1
|
Atalay RT, Kolawole O, Ayele GM, Gobezie AA, Kibreab A, Michael MB. Right Upper Quadrant Pain: A Rare Presentation of Diverticulitis. Cureus 2024; 16:e55674. [PMID: 38586678 PMCID: PMC10997493 DOI: 10.7759/cureus.55674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Acute diverticulitis is a prevalent medical condition with increasing incidence rates. While the sigmoid colon is the most commonly affected part of the large intestine, there have been occurrences of right-sided diverticulitis although uncommon. We present a case report highlighting the atypical presentation of diverticulitis in a 27-year-old female patient. The patient experienced right upper and epigastric pain and was ultimately diagnosed with right-sided diverticulitis, supported by her CT imaging findings. This uncommon presentation underscores the importance of considering diverse clinical manifestations when diagnosing and managing diverticulitis.
Collapse
Affiliation(s)
| | | | - Girma M Ayele
- Internal Medicine, Howard University Hospital, Washington DC, USA
| | - Abay A Gobezie
- Internal Medicine, Howard University Hospital, Washington DC, USA
| | - Angesom Kibreab
- Gastroenterology, Howard University Hospital, Washington DC, USA
| | - Miriam B Michael
- Internal Medicine, Howard University Hospital, Washingon DC, USA
- Internal Medicine, University of Maryland, Baltimore, USA
| |
Collapse
|
2
|
D’Andrea A, Del Giudice C, Fabiani D, Caputo A, Sabatella F, Cante L, Palermi S, Desiderio A, Tagliamonte E, Liccardo B, Russo V. The Incremental Role of Multiorgan Point-of-Care Ultrasounds in the Emergency Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2088. [PMID: 36767456 PMCID: PMC9915087 DOI: 10.3390/ijerph20032088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
Point-of-care ultrasonography (POCUS) represents a goal-directed ultrasound examination performed by clinicians directly involved in patient healthcare. POCUS has been widely used in emergency departments, where US exams allow physicians to make quick diagnoses and to recognize early life-threatening conditions which require prompt interventions. Although initially meant for the real-time evaluation of cardiovascular and respiratory pathologies, its use has been extended to a wide range of clinical applications, such as screening for deep-vein thrombosis and trauma, abdominal ultrasonography of the right upper quadrant and appendix, and guidance for invasive procedures. Moreover, recently, bedside ultrasounds have been used to evaluate the fluid balance and to guide decongestive therapy in acutely decompensated heart failure. The aim of the present review was to discuss the most common applications of POCUS in the emergency setting.
Collapse
Affiliation(s)
- Antonello D’Andrea
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Carmen Del Giudice
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Dario Fabiani
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Adriano Caputo
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Francesco Sabatella
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Luigi Cante
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Alfonso Desiderio
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Ercole Tagliamonte
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Biagio Liccardo
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Vincenzo Russo
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| |
Collapse
|
3
|
Point-of-Care Abdominal Ultrasonography (POCUS) on the Way to the Right and Rapid Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12092052. [PMID: 36140454 PMCID: PMC9497677 DOI: 10.3390/diagnostics12092052] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Point-of-Care ultrasound (POCUS) is based on target ultrasound that is performed wherever a patient is being treated, and by a non-radiologist directly involved in the patient’s care. It is used either for quick diagnosis or procedural guidance. Abdominal pain is one of the most common complaints in emergency departments, and POCUS can help in the differentiation of patients who need additional diagnostic tests or hospital treatment, which eventually reduces the overall costs of health care. POCUS has high sensitivity and specificity in abdominal pathology, it can be helpful in the evaluation of biliary, intestinal, and urinary tract, and it is especially used in trauma. Additionally, the gold standard for abdominal aortic aneurysm detection, follow up and screening is precisely this diagnostic procedure. Unfortunately, the quality of ultrasound examination can be affected by the experience of the physician performing it and the patient’s body weight. There is no doubt that POCUS is being increasingly recognized, but all motivated physicians should be provided with dedicated tutors and enough time for learning. This would certainly help to implement this diagnostic method as a routine in emergency and critical care departments, and significantly shorten the time until definitive diagnosis.
Collapse
|
4
|
Altiero M, Orabona GD, Laccetti E, Rengo A, Danzi R, Romano F, Di Serafino M, Iacobellis F, Francica G, Scaglione M, Romano L. The Use of Ceus Software with No Contrast Media Administration in the Diagnosis of Pneumoperitoneum. Diagnostics (Basel) 2022; 12:diagnostics12020401. [PMID: 35204492 PMCID: PMC8871049 DOI: 10.3390/diagnostics12020401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/22/2022] [Accepted: 01/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Pneumoperitoneum is defined by the presence of free air in the abdominal cavity; gastrointestinal perforation is an important cause of this pathological condition. In emergency situations, radiology is considered vital in the early detection and identification of the site and cause of the perforation, which is critical for proper surgical planning. Aim: The aim of our study was to evaluate a new diagnostic US tool, based on the US contrast-specific software generally used during contrast-enhanced US examination (CEUS), without the administration of sonographic contrast media, and to describe the specific imaging features in the detection of free intra-peritoneal air. Subjects and Methods: One hundred and fifty-seven consecutive and hemodynamically stable patients, who arrived in our E.D. with an acute abdomen between April 2018 and October 2019, underwent US and CT examination, performed by three radiologists (with 5, 5, and 25 years of experience). The US was performed first and divided into two steps, using B-mode US and both B-mode and contrast-specific software US, with no contrast media administration. All the patients underwent CT examination. Results: In 32 out of 157 patients, the surgery confirmed GI perforation. CT correctly detected 31 out of 32 patients; the contrast-specific software US identified 30 perforated patients. CT reached a sensitivity value of 97% and specificity value of 100%; contrast-specific software US demonstrated higher values than B-mode US in sensitivity (93% vs. 70%, respectively) and specificity (98% vs. 88%, respectively). Conclusion: the use of contrast-specific software in emergencies improves image quality, and reaches higher levels of sensitivity and specificity with no time delay compared to standard US examination, helping radiologists expedite diagnoses.
Collapse
Affiliation(s)
- Michele Altiero
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Giuseppina Dell’Aversano Orabona
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
- Correspondence:
| | - Ettore Laccetti
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Alessandro Rengo
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Roberta Danzi
- Department of Radiology, S. Maria delle Grazie Hospital, 80078 Pozzuoli, Italy;
| | - Federica Romano
- Department of Radiology, Monaldi Hospital, 80131 Naples, Italy;
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
| | - Giampiero Francica
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Mariano Scaglione
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
- Department of Radiology, University of Sassari, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
| | - Luigia Romano
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
| |
Collapse
|
5
|
Okumura E, Jimbo H, Sunaga S, Otsuka K, Okada H, Onitsuka T. Nonocclusive Mesenteric Ischemia Is a Potentially Lethal Complication Just after Stroke Onset: Report of Six Case Studies. NMC Case Rep J 2022; 8:631-635. [PMID: 35079527 PMCID: PMC8769417 DOI: 10.2176/nmccrj.cr.2021-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/11/2021] [Indexed: 01/16/2023] Open
Abstract
Nonocclusive mesenteric ischemia (NOMI) is a rare but life-threatening post-stroke complication. This is the first case series report of NOMI after stroke, describing its characteristics and the difficulty of diagnosis. We retrospectively reviewed 367 stroke patients from April 2018 to May 2019 in our hospital. We identified six patients (1.6%) with NOMI after stroke and described their clinical presentation, including characteristics, vital signs, laboratory parameters, treatment, and outcomes. The mean interval between stroke onset and diagnosis of NOMI was 4.6 days (range, 3–10 days). Five patients had disturbance of consciousness caused by stroke, and therefore the major complaints and symptoms associated with NOMI were nonspecific, possibly resulting in delayed diagnosis and treatment. All patients had a high respiratory rate (≥22 breaths/min). C-reactive protein and lactate levels were high (mean, 21.6 mg/L and 2.4 mmol/L, respectively). All patients underwent emergent abdominal operations. Four patients were discharged with modified Rankin Scale scores ≥4, and two patients died. NOMI can be a fatal post-stroke complication and is challenging to diagnose. Further investigations should be conducted to determine the most efficient way to diagnose NOMI after stroke.
