, Box 3808 DUMC, Durham, NC, 27710, USA
| | - Peter L Davis
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, 15213, USA
| | - Mahmoud M Al-Hawary
- University of Michigan, 1500 E. Medical center Dr, Ann Arbor, MI, 48109, USA
- University Hospital, Room B1 D502, San Antonio, USA
| | - Marc S Levine
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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12
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Hanna TN, Rohatgi S, Shekhani HN, Shahid F, Ojili V, Khosa F. Upper gastrointestinal endoscopy: expected post-procedural findings and adverse events. Emerg Radiol 2016; 23:503-11. [PMID: 27461259 DOI: 10.1007/s10140-016-1427-9] [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: 05/10/2016] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
Abstract
Complications related to endoscopy are commonly encountered in the emergency department (ED) due to an increased use of outpatient diagnostic and therapeutic upper gastrointestinal endoscopic procedures. A majority of these procedures are performed on an outpatient basis, and patients with post-procedural symptoms may return to the ED. Since these patients often undergo computed tomography (CT) for diagnosis of post-procedure complications, the emergency radiologist should be familiar with the spectrum of expected post-procedural findings, as well as common and rare complications. We present a pictorial review of post-endoscopy complications and review imaging protocols in different clinical scenarios.
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Affiliation(s)
- Tarek N Hanna
- Division of Emergency Radiology, Emory Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree St NE, Atlanta, GA, 30308, USA.
| | - Saurabh Rohatgi
- Division of Emergency Radiology, Emory Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree St NE, Atlanta, GA, 30308, USA
| | - Haris N Shekhani
- Division of Emergency Radiology, Emory Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree St NE, Atlanta, GA, 30308, USA
| | - Fatima Shahid
- Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail code 7800, San Antonio, TX, 78229, USA
| | - Faisal Khosa
- Division of Radiology, Vancouver General Hospital, Jim Patterson South Ground Floor Room G861, Vancouver, BC, V5Z 1M9, Canada
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13
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Yoganathan KT, Morgan AR, Yoganathan KG. Perforation of the bowel due to cytomegalovirus infection in a man with AIDS: surgery is not always necessary! BMJ Case Rep 2016; 2016:bcr-2015-214196. [PMID: 27440845 DOI: 10.1136/bcr-2015-214196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cytomegalovirus (CMV) infection is the most common viral opportunistic infection in immunocompromised patients and is a rare cause of bowel perforation. It invariably requires surgical intervention and is often fatal. We report a 50-year-old Caucasian man with AIDS, presented 3 weeks after developing abdominal pain and distension. He was treated for CMV retinitis in the past. His adherence to antiretroviral therapy was poor. Examination revealed a recurrence of active CMV retinitis. His abdomen was tender and distended. The plain X-ray of the abdomen revealed a double wall sign (Rigler's sign), indicating pneumoperitoneum due to the bowel perforation. The upper endoscopy was normal. His CD4 count was 30 cells/mm(3) He was treated with cidofovir infusion. He made a full recovery, without requiring any form of surgery. However, he died of adult respiratory distress syndrome 14 months later, due to iatrogenic acute pancreatitis.
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Affiliation(s)
| | - Andrew Roger Morgan
- Department of Surgery, Abertawe Bro Morgannwg University Health Board, Singleton Hospital, Swansea, UK
| | - Kathir G Yoganathan
- Department of GUM/HIV, Abertawe Bro Morgannwg University Health Board, Singleton Hospital, Swansea, UK
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14
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Zeidenberg J, Durso AM, Caban K, Munera F. Imaging of Penetrating Torso Trauma. Semin Roentgenol 2016; 51:239-55. [DOI: 10.1053/j.ro.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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15
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Qian SJ, Ye XS, Chen WS, Li WL. Missed diagnosis of oesophageal perforation in ankylosing spondylitis cervical fracture: Two case reports and literature review. J Int Med Res 2016; 44:170-5. [PMID: 26740499 PMCID: PMC5536578 DOI: 10.1177/0300060515614230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/30/2015] [Indexed: 12/02/2022] Open
Abstract
Oesophageal perforation after blunt injury cervical fracture in patients with ankylosing spondylitis (AS) is rarely reported. The early diagnosis of oesophageal perforation is extremely important. We present two cases of patients with AS who sustained cervical fracture dislocation and spinal cord injury. The ossified sharp fragments caused oesophageal perforation, and the delayed diagnoses had serious consequences. Oesophageal perforation should be suspected in patients with AS and cervical fracture if bone fragments are pressing against the oesophagus and a gas shadow is visible around the fracture site on computed tomography imaging.
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Affiliation(s)
- Sheng-Jun Qian
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xue-Shi Ye
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei-Shan Chen
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wan-Li Li
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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16
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Abstract
Perforation of the rectum requires early recognition and treatment. The diagnosis of rectal perforation is sometimes difficult owing to non specific clinical presentation, especially in elderly patients, in whom, in case of acute abdomen, Computed Tomography (CT) is increasing used as first diagnostic procedure [1]. Several CT signs of gastrointestinal perforation have been described [2, 3]. Recently another CT finding related to colonic perforation called “ dirty mass” has been reported [4]. We present a case of extraperitoneal rectal perforation secondary to colonoscopy in which CT demonstrated the presence of a focal collection of extraluminal fecal matter (“dirty mass”) associated with pneumoretroperitoneum.
