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Barba E, Livovsky DM, Relea L, Alcalá-Gonzalez LG, Quiroga S, Accarino A, Azpiroz F. Evaluation of abdominal gas by plain abdominal radiographs. Neurogastroenterol Motil 2023; 35:e14485. [PMID: 36194191 PMCID: PMC10078561 DOI: 10.1111/nmo.14485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/04/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our aim was to determine the reliability of plain abdominal radiographs for the evaluation of abdominal gas content in patients with functional digestive symptoms. METHODS Abdominal CT scan scout views, mimicking a conventional plain abdominal radiograph, were obtained from 30 patients both during episodes of abdominal distension and basal conditions. Physicians (n = 50) were instructed to rate the estimated volume of gas in the 60 images presented in random sequence using a scale graded from 0 to ≥600 ml. KEY RESULTS The gas volumes estimated in the scout views differed from those measured by CT by a median of 90 (95% CI 70-102) ml, and the misestimation was not related to the absolute volume in the image. The accuracy of the observers, measured by their mean misestimation, was not related to their specialty or the training status (misestimation by 96 (95% CI 85-104) ml in staff vs 78 (70-106) ml in residents; p = 0.297). The accuracy was independent of the order of presentation of the images. Gas volume measured by CT in the images obtained during episodes of abdominal distension differed by a median of 39 (95% CI 29-66) ml from those during basal conditions, and this difference was misestimated by a median of 107 (95% CI 94-119) ml. The accuracy of these estimations was not related to the absolute gas volumes (R = -0.352; p < 0.001) or the magnitude of the differences. CONCLUSIONS & INFERENCES Plain abdominal radiographs have limited value for the evaluation of abdominal gas volume in patients with functional gut disorders.
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Affiliation(s)
- Elizabeth Barba
- Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Universitat Autònoma de Barcelona, Bellaterra, Spain.,Gastroenterology Department, Hospital Clínic de Barcelona, Bellaterra, Spain
| | - Dan M Livovsky
- Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Lucia Relea
- Gastroenterology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Luis G Alcalá-Gonzalez
- Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Sergio Quiroga
- Radiology Department, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Anna Accarino
- Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Fernando Azpiroz
- Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Universitat Autònoma de Barcelona, Bellaterra, Spain
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Monreal-Robles R, Kohn-Gutiérrez AE, Sordia-Ramírez J, Zúñiga-Segura JA, Palafox-Salinas JA, de la Rosa-Pacheco S, Elizondo-Riojas G, González-González JA. Peritoneal cavity circumference on computed tomography predicts outcomes in acute pancreatitis. Eur J Radiol 2020; 132:109327. [PMID: 33049650 DOI: 10.1016/j.ejrad.2020.109327] [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: 07/05/2020] [Revised: 09/10/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We investigated the role of novel intra-abdominal parameters measured by computed tomography (CT) in the prediction of clinical outcomes in acute pancreatitis (AP). METHODS Patients with AP underwent an abdominal CT scan on admission to define different intra-abdominal parameters (abdominal circumference, peritoneal cavity circumference, intraabdominal visceral fat area, and subcutaneous fat area) at the L2-L3 level using the open-source image analysis software Osirix Lite v.11.0.4 to predict clinical outcomes. RESULTS Eighty patients with AP were analyzed. Peritoneal cavity circumference (PCC) was the only variable independently associated with outcomes. PCC showed an area under ROC for prediction of severity in AP of 0.830. A PCC ≥ 85 cm increased the risk of severity of AP (RR 15.7), persistent systemic inflammatory response syndrome (RR 9.3), acute peripancreatic fluid collection (RR 6.4), necrotizing pancreatitis (RR 21.50), and mortality (RR 2.4). We found a 4.7-fold increase in the risk of developing severe AP for each 10 cm increase in PCC. CONCLUSIONS PCC measurement at the L2-L3 level using a non-enhanced abdominal CT scan on admission in patients with AP is useful in the early prediction of severity, persistent systemic inflammatory response syndrome, local complications, and mortality.