Collapse
Affiliation(s)
- Eitaro Okumura
- Neurosurgery Department, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Hiroyuki Jimbo
- Neurosurgery Department, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Shigeki Sunaga
- Neurosurgery Department, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Kunitoshi Otsuka
- Neurosurgery Department, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Hirofumi Okada
- Neurosurgery Department, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Toshiaki Onitsuka
- Neurosurgery Department, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| |
Collapse
|
6
|
Inflammatory Bowel Diseases and Coexisting Spondyloarthritis: A Neglected and too Often Under-Reported Association by Radiologists. A Multicenter Study by Italian Research Group of Imaging in Rheumatology. GASTROENTEROLOGY INSIGHTS 2020. [DOI: 10.3390/gastroent11020008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate the prevalence and the underreporting rate of sacroiliitis (SI) in a large cohort of patients with biopsy-proved Crohn’s disease (CD) who underwent magnetic resonance enterography (MRE) or computed tomography enterography (CTE). Materials and Methods: Patients with CD were recruited from eight Italian health centers in the period from January 2013 to December 2017. Disease activity was recorded according to the CD activity index (CDAI). The scans were read by two blinded readers who defined the presence of SI according to Assessment of SpondyloArthritis International Society (ASAS) classifications and European League Against Rheumatism (EULAR) recommendations. Moreover, SI was scored using a simplified Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. Results: Interobserver agreement in diagnosing SI on imaging was good (K = 0.72–0.83). SI was diagnosed in 129 (14.4%, 54 men, 75 women) out of 894 patients; however, sacroiliac joint (SIJ) abnormalities were not mentioned in the radiological reports of 112 patients (86%). Fifty (38.7%) out of 129 patients also underwent a subsequent SIJ evaluation through a dedicated MRI protocol to confirm SI. SI was found in a higher percentage of patients with “active” than “inactive” CD (18% vs. 4%). Conclusion: This study confirms the feasibility of CTE and MRE for the screening of SI in CD patients; however, it also underlines the remarkable problem concerning the underreporting of this entity in radiological practice.
Collapse
|
7
|
Taylor MA, Merritt CH, Riddle PJ, DeGennaro CJ, Barron KR. Diagnosis at gut point: rapid identification of pneumoperitoneum via point-of-care ultrasound. Ultrasound J 2020; 12:52. [PMID: 33284363 PMCID: PMC7721848 DOI: 10.1186/s13089-020-00195-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/17/2020] [Indexed: 11/11/2022] Open
Abstract
Undifferentiated abdominal pain is a common presentation often requiring immediate medical or surgical intervention. Providing an accurate diagnosis involves a detailed patient history and thorough physical exam. Point of care ultrasound is gaining acceptance as a rapid diagnostic tool that can be used to accurately detect life-threatening conditions while potentially avoiding unnecessary radiation exposure and facilitating rapid treatment. Detection of pneumoperitoneum with point-of-care ultrasound is a simple procedure that relies heavily on the experience of the investigating practitioner. Standard technique involves placing a high-frequency linear-array transducer in the right upper quadrant, where abdominal free air is most likely to accumulate. Detection of the 'gut point', which is the transition of abdominal wall sliding to lack thereof in a single image, is the pathognomonic finding of pneumoperitoneum. If visualization is difficult, moving the patient to the left lateral decubitus position or using the scissors technique can provide additional image views. This representative case report and review highlights the use of abdominal POCUS for the diagnosis of pneumoperitoneum. Ultrasound should continue to be explored by clinicians to narrow the differential diagnosis of acute abdominal pain.
Collapse
Affiliation(s)
- Matthew A Taylor
- University of South Carolina School of Medicine, Columbia, SC, 29209, USA
| | | | - Philip J Riddle
- Department of Internal Medicine, Prisma Health Midlands, University of South Carolina School of Medicine, Columbia, SC, 29209, USA
| | - Carter J DeGennaro
- Department of Emergency Medicine, Prisma Health Midlands, University of South Carolina School of Medicine, Columbia, SC, 29209, USA
| | - Keith R Barron
- Department of Internal Medicine, Prisma Health Midlands, University of South Carolina School of Medicine, Columbia, SC, 29209, USA.
- Ultrasound Institute, University of South Carolina School of Medicine, Columbia, SC, 29209, USA.
- Palmetto Health-USC Medical Group, 5 Medical Park Road, Columbia, SC, 29203, USA.
| |
Collapse
|
8
|
Mjema KM, Sawe HR, Kulola I, Mohamed AS, Sylvanus E, Mfinanga JA, Weber EJ. Aetiologies and outcomes of patients with abdominal pain presenting to an emergency department of a tertiary hospital in Tanzania: a prospective cohort study. BMC Gastroenterol 2020; 20:173. [PMID: 32503438 PMCID: PMC7275297 DOI: 10.1186/s12876-020-01313-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/20/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Abdominal pain in adults represents a wide range of illnesses, often warranting immediate intervention. This study is to fill the gap in the knowledge about incidence, presentation, causes and mortality from abdominal pain in an established emergency department of a tertiary hospital in Tanzania. METHODS This was a prospective cohort study of adult (age ≥ 18 years) patients presenting to the Emergency Medicine Department of Muhimbili National Hospital (EMD-MNH) in Dar Es Salaam, Tanzania with non-traumatic abdominal pain from September 2017 to October 2017. A case report form was used to record data on demographics, clinical presentation, management, diagnosis, outcomes and patient follow-up. The primary outcome of mortality was summarized using descriptive statistics; secondary outcome was, risks for mortality. RESULTS Among 3381 adult patients present during the study period, 288 (8.5%) presented with abdominal pain, and of these 199 (69%) patients were enrolled in our study. Median age was 47 years (IQR 35-60 years), 126 (63%) were female, and 118 (59%) were referred from another hospital. Most common final diagnoses were malignancies 71 (36%), intestinal obstruction 11 (6%) and peptic ulcer disease 9 (5%). Most common EMD interventions given were intravenous fluids 57 (21%), analgesia 49 (25%) and antibiotics 40 (20%). 160 (80%) were admitted of which 15 (8%) underwent surgery directly from EMD. 24-h and 7-day mortality were 4 (2%) and 7 (4%) respectively, while overall in hospital-mortality was 16 (8%). Among the risk factors for mortality were male sex Relative Risk (RR) 2.88 (p = 0.03), hypoglycemia (RR) 5.7 (p = 0.004), ICU admission (RR) 14 (p < 0.0001), receipt of IV fluids (RR) 3.2 (p = 0.0151) and need for surgery (RR) 6.6 (p = 0.0001). CONCLUSION Abdominal pain was associated with significant morbidity and mortality as evidenced by a very high admission rate, need for surgical intervention and a high in-hospital mortality rate. Future studies and quality improvement efforts should focus on identifying why such differences exist and how to reduce the mortality.
Collapse
Affiliation(s)
- Kilalo M Mjema
- Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania. .,Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
| | - Irene Kulola
- Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Amour S Mohamed
- Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Erasto Sylvanus
- Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Juma A Mfinanga
- Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania.,Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Ellen J Weber
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.,Department of Emergency Medicine, University of California, San Francisco, CA, USA
| |
Collapse
|
9
|
Sartelli M, Weber DG, Kluger Y, Ansaloni L, Coccolini F, Abu-Zidan F, Augustin G, Ben-Ishay O, Biffl WL, Bouliaris K, Catena R, Ceresoli M, Chiara O, Chiarugi M, Coimbra R, Cortese F, Cui Y, Damaskos D, de’ Angelis GL, Delibegovic S, Demetrashvili Z, De Simone B, Di Marzo F, Di Saverio S, Duane TM, Faro MP, Fraga GP, Gkiokas G, Gomes CA, Hardcastle TC, Hecker A, Karamarkovic A, Kashuk J, Khokha V, Kirkpatrick AW, Kok KYY, Inaba K, Isik A, Labricciosa FM, Latifi R, Leppäniemi A, Litvin A, Mazuski JE, Maier RV, Marwah S, McFarlane M, Moore EE, Moore FA, Negoi I, Pagani L, Rasa K, Rubio-Perez I, Sakakushev B, Sato N, Sganga G, Siquini W, Tarasconi A, Tolonen M, Ulrych J, Zachariah SK, Catena F. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg 2020; 15:32. [PMID: 32381121 PMCID: PMC7206757 DOI: 10.1186/s13017-020-00313-4] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/29/2020] [Indexed: 02/08/2023] Open
Abstract
Acute colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of acute left-sided colonic diverticulitis (ALCD) according to the most recent available literature. The update includes recent changes introduced in the management of ALCD. The new update has been further integrated with advances in acute right-sided colonic diverticulitis (ARCD) that is more common than ALCD in select regions of the world.