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Saturnino PP, Pinto A, Liguori C, Ponticiello G, Romano L. Role of Multidetector Computed Tomography in the Diagnosis of Colorectal Perforations. Semin Ultrasound CT MR 2015; 37:49-53. [PMID: 26827738 DOI: 10.1053/j.sult.2015.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Colonic perforations can be classified into perforations that occur at the site of a localized pathologic process and cecal perforations that occur secondary to distal colonic obstructions. Rectal perforations may result from foreign bodies inserted into the rectum; moreover, deep rectal biopsies, polypectomy, improper cleansing enema, or thermometer placement may also lead to rectal perforation. Correct identification of the cause and site of the perforation is crucial for appropriate management and surgical planning. Multidetector row computed tomography has a pivot role in planning the type of operative treatment, the prognosis, and in assessing those patients who have clinical symptoms of peritonitis but no radiographic signs of perforation.
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Affiliation(s)
| | - Antonio Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Carlo Liguori
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | | | - Luigia Romano
- Department of Radiology, Cardarelli Hospital, Naples, Italy
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Faggian A, Berritto D, Iacobellis F, Reginelli A, Cappabianca S, Grassi R. Imaging Patients With Alimentary Tract Perforation: Literature Review. Semin Ultrasound CT MR 2015; 37:66-9. [PMID: 26827740 DOI: 10.1053/j.sult.2015.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Alimentary tract perforation is a frequent emergency condition. Imaging plays an important role to make an accurate diagnosis, defining the presence, the level, and the cause of the perforation, essential information to enable the most correct therapeutic choice. Plain radiography is generally performed as the first choice. In case of a clinically suspected bowel perforation, not detected on x-ray imaging, the contribution of computed tomography is essential. Magnetic resonance is not yet widely used in diagnostic workup of patients with acute abdominal pain, but it can be useful in the differential diagnosis of acute abdomen in specific patients (pregnancy and pediatric patients).
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Affiliation(s)
- Angela Faggian
- Institute of Radiology, Second University of Naples, Naples, Italy.
| | - Daniela Berritto
- Institute of Radiology, Second University of Naples, Naples, Italy
| | | | | | | | - Roberto Grassi
- Institute of Radiology, Second University of Naples, Naples, Italy
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Reginelli A, Russo A, Pinto A, Stanzione F, Martiniello C, Cappabianca S, Brunese L, Squillaci E. The role of computed tomography in the preoperative assessment of gastrointestinal causes of acute abdomen in elderly patients. Int J Surg 2014; 12 Suppl 2:S181-S186. [DOI: 10.1016/j.ijsu.2014.08.345] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 01/19/2023]
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20
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Li Y, Song J, Lin N, Zhao C. Computed tomography scan is superior to x-ray plain film in the diagnosis of gastrointestinal tract perforation. Am J Emerg Med 2014; 33:480.e3-5. [PMID: 25239695 DOI: 10.1016/j.ajem.2014.08.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022] Open
Abstract
Gastrointestinal (GI) tract perforation is one of the most severe acute abdomens. In clinical practice, abdominal x-ray plain film remains the first-line diagnostic modality for this entity. A proportion of the perforated patients, however, do not exhibit a classic x ray sign: free air at the subphrenic area. This insufficiency can bring difficulties to the diagnosis, delay appropriate treatments, and even cause lethal consequences. We describe herein a case of GI tract perforation, which was not detected by the abdominal x-ray plain film initially. Strikingly, the abdominal computed tomographic (CT)scan established the diagnosis and predicted the site and cause of the perforation, which were consistent with the intraoperative findings and pathological examination. In addition, CT scan was useful in monitoring the progression of the disease. Given the high performance of CT scan in the present case, we recommend it as a preferred diagnostic modality for patients who are suspected of GI perforation,especially when the abdominal x-ray plain film is inconclusive.
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Affiliation(s)
- Yang Li
- Department of Intensive Care Unit, Shengjing Hospital of China Medical University
| | - Junmin Song
- Department of Gastroenterology, Shengjing Hospital of China Medical University.