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Affiliation(s)
- Roberto Monreal-Robles
- Servicio de Gastroenterología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico; Escuela de Medicina y Ciencias de la Salud, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico.
| | - Ana E Kohn-Gutiérrez
- Departamento de Radiología e Imagen, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - José Sordia-Ramírez
- Servicio de Gastroenterología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Julian A Zúñiga-Segura
- Servicio de Gastroenterología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Javier A Palafox-Salinas
- Departamento de Radiología e Imagen, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Sylvia de la Rosa-Pacheco
- Escuela de Medicina y Ciencias de la Salud, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Guillermo Elizondo-Riojas
- Departamento de Radiología e Imagen, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - José A González-González
- Servicio de Gastroenterología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Ji YF, Zhang XM, Mitchell DG, Li XH, Chen TW, Li Y, Bao ZG, Tang W, Xiao B, Huang XH, Yang L. Gastrointestinal tract involvement in acute pancreatitis: initial findings and follow-up by magnetic resonance imaging. Quant Imaging Med Surg 2017; 7:641-653. [PMID: 29312869 DOI: 10.21037/qims.2017.12.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background To study the initial and follow up patterns of gastrointestinal tract involvement in acute pancreatitis (AP) using magnetic resonance imaging (MRI). Methods A total of 209 patients with AP undergoing abdominal MRI on 1.5 T MRI were compared to 100 control patients selected from our daily clinical caseload who underwent MRI over the same recruitment period and had no other disease which can cause abnormality of gastrointestinal tract. Initial and follow up MRI examinations of gastrointestinal tract abnormalities were noted for AP patients. The severity of AP was graded by the MRSI and APACHE II. Spearman correlation of gastrointestinal tract involvement with MRSI and APACHE II was analyzed. Results In 209 patients with AP, 63% of the AP patients on their initial MRI exams and 5% of control subjects had at least one gastrointestinal tract abnormality (P<0.05). In the control group, thirty-seven patients were normal on MRI, 24 patients with renal cysts, eighteen patients with liver cysts, eleven patients with liver hemangiomas, and ten patients with splenomegaly. The abnormalities of gastrointestinal tract observed in AP patients included thickened stomach wall (20%), thickened duodenum wall (27%), thickened ascending colon wall (11%), thickened transverse colon wall (15%), and thickened descending colon wall (26%), among others. Gastrointestinal tract abnormalities were correlated with the MRSI score (r=0.46, P<0.05) and APACHE II score (r=0.19, P<0.05). Among 62 patients who had follow up examinations, 26% of patients had gastrointestinal tract abnormality, which was significantly lower than that in the initial exams (P<0.05). Resolution of gastrointestinal tract abnormal MRI findings coincided with symptom alleviation in AP patients. Conclusions Gastrointestinal tract abnormalities on MRI are common in AP and they are positively correlated with the severity of AP. It may add value for determining the severity of AP.
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Affiliation(s)
- Yi-Fan Ji
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Xiao-Ming Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Don G Mitchell
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Xing-Hui Li
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Tian-Wu Chen
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Yong Li
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Zhi-Guo Bao
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Wei Tang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Bo Xiao
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Xiao-Hua Huang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Lin Yang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
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Liu LL, Wang XY. Severe acute pancreatitis complicated with gastrointestinal dysfunction: Pathogenesis, diagnosis and treatment. Shijie Huaren Xiaohua Zazhi 2013; 21:3828-3834. [DOI: 10.11569/wcjd.v21.i34.3828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Severe acute pancreatitis (SAP) is often associated with gastrointestinal dysfunction, leading to gastrointestinal motility disorders and even gastrointestinal failure, which has an important effect on SAP progression and prognosis, directly influences the outcome of treatment, is an important cause of death in patients with SAP, and moreover, has been one of the important prognostic factors for SAP. This review aims to discuss the pathophysiology, pathogenesis, diagnosis and treatment of SAP with gastrointestinal dysfunction.
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