Collapse
Affiliation(s)
| | - Dieter G. Weber
- Department of General Surgery, Royal Perth Hospital, The University of Western Australia, Perth, Australia
| | - Yoram Kluger
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Luca Ansaloni
- General Surgery Department, Bufalini Hospital Hospital, Cesena, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Offir Ben-Ishay
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Walter L. Biffl
- Trauma Surgery Department, Scripps Memorial Hospital, La Jolla, CA USA
| | | | - Rodolfo Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Marco Ceresoli
- Department of General and Emergency Surgery, ASST, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, University of Milano, ASST Niguarda Milano, Milan, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Moreno Valley, CA USA
| | | | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | | | | | - Samir Delibegovic
- Department of Surgery, University Clinical Center of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zaza Demetrashvili
- Department General Surgery, Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Belinda De Simone
- Department of Digestive Surgery, Guastalla Hospital, Reggio Emilia, Italy
| | | | - Salomone Di Saverio
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Mario Paulo Faro
- Department of General Surgery, Trauma and Emergency Surgery Division, ABC Medical School, Santo André, SP Brazil
| | - Gustavo P. Fraga
- Trauma/Acute Care Surgery & Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - George Gkiokas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Carlos Augusto Gomes
- Department of Surgery, Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, Brazil
| | - Timothy C. Hardcastle
- Trauma Service, Inkosi Albert Luthuli Central Hospital and Department of Surgery, Nelson R Mandela School of Clinical Medicine, Durban, South Africa
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany
| | | | - Jeffry Kashuk
- Department of Surgery, Assia Medical Group, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Andrew W. Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB Canada
| | - Kenneth Y. Y. Kok
- Department of Surgery, The Brunei Cancer Centre, Jerudong Park, Brunei
| | - Kenji Inaba
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, CA USA
| | - Arda Isik
- Department of General Surgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | | | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY USA
| | - Ari Leppäniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Andrey Litvin
- Surgical Disciplines, Immanuel Kant Baltic Federal University/Regional Clinical Hospital, Kaliningrad, Russian Federation
| | - John E. Mazuski
- Department of Surgery, School of Medicine, Washington University, Saint Louis, USA
| | - Ronald V. Maier
- Department of Surgery, University of Washington, Seattle, WA USA
| | - Sanjay Marwah
- Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Michael McFarlane
- Department of Surgery, Radiology, University Hospital of the West Indies, Kingston, Jamaica
| | - Ernest E. Moore
- Department of Surgery, Denver Health Medical Center, University of Colorado, Denver, CO USA
| | - Frederick A. Moore
- Department of Surgery, Division of Acute Care Surgery, and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL USA
| | - Ionut Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, Kocaali, Turkey
| | - Ines Rubio-Perez
- General Surgery Department, Colorectal Surgery Unit, La Paz University Hospital, Madrid, Spain
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Norio Sato
- Department of Aeromedical Services for Emergency and Trauma Care, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Gabriele Sganga
- Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Walter Siquini
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - Antonio Tarasconi
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Matti Tolonen
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Jan Ulrych
- First Department of Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | | | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| |
Collapse
|
10
|
Caraiani C, Yi D, Petresc B, Dietrich C. Indications for abdominal imaging: When and what to choose? J Ultrason 2020; 20:e43-e54. [PMID: 32320166 PMCID: PMC7266076 DOI: 10.15557/jou.2020.0008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/18/2020] [Indexed: 12/19/2022] Open
Abstract
Imaging has a very important role in evaluating abdominal pathology. A good knowledge of indications is of crucial importance in the management of the patient with abdominal pathology. Ultrasound, which on its own can lead to an accurate diagnosis, plays a pivotal role in the management of abdominal pathology. The use of ultrasound contrast agents has significantly improved ultrasound diagnostic capacities in both hepatic and non-hepatic pathology. The use of computed tomography should be limited due to the potential harmful side effects of ionizing radiation, but it has established roles in evaluating severe abdominal traumatic and non-traumatic emergencies as well as in staging oncologic patients. Magnetic resonance imaging has very limited utility in abdominal emergencies due to difficulty of accessing the scanner and the long duration of the examination compared to computed tomography or ultrasound. However, magnetic resonance imaging has well-established clinical roles particularly for evaluating diffuse or focal hepatic pathology, benign and malignant bile duct pathology, pancreatic tumors, inflammatory bowel disease and rectal tumors. The aims of the following paper are to familiarize the clinician with the indications for imaging in abdominal pathology, to guide the clinician and radiologist in choosing the correct technique for a particular clinical situation, to prevent the overuse of imaging techniques and to prevent misdiagnosis of disease and incorrect therapy resulting from inappropriate imaging. Imaging has a very important role in evaluating abdominal pathology. A good knowledge of indications is of crucial importance in the management of the patient with abdominal pathology. Ultrasound, which on its own can lead to an accurate diagnosis, plays a pivotal role in the management of abdominal pathology. The use of ultrasound contrast agents has significantly improved ultrasound diagnostic capacities in both hepatic and non-hepatic pathology. The use of computed tomography should be limited due to the potential harmful side effects of ionizing radiation, but it has established roles in evaluating severe abdominal traumatic and non-traumatic emergencies as well as in staging oncologic patients. Magnetic resonance imaging has very limited utility in abdominal emergencies due to difficulty of accessing the scanner and the long duration of the examination compared to computed tomography or ultrasound. However, magnetic resonance imaging has well-established clinical roles particularly for evaluating diffuse or focal hepatic pathology, benign and malignant bile duct pathology, pancreatic tumors, inflammatory bowel disease and rectal tumors. The aims of the following paper are to familiarize the clinician with the indications for imaging in abdominal pathology, to guide the clinician and radiologist in choosing the correct technique for a particular clinical situation, to prevent the overuse of imaging techniques and to prevent misdiagnosis of disease and incorrect therapy resulting from inappropriate imaging.
Collapse
Affiliation(s)
- Cosmin Caraiani
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Dong Yi
- Department of Ultrasound, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Bianca Petresc
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Christoph Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirlsanden Bern Beau Site , Salem und Permanence , Switzerland ; Ultrasound Department, First Affiliated Hospital of Zhengzhou University , China
| |
Collapse
|
11
|
Khan MAB, Abu-Zidan FM. Point-of-care ultrasound for the acute abdomen in the primary health care. Turk J Emerg Med 2020; 20:1-11. [PMID: 32355895 PMCID: PMC7189821 DOI: 10.4103/2452-2473.276384] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/07/2019] [Indexed: 01/07/2023] Open
Abstract
Point-of-care ultrasound (POCUS) is a focused examination, which is performed and interpreted at the bedside by the treating physician answering a specific clinical question. It is currently utilized as an essential adjunct to physical examination in many medical specialties. Recent advances in technology have made POCUS machines portable, affordable, and could be used with minimal training even by nonradiologists. This review aims to cover the fundamental physics of POCUS and its applications for diagnosing the acute abdomen in the primary health care including the most common causes encountered by family physicians. These are acute appendicitis, acute cholecystitis, renal colic, ectopic pregnancy, acute diverticulitis, bowel obstruction, and abdominal aortic aneurysm. We hope to encourage primary care physicians to incorporate POCUS in their routine clinical practice. We also highlight challenges encountered when using POCUS in the primary health care including limited availability and the need for proper training. Furthermore, we review the POCUS results when performed by primary health-care physicians. Integrating POCUS in primary health care empowers primary health-care physicians to provide high-quality, safe, and cost-effective care to the patients.
Collapse
Affiliation(s)
- Moien A B Khan
- Department of Family Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| |
Collapse
|
12
|
Lammi M, Vuolle S, Kiekara T, Kurppa K, Pauniaho S. The use of abdominal imaging studies in children visiting emergency department was variable and unsystematic. Acta Paediatr 2019; 108:2089-2094. [PMID: 31104325 DOI: 10.1111/apa.14868] [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: 02/11/2019] [Revised: 04/04/2019] [Accepted: 05/16/2019] [Indexed: 11/29/2022]
Abstract
AIM As imaging is used for various reasons in children with acute gastrointestinal complaints, we evaluated the indications and diagnostic yield of abdominal imaging, particularly ultrasound at emergency department (ED). METHODS Indications and imaging reports of consecutive children who had undergone abdominal imaging in general, surgical and paediatric EDs in the Tampere University Hospital, Finland, in 2015 were collected. Symptoms, clinical findings, imaging indications and findings were categorised and further analysed. RESULTS Altogether 394 imaging studies, 310 ultrasounds, 72 X-rays and 12 computed tomographies (CT), for 348 children (55% boys) aged 0-16.9 years, median 7.1 years, were performed. The most common indications for ultrasound were suspected appendicitis or infection (36%) and explanation for symptoms (32%), for X-ray suspected foreign body (39%) and obstruction (39%) and for CT trauma (50%). The cause of the symptoms or a clinically significant finding was established in 23% of ultrasounds, varying from 0% to 50% depending on the indication, symptoms and age. CONCLUSION There was wide variation in the indications and yield of abdominal imaging. The clinical benefits, particularly those of US, were often questionable, even leading to delayed diagnosis and complications. More uniform imaging guidelines are needed in the paediatric ED.