| | - Nan Lin
- Department of Radiology, Shengjing Hospital of China Medical University
| | - Chuang Zhao
- Department of General Surgery, Shengjing Hospital of China Medical University
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21
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Abstract
Traumatic injury of the esophagus is extremely uncommon. The aims of this study were to use the Pennsylvania Trauma Outcome Study (PTOS) database to identify clinical factors predictive of esophageal trauma, and to report the morbidity and mortality of this injury. A cross-sectional review of patients presenting to 20 Level I trauma centers in Pennsylvania from 2004 to 2010 was performed. We compared clinical and demographic variables between patients with and without esophageal trauma both prior to and after arrival in the emergency room (ER). Primary mechanism of injury and clinical outcomes were analyzed. There were 231 694 patients and 327 (0.14%) had esophageal trauma. Patients with esophageal trauma were considerably younger than those without this injury. The risk of esophageal trauma was markedly increased in males (odds ratio [OR] = 2.62 [CI 1.98-3.47]). The risk was also increased in African Americans (OR = 4.61 [CI 3.65-5.82]). Most cases were from penetrating gunshot and stab wounds. Only 34 (10.4%) of esophageal trauma patients underwent an upper endoscopy; diagnosis was usually made by CT, surgery, or autopsy. Esophageal trauma patients were more likely to require surgery (35.8% vs. 12.5%; P < 0.001). Patients with esophageal trauma had a substantially higher mortality than those without the injury (20.5% vs. 1.4%; P < 0.005). In logistic regression modeling, traumatic injury of the esophagus (OR = 3.43 [2.50-4.71]) and male gender (OR = 1.52 [1.46-1.59]) were independently associated with mortality. For those patients with esophageal trauma, there was an association between trauma severity and mortality (OR = 1.10 [1.07-1.12]) but not for undergoing surgery within the first 24 hours of hospitalization (OR = 0.84; 0.39-1.83). Our study on traumatic injury of the esophagus is in concordance with previous studies demonstrating that this injury is rare but carries considerable morbidity (∼46%) and mortality (∼20%). The injury has a higher morbidity and mortality when the thoracic esophagus is involved compared to the cervical esophagus alone. The injury most commonly occurs in younger, Black males suffering gunshot wounds. Efforts to control gun violence in Pennsylvania are of paramount importance.
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Affiliation(s)
- Marc Makhani
- Section of Gastroenterology, Temple University School of Medicine, Philadelphia, PA
| | - Deena Midani
- Division of Internal Medicine, Temple University School of Medicine, Philadelphia, PA
| | - Amy Goldberg
- Department of Trauma Surgery, Temple University School of Medicine, Philadelphia, PA
| | - Frank K Friedenberg
- Section of Gastroenterology, Temple University School of Medicine, Philadelphia, PA
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22
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Computed Tomography of Iatrogenic Complications of Upper Gastrointestinal Endoscopy, Stenting, and Intubation. Radiol Clin North Am 2014; 52:1055-70. [DOI: 10.1016/j.rcl.2014.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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23
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Diagnostic performance of CT esophagography in patients with suspected esophageal rupture. Emerg Radiol 2014. [PMID: 24748526 DOI: 10.1007/s10140-014-1222-4.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Esophageal rupture is a surgical catastrophe. The gold standard for diagnosing is iodine, water-soluble contrast medium esophagography. CT esophagography has shown promising results. This study aimed to assess the diagnostic performance of CT esophagography in patients with a suspicion of esophageal rupture. This prospective study assessed the performance of a diagnostic test and was approved by local IRB committee. Patients who presented with a clinical suspicion of esophageal rupture were included. CT esophagography findings were described by the emergency radiologist. Clinical outcomes (presence or absence of esophageal rupture) were reported by surgeons. The operative characteristics were calculated. A final predictive scale for rupture was built. A total of 64 patients were recruited (age 26.5 years, 90 % male, 82 % trauma). Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were 77.7 % (95 % confidence interval (CI) 45-100), 94.3 % (87.2-100), 14 (9.81-19.9), and 0.24 (0.05-1.22), respectively. The final model for predicting rupture included five variables: age (odds ratio (OR) 1.03; 95 % CI, 0.95-1.11; p=0.04), leakage of contrast media into the mediastinum or pleural space (OR 10.0; 95 % CI, 0.64-156.9; p=0.10), extraluminal air or fluid collections (OR 43.1; 95 % CI, 1.52-1217.3; p=0.027), esophageal wall thickening (OR 10.1; 95 % CI, 0.50-202.8; p=0.12), and left pneumothorax or pleural effusion (OR 6.5; 95 % CI, 0.31-132.7; p=0.2). The overall agreement was 0.40 (95 % CI, 0.09-0.72) for the predictive model. The model sensitivity was 50.0 %, and the specificity was 98.4 %. CT esophagography shows a good diagnostic performance in patients with a suspected esophageal rupture.
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Suarez-Poveda T, Morales-Uribe CH, Sanabria A, Llano-Sánchez A, Valencia-Delgado AM, Rivera-Velázquez LF, Bedoya-Ospina JF. Diagnostic performance of CT esophagography in patients with suspected esophageal rupture. Emerg Radiol 2014; 21:505-10. [PMID: 24748526 DOI: 10.1007/s10140-014-1222-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/01/2014] [Indexed: 11/25/2022]
Abstract
Esophageal rupture is a surgical catastrophe. The gold standard for diagnosing is iodine, water-soluble contrast medium esophagography. CT esophagography has shown promising results. This study aimed to assess the diagnostic performance of CT esophagography in patients with a suspicion of esophageal rupture. This prospective study assessed the performance of a diagnostic test and was approved by local IRB committee. Patients who presented with a clinical suspicion of esophageal rupture were included. CT esophagography findings were described by the emergency radiologist. Clinical outcomes (presence or absence of esophageal rupture) were reported by surgeons. The operative characteristics were calculated. A final predictive scale for rupture was built. A total of 64 patients were recruited (age 26.5 years, 90 % male, 82 % trauma). Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were 77.7 % (95 % confidence interval (CI) 45-100), 94.3 % (87.2-100), 14 (9.81-19.9), and 0.24 (0.05-1.22), respectively. The final model for predicting rupture included five variables: age (odds ratio (OR) 1.03; 95 % CI, 0.95-1.11; p=0.04), leakage of contrast media into the mediastinum or pleural space (OR 10.0; 95 % CI, 0.64-156.9; p=0.10), extraluminal air or fluid collections (OR 43.1; 95 % CI, 1.52-1217.3; p=0.027), esophageal wall thickening (OR 10.1; 95 % CI, 0.50-202.8; p=0.12), and left pneumothorax or pleural effusion (OR 6.5; 95 % CI, 0.31-132.7; p=0.2). The overall agreement was 0.40 (95 % CI, 0.09-0.72) for the predictive model. The model sensitivity was 50.0 %, and the specificity was 98.4 %. CT esophagography shows a good diagnostic performance in patients with a suspected esophageal rupture.
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Affiliation(s)
- Tatiana Suarez-Poveda
- Department of Radiology, Universidad de Antioquia-Hospital San Vicente Fundacion, Calle 64 No. 51 D-154, Medellin, Colombia,
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Solis CV, Chang Y, De Moya MA, Velmahos GC, Fagenholz PJ. Free air on plain film: Do we need a computed tomography too? J Emerg Trauma Shock 2014; 7:3-8. [PMID: 24550622 PMCID: PMC3912647 DOI: 10.4103/0974-2700.125631] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/15/2013] [Indexed: 11/15/2022] Open
Abstract
Context: Standard teaching is that patients with pneumoperitoneum on plain X-ray and clinical signs of abdominal pathology should undergo urgent surgery. It is unknown if abdominal computed tomography (CT) provides additional useful information in this scenario. Aims: The aim of this study is to determine whether or not CT scanning after identification of pneumoperitoneum on plain X-ray changes clinical management or outcomes. Settings and Design: Retrospective study carried out over 4 years at a tertiary care academic medical center. All patients in our acute care surgery database with pneumoperitoneum on plain X-ray were included. Patients who underwent subsequent CT scanning (CT group) were compared with patients who did not (non-CT group). Statistical Analysis Used: The Wilcoxon rank-sum test, t-test and Fisher's exact test were used as appropriate to compare the groups. Results: There were 25 patients in the non-CT group and 18 patients in the CT group. There were no differences between the groups at presentation. All patients in the non-CT group underwent surgery, compared with 83% (n = 15) of patients in the CT group (P = 0.066). 16 patients in the non-CT and 11 patients in the CT group presented with peritonitis and all underwent surgery regardless of group. For patients undergoing surgery, there were no differences in outcomes between the groups. After X-ray, patients undergoing CT required 328.0 min to arrive in the operating room compared with 136.0 min in the non-CT group (P = 0.007). Conclusions: In patients with pneumoperitoneum on X-ray and peritonitis on physical exam, CT delays surgery without providing any measurable benefit.
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Affiliation(s)
- Carolina V Solis
- Department of Surgery, Duke University Hospital, Durham, NC, USA ; Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Yuchiao Chang
- Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Marc A De Moya
- Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital, Boston, MA, USA ; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - George C Velmahos
- Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital, Boston, MA, USA ; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Peter J Fagenholz
- Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital, Boston, MA, USA ; Department of Surgery, Harvard Medical School, Boston, MA, USA
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26
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Harger BL, Hoffman LE, Arkless R. Miscellaneous Abdomen Diseases. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Panes J, Bouhnik Y, Reinisch W, Stoker J, Taylor SA, Baumgart DC, Danese S, Halligan S, Marincek B, Matos C, Peyrin-Biroulet L, Rimola J, Rogler G, van Assche G, Ardizzone S, Ba-Ssalamah A, Bali MA, Bellini D, Biancone L, Castiglione F, Ehehalt R, Grassi R, Kucharzik T, Maccioni F, Maconi G, Magro F, Martín-Comín J, Morana G, Pendsé D, Sebastian S, Signore A, Tolan D, Tielbeek JA, Weishaupt D, Wiarda B, Laghi A. Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis 2013; 7:556-85. [PMID: 23583097 DOI: 10.1016/j.crohns.2013.02.020] [Citation(s) in RCA: 441] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 02/20/2013] [Indexed: 12/12/2022]
Abstract
The management of patients with IBD requires evaluation with objective tools, both at the time of diagnosis and throughout the course of the disease, to determine the location, extension, activity and severity of inflammatory lesions, as well as, the potential existence of complications. Whereas endoscopy is a well-established and uniformly performed diagnostic examination, the implementation of radiologic techniques for assessment of IBD is still heterogeneous; variations in technical aspects and the degrees of experience and preferences exist across countries in Europe. ECCO and ESGAR scientific societies jointly elaborated a consensus to establish standards for imaging in IBD using magnetic resonance imaging, computed tomography, ultrasonography, and including also other radiologic procedures such as conventional radiology or nuclear medicine examinations for different clinical situations that include general principles, upper GI tract, colon and rectum, perineum, liver and biliary tract, emergency situation, and the postoperative setting. The statements and general recommendations of this consensus are based on the highest level of evidence available, but significant gaps remain in certain areas such as the comparison of diagnostic accuracy between different techniques, the value for therapeutic monitoring, and the prognostic implications of particular findings.