Collapse
Affiliation(s)
- Matleena Lammi
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Center for Child Health Research Tampere University Tampere Finland
| | - Satu Vuolle
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Center for Child Health Research Tampere University Tampere Finland
| | - Tommi Kiekara
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Medical Imaging Centre Tampere University Hospital Tampere Finland
| | - Kalle Kurppa
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Center for Child Health Research Tampere University Tampere Finland
- University Consortium of Seinäjoki Seinäjoki Finland
| | | |
Collapse
|
13
|
Diagnostic Accuracy of Ultrasound in the Diagnosis of Small Bowel Obstruction. Diagnostics (Basel) 2019; 9:diagnostics9030088. [PMID: 31390727 PMCID: PMC6787646 DOI: 10.3390/diagnostics9030088] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/24/2019] [Accepted: 08/05/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Small bowel obstruction (SBO) is a common presentation to the Emergency Department (ED). This study aimed to analyze the accuracy of ultrasound (US) in diagnosing and staging SBO. OBJECTIVES The main object of this study was to analyze the accuracy of ultrasound in diagnosing and staging SBO compared to CT. METHODS Retrospectively, stable patients with an ultrasonographic diagnosis of SBO who underwent abdominal CT immediately after US and before receiving naso-intestinal decompression, were included. US criteria for the diagnosis of SBO were related to morphological and functional findings. US diagnosis of obstruction was made if fluid-filled dilated small bowel loops were detected, peristalsis was abnormal and parietal abnormalities were present. Morphologic and functional sonographic findings were assigned to three categories: simple SBO, compensated SBO and decompensated SBO. US findings were compared with the results of CT examinations: Morphologic CT findings (divided into loop, vascular, mesenteric and peritoneal signs) allowed the classification of SBO in simple, decompensated and complicated. RESULTS US diagnostic accuracy rates in relation to CT results were calculated: ultrasound compared to CT imaging, had a sensitivity of 92.31% (95% CI, 74.87% to 99.05%) and a specificity of 94.12% (95% CI, 71.31% to 99.85%) in the diagnosis of SBO. CONCLUSIONS This study, similarly to the existing literature, suggests that ultrasound is highly accurate in the diagnosis of SBO, and that the most valuable sonographic signs are the presence of dilated bowel loops ad abnormal peristalsis.
Collapse
|
14
|
De Simone B, Ansaloni L, Sartelli M, Coccolini F, Napoli JA, Catena F. The Video-Consulting Emergency protocol: a proposition from the World Society of Emergency Surgery members for the initial management of non-traumatic acute abdomen. MINERVA CHIR 2019; 74:189-194. [DOI: 10.23736/s0026-4733.18.07963-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
15
|
Manetta R, Capretti I, Belleggia N, Marsecano C, Viscido A, Bruno F, Arrigoni F, Ma L, Guglielmi G, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Magnetic resonance enterography (MRE) and ultrasonography (US) in the study of the small bowel in Crohn's disease: state of the art and review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:38-50. [PMID: 31085972 PMCID: PMC6625566 DOI: 10.23750/abm.v90i5-s.8337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Indexed: 02/06/2023]
Abstract
Crohn’s disease (CD) is a chronic idiopathic disease and its diagnosis is based on a combination of clinical symptoms, laboratory tests and imaging data. There isn’t a diagnostic gold standard: the ileocolonoscopy with mucosal biopsies represents the standard for luminal disease, while cross-sectional imaging such as Ultrasound (US), Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) can show transmural alterations and extraintestinal manifestations. CD is usually diagnosed in the young age and after baseline diagnosis, the patients have to undergo to variable follow-up depending on remission or active disease. The aim of our review is to compare Magnetic Resonance Enterography (MRE) to Ultrasonography (US) in the follow-up of CD. (www.actabiomedica.it)
Collapse
Affiliation(s)
- Rosa Manetta
- Division of Radiology, S. Salvatore Hospital, L'Aquila, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Mervak BM, Altun E, McGinty KA, Hyslop WB, Semelka RC, Burke LM. MRI in pregnancy: Indications and practical considerations. J Magn Reson Imaging 2019; 49:621-631. [PMID: 30701610 DOI: 10.1002/jmri.26317] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022] Open
Abstract
There is a constantly evolving knowledgebase regarding the safety of MRI in pregnant patients, as well as the safety of gadolinium administration, given potential fetal risks. This review provides an overview of national and international recommendations for patient screening and safety by trimester, evaluates the most recent literature regarding administration of gadolinium in pregnant patients, and discusses technical requirements when imaging pregnant patients. A protocol for imaging pregnant patients is provided, and multiple common indications for MRI in pregnancy are discussed. Level of Evidence 5. Technical Efficacy Stage 5. J. Magn. Reson. Imaging 2019;49:621-631.
Collapse
Affiliation(s)
- Benjamin M Mervak
- Division of Abdominal Imaging, University of North Carolina Department of Radiology, Chapel Hill, North Carolina, USA
| | - Ersan Altun
- Division of Abdominal Imaging, University of North Carolina Department of Radiology, Chapel Hill, North Carolina, USA
| | - Katrina A McGinty
- Division of Abdominal Imaging, University of North Carolina Department of Radiology, Chapel Hill, North Carolina, USA
| | - W Brian Hyslop
- Division of Abdominal Imaging, University of North Carolina Department of Radiology, Chapel Hill, North Carolina, USA
| | - Richard C Semelka
- Division of Abdominal Imaging, University of North Carolina Department of Radiology, Chapel Hill, North Carolina, USA.,Richard Semelka, MD. Consulting
| | - Lauren M Burke
- Division of Abdominal Imaging, University of North Carolina Department of Radiology, Chapel Hill, North Carolina, USA
| |
Collapse
|
17
|
Wu CY, Lee CY, Yang IJ, Shen H, Torng PL. Double collecting system with ectopic ureterocele masquerading as an ovarian torsion. Taiwan J Obstet Gynecol 2018; 57:867-870. [PMID: 30545543 DOI: 10.1016/j.tjog.2018.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Ureterocele in a duplex system is rare and commonly presented with urinary tract infection at neonatal age, infant or childhood. Symptomatic ureterocele in reproductive-age is a diagnostic challenge and should be highly awarded to avoid miss-diagnosis. CASE REPORT An adolescent girl with right ectopic ureterocele presented as acute abdomen that mimicked ovarian torsion received emergent laparoscopic surgery. Right ureterocele was identified and excised. Computed tomography later showed bilateral renal duplications with visible renal parenchyma and upper ureters. Recurrent abdominal pain with pelvic abscess occurred 10 days after surgery. Laparoscopic right partial nephrectomy of the upper moiety and resection of the residual ureterocele was performed. Cystoscopy showed absence of intravesical ureterocele and her symptoms were completely resolved after surgery. CONCLUSION Infected ureterocele in a duplex system is a rare condition and should be kept in mind as differential diagnosis.
Collapse
Affiliation(s)
- Chia-Ying Wu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Yi Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ih-Jane Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hung Shen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pao-Ling Torng
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Hsin-Chu Br, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
18
|
Kozaci N, Avci M, Tulubas G, Ararat E, Karakoyun OF, Karaman C, Erol B. Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918808115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objectives: This prospective study was performed to evaluate the diagnostic accuracy of bedside point-of-care abdominal ultrasonography performed by emergency physician in patients with non-traumatic acute abdominal pain. Methods: The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point-of-care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard. Results: The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point-of-care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients. Conclusion: This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point-of-care abdominal ultrasonography after training.
Collapse
Affiliation(s)
- Nalan Kozaci
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Mustafa Avci
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Gul Tulubas
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ertan Ararat
- Department of Emergency Medicine, Uşak University Education and Research Hospital, Uşak, Turkey
| | - Omer Faruk Karakoyun
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Cagri Karaman
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Bekir Erol
- Department of Radiology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| |
Collapse
|
19
|
Mazzei MA. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery: a brief radiological commentary. World J Emerg Surg 2018; 13:34. [PMID: 30069228 PMCID: PMC6064129 DOI: 10.1186/s13017-018-0197-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/19/2018] [Indexed: 01/26/2023] Open
Abstract
The aim of this letter is to report some deeper explanations regarding the role of imaging in acute mesenteric ischemia. The correlation between some computed tomography findings and the cause of ischemia as well as other main factors that could condition the computed tomography appearance of this critical issue is also discussed.
Collapse
Affiliation(s)
- Maria Antonietta Mazzei
- Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| |
Collapse
|
20
|
Jin BB, Gong YZ, Ma Y, He ZH. Gynecological emergency ultrasound in daytime and at night: differences that cannot be ignored. Ther Clin Risk Manag 2018; 14:1141-1147. [PMID: 29950851 PMCID: PMC6016594 DOI: 10.2147/tcrm.s169165] [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] [Indexed: 11/25/2022] Open
Abstract
Background Ultrasonography, the preferred adjunct examination method and the differential diagnostic tool for gynecologic emergency, can reflect the change pattern of gynecological diseases in daytime and at night. The purpose of this study was to analyze the diseases through gynecological emergency ultrasound in daytime and at night and to evaluate the day–night difference in the accuracy of ultrasound diagnosis. Materials and methods Retrospective analysis was performed on the 2016 clinical data of the patients who had undergone gynecological emergency ultrasound at The First Affiliated Hospital of Guangxi Medical University, and the results of the ultrasound diagnosis were compared with the clinical diagnosis. Results The following categories of gynecologic emergency diseases during the daytime and at night have significant statistical differences in the constituent ratio (P<0.001); ectopic pregnancy, intrauterine pregnancy, acute pelvic inflammatory disease, no organic lesion in uterine and adnexa; while the constituent ratio of abortion and trophoblastic diseases, ovarian tumor, uterine and endometrial lesions, was no statistical difference during the daytime and at night (P>0.05). The overall coincidence rate of ultrasound diagnosis was 96.3% (daytime, 97.9%; night, 86.4%). The coincidence rates of ectopic pregnancy ultrasonography diagnosis in daytime and at night were 96.4 and 75.4%, respectively; the difference was statistically significant (P<0.001). Conclusion Since the different constituent ratio of disease between daytime and night gynecological emergency ultrasound was significantly different, and the diagnostic accuracy of ultrasound at night was low; hence, the ultrasound doctor at night should pay attention to improve the accuracy of diagnosis and the ability of differential diagnosis of ectopic pregnancy, and it is suggested that some suspected cases during the night should be reexamined again in the daytime to eliminate the errors resulted from subjective factors.
Collapse
Affiliation(s)
| | | | - Yan Ma
- Department of Ultrasonography
| | - Zhong-Hui He
- Department of Gynecology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| |
Collapse
|
21
|
Abdellatif A, Kramer M, Failing K, von Pückler K. Correlation between Preoperative Ultrasonographic Findings and Clinical, Intraoperative, Cytopathological, and Histopathological Diagnosis of Acute Abdomen Syndrome in 50 Dogs and Cats. Vet Sci 2017; 4:vetsci4030039. [PMID: 29056698 PMCID: PMC5644663 DOI: 10.3390/vetsci4030039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 11/16/2022] Open
Abstract
Acute abdomen syndrome is an emergency in small animal practice that requires rapid diagnosis to determine the appropriate treatment. No studies have correlated the preoperative abdominal ultrasonography (US) findings with the clinical, surgical, cytopathologic, and histopathologic findings. This retrospective study was designed to evaluate abdominal US in the diagnosis of acute abdomen syndrome using surgery as a "criterion standard". The most frequently misinterpreted lesions with US were also identified. The study included 50 dogs and cats with physical examination, an US diagnosis, US guided fine-needle aspiration cytology, intraoperative findings, and histopathology. Intraoperatively, 49 primary and 43 secondary lesions were identified. The sensitivity, specificity, and positive and negative predictive values for US were calculated. There was a good agreement between the US diagnosis and intraoperative findings of 86.9% (80/92), for both primary and secondary lesions (p < 0.0001). Cytology and histopathology examinations corroborated the US in 86.4% (n = 64/74) of primary and 66.2% of secondary (n = 49/79) lesions. Using US as the "criterion standard", the sensitivity of abdominal palpation for identification of ascites and masses was 32.4% and 43.7%, respectively, while the specificity was 93.7% and 94.4%, respectively. Abdominal US is a useful preoperative modality for diagnosing acute abdominal diseases in dogs and cats. Care should be taken with interpretation of gastrointestinal perforation, omental tumors, and common bile duct rupture, as these lesions are frequently misinterpreted with US.
Collapse
Affiliation(s)
- Ahmed Abdellatif
- Department of Veterinary Clinical Science, Clinic for Small Animals (Surgery), Justus-Liebig University (JLU), 35392 Gießen, Germany.
- Animal Surgery Department, Assiut University, Assiut 71515, Egypt.
| | - Martin Kramer
- Department of Veterinary Clinical Science, Clinic for Small Animals (Surgery), Justus-Liebig University (JLU), 35392 Gießen, Germany.
| | - Klaus Failing
- Unit for Biomathematics and Data Processing, Veterinary Faculty, Justus-Liebig University (JLU), Gießen 35392, Germany.
| | - Kerstin von Pückler
- Department of Veterinary Clinical Science, Clinic for Small Animals (Surgery), Justus-Liebig University (JLU), 35392 Gießen, Germany.
| |
Collapse
|
22
|
Mazzei MA, Guerrini S, Gentili F, Galzerano G, Setacci F, Benevento D, Mazzei FG, Volterrani L, Setacci C. Incidental extravascular findings in computed tomographic angiography for planning or monitoring endovascular aortic aneurysm repair: Smoker patients, increased lung cancer prevalence? World J Radiol 2017; 9:304-311. [PMID: 28794826 PMCID: PMC5529319 DOI: 10.4329/wjr.v9.i7.304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/16/2017] [Accepted: 05/31/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To validate the feasibility of high resolution computed tomography (HRCT) of the lung prior to computed tomography angiography (CTA) in assessing incidental thoracic findings during endovascular aortic aneurysm repair (EVAR) planning or follow-up.
METHODS We conducted a retrospective study among 181 patients (143 men, mean age 71 years, range 50-94) referred to our centre for CTA EVAR planning or follow-up. HRCT and CTA were performed before or after 1 or 12 mo respectively to EVAR in all patients. All HRCT examinations were reviewed by two radiologists with 15 and 8 years’ experience in thoracic imaging. The results were compared with histology, bronchoscopy or follow-up HRCT in 12, 8 and 82 nodules respectively.
RESULTS There were a total of 102 suspected nodules in 92 HRCT examinations, with a mean of 1.79 nodules per patient and an average diameter of 9.2 mm (range 4-56 mm). Eighty-nine out of 181 HRCTs resulted negative for the presence of suspected nodules with a mean smoking history of 10 pack-years (p-y, range 5-18 p-y). Eighty-two out of 102 (76.4%) of the nodules met criteria for computed tomography follow-up, to exclude the malignant evolution. Of the remaining 20 nodules, 10 out of 20 (50%) nodules, suspected for malignancy, underwent biopsy and then surgical intervention that confirmed the neoplastic nature: 4 (20%) adenocarcinomas, 4 (20%) squamous cell carcinomas, 1 (5%) small cell lung cancer and 1 (5%) breast cancer metastasis); 8 out of 20 (40%) underwent bronchoscopy (8 pneumonia) and 2 out of 20 (10%) underwent biopsy with the diagnosis of sarcoidosis.
CONCLUSION HRCT in EVAR planning and follow-up allows to correctly identify patients requiring additional treatments, especially in case of lung cancer.
Collapse
|
23
|
Poggio G, Mariano J, Gopar L, Ucar M. La ecografía primero: ¿Por qué, cómo y cuándo? ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.rard.2016.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
24
|
The value of initial sonography compared to supplementary CT for diagnosing right-sided colonic diverticulitis. Jpn J Radiol 2017; 35:358-365. [DOI: 10.1007/s11604-017-0646-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/25/2017] [Indexed: 11/26/2022]
|
25
|
Lai W, Gutteridge C, Regan A, Lambert A. The Value of a Surgical Assessment Unit Ultrasound Facility. BMJ QUALITY IMPROVEMENT REPORTS 2017; 6:bmjquality_uu209155.w3729. [PMID: 28469898 PMCID: PMC5411714 DOI: 10.1136/bmjquality.u209155.w3729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 03/16/2017] [Indexed: 11/04/2022]
Abstract
Ultrasound scan (USS) is a common and important mode of investigation for emergency surgical admissions. Delay in investigation often leads to delayed diagnosis and treatment, and possible extended length of stay (LOS), which has clinical, cost and service provision implications. We aim to investigate the clinical impact on patient care and the cost-effectiveness of a pilot Surgical Assessment Unit (SAU) USS facility. We performed a retrospective data collection on 100 consecutive SAU inpatients who had an USS investigation on the ward since the introduction of the facility, matched by 100 consecutive SAU inpatients who had an USS in the radiology department before the pilot study. Results of the audit show SAU USS has a reduced mean LOS by 1.44 days compared to departmental USS, and led to more same day discharge than departmental USS (20 vs. 5), thus avoiding unnecessary overnight stay. It also significantly reduced mean waiting time from admission to investigation by 5.21 hours, which can be translated into improved patient and staff satisfaction. All these findings are both statistically and clinically significant. The estimated cost of each SAU USS is comparable to the average departmental USS (£29.71 vs. £30.80). Using the average cost of an excess bed day = £273, SAU USS has produced an estimated saving of £394.72/patient. This does not include saved opportunistic costs such as prevented elective operation cancellations, fines incurred from surgery waiting time/A+E breaches etc. To conclude SAU USS has a significant positive impact on patient care in surgical admissions by reducing LOS and investigation waiting time, as well as facilitating same day discharge.