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Affiliation(s)
- J Panes
- Gastroenterology Department, Hospital Clinic Barcelona, CIBERehd, IDIBAPS, Barcelona, Spain.
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Priola AM, Priola SM, Volpicelli G, Giraudo MT, Martino V, Fava C, Veltri A. Accuracy of 64-row multidetector CT in the diagnosis of surgically treated acute abdomen. Clin Imaging 2013; 37:902-7. [PMID: 23764231 DOI: 10.1016/j.clinimag.2013.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 02/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the accuracy of 64-row computed tomography (CT) in the differential diagnosis of acute abdomen in the emergency department. MATERIALS AND METHODS Prospective analysis of 181 patients with surgically treated acute abdomen. RESULTS In 158/181 cases, CT was totally concordant with surgical repertoire. Partial concordance was found in 15 cases. Overall sensitivity was 87.3% when only cases of complete concordance were considered, 95.6% if also partial concordance cases were included. CONCLUSION CT showed high reliability in the differential diagnosis of acute abdomen surgically treated, although associated conditions can sometimes be missed.
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Affiliation(s)
- Adriano Massimiliano Priola
- Department of Diagnostic and Interventional Radiology, University of Turin, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043, Orbassano (Torino), Italy.
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29
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Wu CH, Huang CC, Wang LJ, Wong YC, Wang CJ, Lo WC, Lin BC, Wan YL, Hsueh C. Value of CT in the discrimination of fatal from non-fatal stercoral colitis. Korean J Radiol 2012; 13:283-9. [PMID: 22563265 PMCID: PMC3337864 DOI: 10.3348/kjr.2012.13.3.283] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 11/25/2011] [Indexed: 12/17/2022] Open
Abstract
Objective Clinical presentation and physical signs may be unreliable in the diagnosis of stercoral colitis (SC). This study evaluates the value of computed tomography (CT) in distinguishing fatal from non-fatal SC. Materials and Methods Ten patients diagnosed as SC were obtained from inter-specialist conferences. Additional 13 patients with suspected SC were identified via the Radiology Information System (RIS). These patients were divided into two groups; fatal and non-fatal SCs. Their CT images are reviewed by two board-certified radiologists blinded to the clinical data and radiographic reports. Results SC occurred in older patients and displayed no gender predisposition. There was significant correlation between fatal SC and CT findings of dense mucosa (p = 0.017), perfusion defects (p = 0.026), ascites (p = 0.023), or abnormal gas (p = 0.033). The sensitivity, specificity, and accuracy of dense mucosa were 71%, 86%, and 81%, respectively. These figures were 75%, 79%, and 77% for perfusion defects; 75%, 80%, and 78% for ascites; and 50%, 93%, and 78% for abnormal gas, respectively. Each CT sign of mucosal sloughing and pericolonic abscess displayed high specificity of 100% and 93% for diagnosing fatal SC, respectively. However, this did not reach statistical significance in diagnosing fatal SC. Conclusion CT appears to be valuable in discriminating fatal from non-fatal SC.
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Affiliation(s)
- Cheng-Hsien Wu
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
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30
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Kaman L, Iqbal J, Kundil B, Kochhar R. Management of Esophageal Perforation in Adults. Gastroenterology Res 2010; 3:235-244. [PMID: 27942303 PMCID: PMC5139851 DOI: 10.4021/gr263w] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2010] [Indexed: 12/16/2022] Open
Abstract
Perforation of esophagus in the adult is a very morbid condition with high morbidity and mortality. The ideal treatment is controversial. The main causes for esophageal perforation in adults are iatrogenic, traumatic, spontaneous and foreign bodies. The morbidity and mortality rate is directly related to the delay in diagnosis and initiation of optimum treatment. The reported mortality from treated esophageal perforation is 10% to 25%, when therapy is initiated within 24 hours of perforation, but it could rise up to 40% to 60% when the treatment is delayed beyond 48 hours. Primary closure of the perforation site and wide drainage of the mediastinum is recommended if perforation is detected in less than 24 hours. Treatment option for delayed or missed rupture of esophagus is not very clear and is controversial. Recently a substantial number of patients with esophageal perforation are being managed by nonoperative measures. Patients with small perforations and minimal extraesophageal involvement may be better managed by nonoperative treatment Major prognostic factors determining mortality are the etiology and site of the injury, the presence of underlying esophageal pathology, the delay in diagnosis and the method of treatment. For optimum outcome for management of esophageal perforations in adults a multidisciplinary approach is needed.
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Affiliation(s)
- Lileswar Kaman
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Javid Iqbal
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Byju Kundil
- Department of GI Surgery, Lakeshore Hospital, Cochin, Kerala, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Singh JP, Steward MJ, Booth TC, Mukhtar H, Murray D. Evolution of imaging for abdominal perforation. Ann R Coll Surg Engl 2010; 92:182-8. [PMID: 20412668 DOI: 10.1308/003588410x12664192075251] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Gastrointestinal (GI) perforation is a common surgical presentation. In recent years, computed tomography (CT) has been shown to be accurate for predicting the site of GI perforation, and has become the investigation of choice. However the signs may be subtle or only indirectly related to the site or aetiology of perforation. SUBJECTS AND METHODS A MEDLINE and PubMed search was performed for journals before June 2009 with MeSH major terms 'CT' and 'perforation'. Non-English speaking literature was excluded. RESULTS Examples of GI perforation of various aetiologies are reviewed (inflammatory, neoplastic, traumatic and iatrogenic) high-lighting characteristic CT appearances as well as pitfalls in diagnosis. Features of perforation include the presence of free gas or fluid within the supra- and/or inframesocolic compartments, segmental bowel wall thickening, bowel wall discontinuity, stranding of the mesenteric fat and abscess formation. CONCLUSIONS These differentiating features facilitate accurate multidisciplinary pre-operative evaluation, necessary to plan patient management and potential surgical approach.
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Affiliation(s)
- J P Singh
- Department of Radiology, The Whittington Hospital, Royal Free and University College Medical School, London, UK
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32
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Woo KMC, Schneider JI. High-risk chief complaints I: chest pain--the big three. Emerg Med Clin North Am 2010; 27:685-712, x. [PMID: 19932401 DOI: 10.1016/j.emc.2009.07.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chest pain is one of the most frequently seen chief complaints in patients presenting to emergency departments, and is considered to be a "high-risk" chief complaint. The differential diagnosis for chest pain is broad, and potential causes range from the benign to the immediately life-threatening. Although many (if not most) emergency department patients with chest pain do not have an immediately life-threatening condition, correct diagnoses can be difficult to make, incorrect diagnoses may lead to catastrophic therapies, and failure to make a timely diagnosis may contribute to significant morbidity and mortality. Several atraumatic "high-risk" causes of chest pain are discussed in this article, including myocardial infarction and ischemia, thoracic aortic dissection, and pulmonary embolism. Also included are brief discussions of tension pneumothorax, esophageal perforation, and cardiac tamponade.
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Affiliation(s)
- Kar-mun C Woo
- Department of Emergency Medicine, Boston Medical Center, Dowling 1 South, 1 Boston Medical Center Place, Boston, MA 02118, USA
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33
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Kaewlai R, Kurup D, Singh A. Imaging of Abdomen and Pelvis: Uncommon Acute Pathologies. Semin Roentgenol 2009; 44:228-36. [DOI: 10.1053/j.ro.2009.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Wang Y, Deng XB, Jiang K, Wang XY. Imaging presentations of esophageal perforation. Shijie Huaren Xiaohua Zazhi 2009; 17:312-315. [DOI: 10.11569/wcjd.v17.i3.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To illustrate imaging presentations related to esophageal perforation and their significance for therapeutic decisions.
METHODS: We studied 21 patients with suspected esophageal injury from June 2002 to October 2008 at our hospital. Ten patients underwent standard chest radiography and 2 patients were submitted to cervical plain film, while 11 patients with suspected esophageal perforation were submitted to gastrografin swallow study (7 with iodine and 4 with barium). Nine patients underwent row spiral CT examination (2 with enhancement). Imaging presentations were compared and analyzed.
RESULTS: Chest radiography (n = 10) revealed hydropneumothorax in 4/10 and pleural effusions in 4/10, and pulmonary infection were observed in 3/10; Changes of mediastinum were seen in 7/10 patients, pneumomediastinum in 3 cases, mediastinum widen in 3 cases, and air-fluid level in 1 case. Subcutaneous emphysema in the neck, chest was noted in 4/10. Esophagography (n = 11) demonstrated contrast medium extravasation in 9/11, indicating a submucosal contrast medium collection in 4/11, except for 2 cases with negative finding. Enhanced CT scans (n = 9) revealed periesophageal air and fluid collections with irregular soft tissue masses in 5/11 patients, thicken wall with typical localization in 4/11, abscess formation in mediastinum or under diaphragm in 4/11. Contrast-enhanced CT (n = 2) demonstrated abscess formation with contrast enhancement of the margins.
CONCLUSION: Esophagography and CT examination are the main diagnosis methods for suspected esophageal perforation. CT findings of inflammatory reaction for esophageal perforation are especially important for surgical treatment.
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35
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Young CA, Menias CO, Bhalla S, Prasad SR. CT features of esophageal emergencies. Radiographics 2008; 28:1541-53. [PMID: 18936020 DOI: 10.1148/rg.286085520] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Esophageal emergencies-primarily, perforation and conditions with the potential to progress to perforation-result in significant morbidity and mortality if they are not recognized and treated promptly. The spectrum of esophageal emergencies includes esophagitis, foreign body impaction, and traumatic esophageal injury. Because there is considerable variability in the clinical manifestations of emergent esophageal conditions, computed tomography (CT) may play both primary and complementary roles in their diagnosis and evaluation. An awareness of the CT findings associated with the spectrum of acute esophageal disease facilitates the accurate and prompt diagnosis of esophageal emergencies and thereby contributes to a more successful outcome.