Collapse
|
26
|
Ischemic Colitis Diagnosed by Magnetic Resonance Imaging during Lenalidomide Treatment in a Patient with Relapsed Multiple Myeloma. TUMORI JOURNAL 2016. [DOI: 10.5301/tj.5000392 10.5301/tj.5000392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Multiple myeloma is the second most common hematological neoplasm that also affects young patients. The progression-free survival after autologous stem cell transplant has improved with the introduction of several novel agents such as lenalidomide, which may, however, increase the risk of adverse events. Methods We describe the case of a 54-year-old woman with relapse of multiple myeloma 3 years after myeloablative allogeneic stem cell transplant who developed abdominal pain and bloody diarrhea following 7 months of lenalidomide therapy. Results Abdominal plain x-ray and magnetic resonance imaging (MRI) without intravenous contrast material showed left-sided and splenic flexure acute ischemic colitis with reperfusion phenomena. Continuous intravenous infusion of unfractionated heparin was given with metronidazole and meropenem and the patient improved within a few days. MRI performed 15 days later confirmed complete recovery of ischemic colitis. Conclusions To our knowledge there have been no previously reported cases of ischemic colitis during lenalidomide therapy as a single agent in relapsed or refractory multiple myeloma, in particular promptly diagnosed by MRI.
Collapse
|
27
|
Ischemic Colitis Diagnosed by Magnetic Resonance Imaging during Lenalidomide Treatment in a Patient with Relapsed Multiple Myeloma. TUMORI JOURNAL 2016; 102:63B0D4D4-3B25-40F9-BB67-AC9859D9B0B8. [DOI: 10.5301/tj.5000392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2015] [Indexed: 11/20/2022]
Abstract
Introduction Multiple myeloma is the second most common hematological neoplasm that also affects young patients. The progression-free survival after autologous stem cell transplant has improved with the introduction of several novel agents such as lenalidomide, which may, however, increase the risk of adverse events. Methods We describe the case of a 54-year-old woman with relapse of multiple myeloma 3 years after myeloablative allogeneic stem cell transplant who developed abdominal pain and bloody diarrhea following 7 months of lenalidomide therapy. Results Abdominal plain x-ray and magnetic resonance imaging (MRI) without intravenous contrast material showed left-sided and splenic flexure acute ischemic colitis with reperfusion phenomena. Continuous intravenous infusion of unfractionated heparin was given with metronidazole and meropenem and the patient improved within a few days. MRI performed 15 days later confirmed complete recovery of ischemic colitis. Conclusions To our knowledge there have been no previously reported cases of ischemic colitis during lenalidomide therapy as a single agent in relapsed or refractory multiple myeloma, in particular promptly diagnosed by MRI.
Collapse
|
28
|
Abstract
BACKGROUND Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine in collaboration with four other medical societies launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines [all clinical questions (CQs) and recommendations are shown in supplementary information]. METHODS A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. RESULTS A total of 108 questions based on 9 subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two-step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. CONCLUSIONS The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence-based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen.
Collapse
|
29
|
Acute abdominal pain in children: usefulness of three-view abdominal radiographs in the emergency department. Emerg Radiol 2016; 23:469-75. [PMID: 27435234 DOI: 10.1007/s10140-016-1423-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/06/2016] [Indexed: 11/25/2022]
Abstract
Diagnostic imaging is often an integral component in the workup of a pediatric patient with acute abdominal pain. The purpose of this study was to compare the diagnostic value of a three-view acute abdominal series (AAS) with that of a single supine view (SSV) in children with acute abdominal pain. All subjects aged ≤18 years that underwent an emergency three-view AAS examination for acute abdominal pain at a single urban hospital system were included. Retrospective evaluation of radiological diagnosis, number of radiological images, further imaging, management, and clinical outcomes was performed. "Positive" AAS studies were compared with corresponding SSV images for direct comparison of diagnostic value. Standard nonparametric statistical evaluation was performed. Five hundred forty-one AAS studies were included in the study. Greater than three radiographs were acquired in 29 % (153/541) of the subjects. Two hundred ninety-nine out of 541 AAS studies included a technically adequate SSV of the abdomen and pelvis. Most AAS examinations were categorized as negative (n = 485; 90 %). Of the 56 examinations initially classified as positive, there was no significant statistical difference between diagnostic accuracy between the AAS and SSV on retrospective evaluation. For pediatric subjects with nontraumatic acute abdominal pain, the yield of conventional radiographic study is exceedingly low. If required, a technically adequate single supine anteroposterior (AP) view of the abdomen and pelvis is sufficient for initial radiographic evaluation while reducing unnecessary radiation exposure to the patient.
Collapse
|
30
|
Abstract
Pregnant women with an acute abdomen present a critical issue due to the necessity for an immediate diagnosis and treatment; in fact, a diagnostic delay could worsen the outcome for both the mother and the fetus. There is evidence that emergencies during pregnancy are subject to mismanagement; however, the percentage of errors in the diagnosis of emergencies in pregnancy has not been studied in depth. The purpose of this article is to review the most common imaging error emergencies. The topics covered are divided into gynecological and non-gynecological entities and, for each pathology, possible errors have been dealt with in the diagnostic pathway, the possible technical errors in the exam execution, and finally the possible errors in the interpretation of the images. These last two entities are often connected owing to a substandard examination, which can cause errors in the interpretation. Consequently, the systemization of errors reduces the possibility of reoccurrences in the future by providing a valid approach in helping to learn from these errors.
Collapse
|
31
|
Abstract
Right lower quadrant pain in children can result from various underlying conditions other than acute appendicitis. The common mimics of acute appendicitis are related to acute gastrointestinal and genitourinary diseases. Diagnosis of right lower quadrant pain in the pediatric population can be challenging, especially when the symptoms are often nonspecific. This article reviews the currently available imaging techniques for evaluating a child with right lower quadrant pain and the spectrum of differential diagnoses with a focus on imaging clues to a specific diagnosis.
Collapse
|
32
|
Abstract
Acute diverticulitis, defined as acute inflammation of a colonic diverticulum, is a common emergency presentation managed by both surgeons and physicians. There have been advances in the medical treatments offered to patients in recent years. Factors predisposing individuals to the development of acute diverticulitis include obesity, smoking, lack of physical activity and medication use, such as NSAIDs. Although widely used, there is limited evidence on the efficacy of individual antibiotic regimens and antibiotic treatment may not be required in all patients. Mesalazine seems to be the only effective treatment for the primary prevention of acute diverticulitis. Finally, evidence of effective measures for the prevention of recurrence is lacking. Furthermore, high-quality randomized controlled trials are required for medical treatments in patients with acute diverticulitis, if management is to be evidence based.
Collapse
Affiliation(s)
- Antonio Tursi
- a Gastroenterology Service, ASL BAT, Andria, BT, Italy
| |
Collapse
|
33
|
Mazzei MA, Guerrini S, Mazzei FG, Cioffi Squitieri N, Notaro D, de Donato G, Galzerano G, Sacco P, Setacci F, Volterrani L, Setacci C. Follow-up of endovascular aortic aneurysm repair: Preliminary validation of digital tomosynthesis and contrast enhanced ultrasound in detection of medium- to long-term complications. World J Radiol 2016; 8:530-536. [PMID: 27247719 PMCID: PMC4882410 DOI: 10.4329/wjr.v8.i5.530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 12/29/2015] [Accepted: 02/17/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To validate the feasibility of digital tomosynthesis of the abdomen (DTA) combined with contrast enhanced ultrasound (CEUS) in assessing complications after endovascular aortic aneurysm repair (EVAR) by using computed tomography angiography (CTA) as the gold standard.
METHODS: For this prospective study we enrolled 163 patients (123 men; mean age, 65.7 years) referred for CTA for EVAR follow-up. CTA, DTA and CEUS were performed at 1 and 12 mo in all patients, with a maximum time interval of 2 d.
RESULTS: Among 163 patients 33 presented complications at CTA. DTA and CTA correlated for the presence of complications in 32/33 (96.96%) patients and for the absence of complications in 127/130 (97.69%) patients; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DTA were 97%, 98%, 91%, 99%, and 98%, respectively. CEUS and CTA correlated for the presence of complications in 19/33 (57.57%) patients and for the absence of complications in 129/130 (99.23%) patients; the sensitivity, specificity, PPV, NPV and accuracy of CEUS were 58%, 99%, 95%, 90%, and 91%, respectively. Sensitivity, specificity and accuracy of combining DTA and CEUS together in detecting EVAR complications were 77%, 98% and 95%, respectively.
CONCLUSION: Combining DTA and CEUS in EVAR follow-up has the potential to limit the use of CTA only in doubtful cases.