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Affiliation(s)
- Catherine A Young
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Barnes Jewish Hospital, St. Louis, MO 63110, USA.
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Zissin R, Osadchy A, Gayer G. Abdominal CT findings in small bowel perforation. Br J Radiol 2008; 82:162-71. [PMID: 18852210 DOI: 10.1259/bjr/78772574] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Small bowel perforation is an emergent medical condition for which the diagnosis is usually not made clinically but by CT, a common imaging modality used for the diagnosis of acute abdomen. Direct CT features that suggest perforation include extraluminal air and oral contrast, which are often associated with secondary CT signs of bowel pathology. This pictorial review illustrates the CT findings of small bowel perforation caused by various clinical entities.
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Affiliation(s)
- R Zissin
- Department of Diagnostic Imaging, Meir Medical Center, Kfar Saba, Israel.
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Wilmot ASH, Levine MS, Rubesin SE, Kucharczuk JC, Laufer I. Intraluminal migration of surgical drains after transhiatal esophagogastrectomy: radiographic findings and clinical relevance. AJR Am J Roentgenol 2007; 189:780-5. [PMID: 17885045 DOI: 10.2214/ajr.07.2322] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objectives of our study were to review our experience with a group of patients in whom contrast examinations after transhiatal esophagogastrectomy and gastric pull-through revealed intraluminal migration of a surgical drain and to describe the radiographic appearance and clinical relevance of this phenomenon. CONCLUSION Our findings indicate that intraluminal migration of a surgical drain after transhiatal esophagogastrectomy is an infrequent but serious phenomenon that hinders or prevents healing of an anastomotic leak. Radiologists should be aware of this phenomenon and should be able to recognize the findings of an intraluminal drain on contrast examinations. When such drains are identified, we believe that they should be promptly withdrawn or removed to facilitate healing of anastomotic leaks.
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Affiliation(s)
- Andrew S H Wilmot
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA
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Zissin R, Hertz M, Osadchy A, Even-Sapir E, Gayer G. Abdominal CT findings in nontraumatic colorectal perforation. Eur J Radiol 2007; 65:125-32. [PMID: 17466477 DOI: 10.1016/j.ejrad.2007.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 03/08/2007] [Accepted: 03/13/2007] [Indexed: 12/31/2022]
Abstract
Colorectal perforation is an emergent medical condition in which the diagnosis and the etiology are often established on CT, the common imaging modality used for evaluating the acute abdomen. The cardinal, direct CT features suggesting perforation are extraluminal air and enteric contrast, added by secondary signs of bowel pathology, such as focal bowel wall thickening and bowel wall defect. This pictorial review will illustrate the CT findings of colorectal perforation caused by various clinical entities.
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Affiliation(s)
- Rivka Zissin
- Department of Diagnostic Imaging, Meir Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Kfar Saba 44281, Israel.
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Strauss DC, Tandon R, Mason RC. Distal thoracic oesophageal perforation secondary to blunt trauma: case report. World J Emerg Surg 2007; 2:8. [PMID: 17374175 PMCID: PMC1852095 DOI: 10.1186/1749-7922-2-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 03/21/2007] [Indexed: 11/10/2022] Open
Abstract
Background Traumatic perforation of the distal oesophagus due to blunt trauma is a very rare condition and is still associated with a significant morbidity and mortality. This is further exacerbated by delayed diagnosis and management as symptoms and signs are often masked by or ascribed to more common blunt thoracic injuries. Case report We present a case of a distal oesophageal perforation, secondary to a fall from a third storey window, which was masked by concomitant thoracic injuries and missed on both computed tomography imaging and laparotomy. The delay in his diagnosis significantly worsened the patient's recovery by allowing the development of an overwhelming chest sepsis that contributed to his death. Conclusion Early identification of an intrathoracic oesophageal perforation requires deliberate consideration and is essential to ensure a favorable outcome. Treatment should be individualised taking into account the nature of the oesophageal defect, time elapsed from injury and the patient's general condition.
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Affiliation(s)
- Dirk C Strauss
- Department of General Surgery, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK
| | - Ruchi Tandon
- Department of General Surgery, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK
| | - Robert C Mason
- Department of General Surgery, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK
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Affiliation(s)
- S Milanchi
- Cedars-Sinai Medical Center, Department of Surgery, 8700 Beverly Blvd, Los Angeles, California 90048, USA.
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Abstract
OBJECTIVE Duodenal diverticulitis is a rare complication of duodenal diverticulosis. It is often clinically misdiagnosed because it has no pathognomonic signs or symptoms and its CT findings may mimic other intraabdominal processes. We describe two patients with duodenal diverticulitis who presented with abdominal pain, nausea, and leukocytosis. At the time of initial presentation, only one of the two patients was diagnosed correctly. In the first case, which was initially misdiagnosed as acute pancreatitis, the correct diagnosis was evident only after the disease process had become more quiescent and a follow-up CT scan using orally and i.v.-administered contrast agents was performed. In the second case, the coronal reformatted images confirmed the diagnosis suggested by the axial images. CONCLUSION Duodenal diverticulitis can be a difficult CT diagnosis to make; however, maintaining it in the differential diagnosis of duodenal and pancreatic inflammatory processes and masses as well as defining the anatomy with nonaxial imaging including coronal images may be helpful in confirming the diagnosis.
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Affiliation(s)
- Monica S Pearl
- Department of Radiology, George Washington University Medical Center, 900 23rd St., NW, 1st Floor Radiology, Washington, DC 20037, USA
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Zissin R, Konikoff F, Gayer G. CT findings of latrogenic complications following gastrointestinal endoluminal procedures. Semin Ultrasound CT MR 2006; 27:126-38. [PMID: 16623367 DOI: 10.1053/j.sult.2006.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abdominal CT, a simple and safe imaging modality, plays an important role in evaluating patients suspected of having abdominal complications following nonsurgical gastrointestinal procedures, to accurately determine the presence or absence of such insults. This pictorial article reviews and demonstrates the CT findings of various complications following upper endoscopy, percutaneous endoscopic gastrostomy, endoscopic retrograde cholangiopancreatography, endoscopic US, colonoscopy, and enemas (barium as well as cleansing).
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Affiliation(s)
- R Zissin
- Dept. of Diagnostic Imaging, Meir Medical Center, Kfar Saba 44281, Israel.
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Affiliation(s)
- Lara K Kulchycki
- Harvard Affiliated Emergency Medicine Residency, Harvard Medical School, Massachusetts, USA
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Woodfield CA, Levine MS. The postoperative stomach. Eur J Radiol 2005; 53:341-52. [PMID: 15741008 DOI: 10.1016/j.ejrad.2004.12.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Revised: 12/14/2004] [Accepted: 12/17/2004] [Indexed: 12/26/2022]
Abstract
Gastric surgery may be performed for the treatment of a variety of benign and malignant diseases of the upper gastrointestinal tract, including peptic ulcers and gastric carcinoma. Radiographic studies with water-soluble contrast agents often are obtained to rule out leaks, obstruction, or other acute complications during the early postoperative period. Barium studies may also be obtained to evaluate for anastomotic strictures or ulcers, bile reflux gastritis, recurrent tumor, or other chronic complications during the late postoperative period. Cross-sectional imaging studies such as CT are also helpful for detecting abscesses or other postoperative collections, recurrent or metastatic tumor, or less common complications such as afferent loop syndrome or gastrojejunal intussusception. It is important for radiologists to be familiar not only with the radiographic findings associated with these various abnormalities but also with the normal appearances of the postoperative stomach on radiographic examinations, so that such appearances are not mistaken for pseudoleaks or other postoperative complications. The purpose of this article is to describe the normal postsurgical anatomy after the most commonly performed operations (including partial gastrectomy, esophagogastrectomy and gastric pull-through, and total gastrectomy and esophagojejunostomy) and to review the acute and chronic complications, normal postoperative findings, and major abnormalities detected on radiographic examinations in these patients.
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Affiliation(s)
- Courtney A Woodfield
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Buckley O, Geoghegan T, O'Riordain DS, Lyburn ID, Torreggiani WC. Computed tomography in the imaging of colonic diverticulitis. Clin Radiol 2004; 59:977-83. [PMID: 15488845 DOI: 10.1016/j.crad.2004.05.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2003] [Revised: 04/13/2004] [Accepted: 05/04/2004] [Indexed: 02/08/2023]
Abstract
Colonic diverticulitis occurs when diverticula within the colon become infected or inflamed. It is becoming an increasingly common cause for hospital admission, particularly in western society, where it is linked to a low fibre diet. Symptoms of diverticulitis include abdominal pain, diarrhoea and pyrexia, however, symptoms are often non-specific and the clinical diagnosis may be difficult. In addition, elderly patients and those taking corticosteroids may have limited findings on physical examination, even in the presence of severe diverticulitis. A high index of suspicion is required in such patients in order to avoid a significant delay in arriving at the correct diagnosis. Imaging plays an important role in establishing an early and correct diagnosis. In the past, contrast enema studies were the principal imaging test used to make the diagnosis. However, such studies lack sensitivity and have limited success in identifying abscesses that may require drainage. Conversely computed tomography (CT) is both sensitive and specific in making a diagnosis of diverticulitis. In addition, it is the imaging technique of choice in depicting complications such as perforation, abscess formation and fistulae. CT-guided drainage of diverticular abscesses helps to reduce sepsis and to permit a one-stage, rather than two-stage, surgical operation. The purpose of this review article is to discuss the role of CT in the imaging of diverticulitis, describe the CT imaging features and complications of this disease, as well as review the impact and rationale of CT imaging and intervention in the overall management of patients with diverticulitis.
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Affiliation(s)
- O Buckley
- Department of Surgery, Adelaide and Meath Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland
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