Collapse
|
34
|
Mayumi T, Yoshida M, Tazuma S, Furukawa A, Nishii O, Shigematsu K, Azuhata T, Itakura A, Kamei S, Kondo H, Maeda S, Mihara H, Mizooka M, Nishidate T, Obara H, Sato N, Takayama Y, Tsujikawa T, Fujii T, Miyata T, Maruyama I, Honda H, Hirata K. The Practice Guidelines for Primary Care of Acute Abdomen 2015. J Gen Fam Med 2016. [DOI: 10.14442/jgfm.17.1_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
|
35
|
Ray P, Pawsey AKM, Preston JT. Obesity is not always the answer. BMJ Case Rep 2016; 2016:bcr-2015-213784. [PMID: 26822377 DOI: 10.1136/bcr-2015-213784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Partha Ray
- Department of Surgery, James Paget University Hospital, Gorleston-on-Sea, UK
| | | | - Jane Thomas Preston
- Department of Obstetrics and Gynaecology, James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK
| |
Collapse
|
36
|
Sartelli M, Catena F, Ansaloni L, Coccolini F, Griffiths EA, Abu-Zidan FM, Di Saverio S, Ulrych J, Kluger Y, Ben-Ishay O, Moore FA, Ivatury RR, Coimbra R, Peitzman AB, Leppaniemi A, Fraga GP, Maier RV, Chiara O, Kashuk J, Sakakushev B, Weber DG, Latifi R, Biffl W, Bala M, Karamarkovic A, Inaba K, Ordonez CA, Hecker A, Augustin G, Demetrashvili Z, Melo RB, Marwah S, Zachariah SK, Shelat VG, McFarlane M, Rems M, Gomes CA, Faro MP, Júnior GAP, Negoi I, Cui Y, Sato N, Vereczkei A, Bellanova G, Birindelli A, Di Carlo I, Kok KY, Gachabayov M, Gkiokas G, Bouliaris K, Çolak E, Isik A, Rios-Cruz D, Soto R, Moore EE. WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting. World J Emerg Surg 2016; 11:37. [PMID: 27478494 PMCID: PMC4966807 DOI: 10.1186/s13017-016-0095-0] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/26/2016] [Indexed: 02/06/2023] Open
Abstract
Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of Emergency Surgery (WSES) Consensus Conference on acute diverticulitis was held during the 3rd World Congress of the WSES in Jerusalem, Israel, on July 7th, 2015. During this consensus conference the guidelines for the management of acute left sided colonic diverticulitis in the emergency setting were presented and discussed. This document represents the executive summary of the final guidelines approved by the consensus conference.
Collapse
Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62019 Macerata, Italy
| | - Fausto Catena
- Department of Surgery, Maggiore Hospital, Parma, Italy
| | - Luca Ansaloni
- General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Ewen A. Griffiths
- General and Upper GI Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | - Jan Ulrych
- 1st Department of Surgery - Department of Abdominal, Thoracic Surgery and Traumatology, General University Hospital, Prague, Czech Republic
| | - Yoram Kluger
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ofir Ben-Ishay
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Frederick A. Moore
- Department of Surgery, Division of Acute Care Surgery, and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL USA
| | - Rao R. Ivatury
- Department of Surgery, Virginia Commonwealth University, Richmond, VA USA
| | - Raul Coimbra
- Department of Surgery, UC San Diego Medical Center, San Diego, USA
| | - Andrew B. Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Ari Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Gustavo P. Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Ronald V. Maier
- Department of Surgery, University of Washington, Seattle, WA USA
| | - Osvaldo Chiara
- Emergency Department, Niguarda Ca’Granda Hospital, Milan, Italy
| | - Jeffry Kashuk
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Boris Sakakushev
- First Clinic of General Surgery, University Hospital/UMBAL/St George Plovdiv, Plovdiv, Bulgaria
| | - Dieter G. Weber
- Department of Traumatology, John Hunter Hospital, Newcastle, NSW Australia
| | - Rifat Latifi
- Department of Surgery, Trauma Research Institute, University of Arizona, Tucson, AZ USA
| | - Walter Biffl
- Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Kenji Inaba
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA USA
| | - Carlos A. Ordonez
- Department of Surgery, Fundación Valle del Lili, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany
| | - Goran Augustin
- Department of Surgery, University Hospital Center Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zaza Demetrashvili
- Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Renato Bessa Melo
- Department of General Surgery, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sanjay Marwah
- Department of Surgery, Pt BDS Post-graduate Institute of Medical Sciences, Rohtak, India
| | | | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore, Singapore
| | - Michael McFarlane
- Department of Surgery, Radiology, Anaesthetics and Intensive Care, University Hospital of the West Indies, Kingston, Jamaica
| | - Miran Rems
- Surgical Department, General Hospital Jesenice, Jesenice, Slovenia
| | - Carlos Augusto Gomes
- Federal University of Juiz de Fora (UFJF) AND Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, MG Brazil
| | - Mario Paulo Faro
- Department of General Surgery, Trauma and Emergency Surgery Division, ABC Medical School, Santo André, SP Brazil
| | - Gerson Alves Pereira Júnior
- Emergency Surgery and Trauma Unit, Department of Surgery, University of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Ionut Negoi
- Emergency Hospital of Bucharest, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Norio Sato
- Department of Primary Care & Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Andras Vereczkei
- Department of Surgery, Medical School University of Pécs, Pécs, Hungary
| | | | | | - Isidoro Di Carlo
- Department of Surgical Sciences, Organs Transplantation and Advanced Technologies, “G.F. Ingrassia” University of Catania, Cannizzaro Hospital, Catania, Italy
| | - Kenneth Y Kok
- Department of Surgery, The Brunei Cancer Centre, Jerudong Park, Brunei
| | - Mahir Gachabayov
- Department of Surgery, Clinical Hospital of Emergency Medicine, Vladimir City, Russian Federation
| | - Georgios Gkiokas
- 2nd Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Elif Çolak
- Department of Surgery, Samsun Education and Research Hospital, Samsun, Turkey
| | - Arda Isik
- Department of Surgery, Mengucek Gazi Training Research Hospital, Erzincan, Turkey
| | - Daniel Rios-Cruz
- Department of Surgery, Hospital de Alta Especialidad de Veracruz, Veracruz, Mexico
| | - Rodolfo Soto
- Department of Emergency Surgery and Critical Care, Centro Medico Imbanaco, Cali, Colombia
| | - Ernest E. Moore
- Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA
| |
Collapse
|
37
|
Gangadhar K, Kielar A, Dighe MK, O’Malley R, Wang C, Gross JA, Itani M, Lalwani N. Multimodality approach for imaging of non-traumatic acute abdominal emergencies. Abdom Radiol (NY) 2016; 41:136-48. [PMID: 26830620 DOI: 10.1007/s00261-015-0586-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
"Acute abdomen" includes spectrum of medical and surgical conditions ranging from a less severe to life-threatening conditions in a patient presenting with severe abdominal pain that develops over a period of hours. Accurate and rapid diagnosis of these conditions helps in reducing related complications. Clinical assessment is often difficult due to availability of over-the-counter analgesics, leading to less specific physical findings. The key clinical decision is to determine whether surgical intervention is required. Laboratory and conventional radiographic findings are often non-specific. Thus, cross-sectional imaging plays a pivotal role for helping direct management of acute abdomen. Computed tomography is the primary imaging modality used for these cases due to fast image acquisition, although US is more specific for conditions such as acute cholecystitis. Magnetic resonance imaging or ultrasound is very helpful in patients who are particularly sensitive to radiation exposure, such as pregnant women and pediatric patients. In addition, MRI is an excellent problem-solving modality in certain conditions such as assessment for choledocholithiasis in patients with right upper quadrant pain. In this review, we discuss a multimodality approach for the usual causes of non-traumatic acute abdomen including acute appendicitis, diverticulitis, cholecystitis, and small bowel obstruction. A brief review of other relatively less frequent but important causes of acute abdomen, such as perforated viscus and bowel ischemia, is also included.
Collapse
|
38
|
Mayumi T, Yoshida M, Tazuma S, Furukawa A, Nishii O, Shigematsu K, Azuhata T, Itakura A, Kamei S, Kondo H, Maeda S, Mihara H, Mizooka M, Nishidate T, Obara H, Sato N, Takayama Y, Tsujikawa T, Fujii T, Miyata T, Maruyama I, Honda H, Hirata K. Practice Guidelines for Primary Care of Acute Abdomen 2015. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 23:3-36. [PMID: 26692573 DOI: 10.1002/jhbp.303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 12/11/2022]
Abstract
Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine, in collaboration with four other medical societies, launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines (all clinical questions and recommendations were shown in supplementary information). A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. A total of 108 questions based on nine subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two-step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence-based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen.
Collapse
Affiliation(s)
- Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Chemotherapy Research Institute, International University of Health and Welfare, Ichikawa, Japan
| | - Susumu Tazuma
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Akira Furukawa
- Department of Radiological Sciences, Faculty of Health Sciences and Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Osamu Nishii
- Department of Obstetrics and Gynecology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kanagawa, Japan
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Takeo Azuhata
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University, School of Medicine, Tokyo, Japan
| | - Seiji Kamei
- Department of Radiology, The Aichi Prefectural Federation of Agricultural Cooperatives for Health and Welfare Kainan Hospital, Aichi, Japan
| | - Hiroshi Kondo
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shigenobu Maeda
- Emergency Department, Fukui Prefectural Hospital, Fukui, Japan
| | - Hiroshi Mihara
- Center for Medical Education, University of Toyama, Toyama, Japan
| | - Masafumi Mizooka
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Toshihiko Nishidate
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Norio Sato
- Department of Primary Care and Emergency Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yuichi Takayama
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Tomoyuki Tsujikawa
- Comprehensive Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Tomoyuki Fujii
- Chairperson of the Executive Board, Japan Society of Obstetrics and Gynecology, Tokyo, Japan
| | - Tetsuro Miyata
- President, Japanese Society for Vascular Surgery, Tokyo, Japan
| | | | | | - Koichi Hirata
- President, Japanese Society for Abdominal Emergency Medicine, Tokyo, Japan
| |
Collapse
|
39
|
Hobbs JM. Diagnostic Imaging of Appendicitis With Supplementation by Transabdominal and Transvaginal Sonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2015. [DOI: 10.1177/8756479315611656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute appendicitis is a condition that can affect any member of the population. Without timely treatment there is a high likelihood of rupture leading to peritonitis, and early diagnosis is imperative to obtaining treatment. Sonography can be used without fear of radiation exposure to the patient and with relatively little discomfort, ideal for pediatric patients. It can also be used with little patient preparation, with the possibility of a more rapid diagnosis than other imaging modalities. For patients presenting with atypical symptoms, sonography may be used to increase diagnostic accuracy, which will lead to a drop in the surgical removal rate of a healthy appendix. When diagnostic criteria are met, sonography results can be correlated with the patient’s blood test and clinical symptoms to make a positive diagnosis. The addition of the transvaginal approach for female patients has further increased the rate of success of diagnosing acute appendicitis, so that appropriate emergent surgery can be done.
Collapse
|
40
|
Ashaolu BA, Asaleye MC, Adetiloye AV, Alatise IO. Spectrum of diseases and diagnostic values of ultrasound in adult patients with nontraumatic acute abdomen in a nigerian tertiary health facility. Niger J Surg 2015; 21:6-12. [PMID: 25838758 PMCID: PMC4382646 DOI: 10.4103/1117-6806.152731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aim and Objective: The purpose of this study was to determine the spectrum of disease on abdominal ultrasound (US) and the diagnostic efficacy of US in adult patients with nontraumatic acute abdomen at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife. Materials and Methods: The study population included consecutive 150 adult patients aged 15 years and above presenting with nontraumatic acute abdomen via the adult emergency unit or as inpatients referred to the Radiology Department of OAUTHC, Ile-Ife for abdominal US. MINDRAY D.C-6 real-time US scanner with 3.5, 5.0, and 7.5 MHz probes and Doppler facilities were used to assess the intra-abdominal organs and the findings were compared with the clinical and surgical findings in those cases that were operated. Results: The common spectrum of diseases encountered on US in this study included appendicitis (66 [44%]), ectopic pregnancy (34 [22%]), intestinal obstruction (13 [8.7%]) while the least finding was renal abscess 1 (0.7%). The correlation of US findings with surgical findings in this study showed sensitivity, specificity, and kappa agreement for appendicitis of 83.3%, 100.0%, and 0.808; ectopic pregnancy of 100.0%, 97.8%, and 0.958; acute cholecystitis of 100.0%, 100.0%, and 1.0. However, perforated viscus showed the least sensitivity (60.0%), specificity (99.2%), and kappa agreement 0.654. All the disease entities showed good kappa agreement beyond chance, and they were all statistically significant (P < 0.001). Conclusions: This study has shown a relatively high sensitivity, specificity and diagnostic accuracy of US in cases of nontraumatic acute abdomen in a careful hand. We, therefore, recommended that these advantages of US should be capitalized upon in settings where other advanced diagnostic modalities are not available.
Collapse
Affiliation(s)
- Bimbo Ayoola Ashaolu
- Department of Radiology, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Osun, Nigeria
| | | | - Adebayo Victor Adetiloye
- Department of Radiology, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Osun, Nigeria
| | - Isaac Olusegun Alatise
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Osun, Nigeria
| |
Collapse
|
41
|
Sartelli M, Moore FA, Ansaloni L, Di Saverio S, Coccolini F, Griffiths EA, Coimbra R, Agresta F, Sakakushev B, Ordoñez CA, Abu-Zidan FM, Karamarkovic A, Augustin G, Costa Navarro D, Ulrych J, Demetrashvili Z, Melo RB, Marwah S, Zachariah SK, Wani I, Shelat VG, Kim JI, McFarlane M, Pintar T, Rems M, Bala M, Ben-Ishay O, Gomes CA, Faro MP, Pereira GA, Catani M, Baiocchi G, Bini R, Anania G, Negoi I, Kecbaja Z, Omari AH, Cui Y, Kenig J, Sato N, Vereczkei A, Skrovina M, Das K, Bellanova G, Di Carlo I, Segovia Lohse HA, Kong V, Kok KY, Massalou D, Smirnov D, Gachabayov M, Gkiokas G, Marinis A, Spyropoulos C, Nikolopoulos I, Bouliaris K, Tepp J, Lohsiriwat V, Çolak E, Isik A, Rios-Cruz D, Soto R, Abbas A, Tranà C, Caproli E, Soldatenkova D, Corcione F, Piazza D, Catena F. A proposal for a CT driven classification of left colon acute diverticulitis. World J Emerg Surg 2015; 10:3. [PMID: 25972914 PMCID: PMC4429354 DOI: 10.1186/1749-7922-10-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/30/2014] [Indexed: 02/08/2023] Open
Abstract
Computed tomography (CT) imaging is the most appropriate diagnostic tool to confirm suspected left colonic diverticulitis. However, the utility of CT imaging goes beyond accurate diagnosis of diverticulitis; the grade of severity on CT imaging may drive treatment planning of patients presenting with acute diverticulitis. The appropriate management of left colon acute diverticulitis remains still debated because of the vast spectrum of clinical presentations and different approaches to treatment proposed. The authors present a new simple classification system based on both CT scan results driving decisions making management of acute diverticulitis that may be universally accepted for day to day practice.
Collapse
Affiliation(s)
| | | | - Luca Ansaloni
- General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | | | | | - Raul Coimbra
- Department of Surgery, UC San Diego Health System, San Diego, USA
| | - Ferdinando Agresta
- Department of Surgery, Ospedale Civile, ULSS19 del Veneto, Adria, (RO) Italy
| | - Boris Sakakushev
- First Clinic of General Surgery, University Hospital St George, Plovdiv, Bulgaria
| | - Carlos A Ordoñez
- Department of Surgery, Fundación Valle del Lili, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia
| | - Fikri M Abu-Zidan
- Department of Surgery, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | - Goran Augustin
- Department of Surgery, University Hospital Center, Zagreb, Croatia
| | - David Costa Navarro
- General and Digestive Tract Surgery, Alicante University General Hospital, Alicante, Spain
| | - Jan Ulrych
- 1st Surgical Department of First Faculty of Medicine, General University Hospital, Prague Charles University, Prague, Czech Republic
| | - Zaza Demetrashvili
- Department of General Surgery, Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Renato B Melo
- Department of General Surgery, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sanjay Marwah
- Department of Surgery, Pt BDS Post-graduate Institute of Medical Sciences, Rohtak, India
| | | | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Jae Il Kim
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Michael McFarlane
- Department of Surgery, Radiology, Anaesthetics and Intensive Care University Hospital of the West Indies, Kingston, Jamaica
| | - Tadaja Pintar
- Department of Abdominal Surgery, Umc Ljubljana, Ljubljana, Slovenia
| | - Miran Rems
- Surgical Department, General Hospital Jesenice, Jesenice, Slovenia
| | - Miklosh Bala
- Department of General Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Offir Ben-Ishay
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Carlos Augusto Gomes
- Federal University of Juiz de Fora (UFJF) AND Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, MG Brazil
| | - Mario Paulo Faro
- Department of General Surgery, Trauma and Emergency Surgery Division, ABC Medical School, Santo André, SP Brazil
| | - Gerson Alves Pereira
- Emergency Surgery and trauma Unit, Department of Surgery, Ribeirão, Preto, Brazil
| | | | - Gianluca Baiocchi
- Clinical and Experimental Sciences, Brescia Ospedali Civili, Brescia, Italy
| | - Roberto Bini
- General and Emergency Surgery SG Bosco Hospital, Turin, Italy
| | - Gabriele Anania
- Department of Surgery, Arcispedale S. Anna, Medical University of Ferrara, Ferrara, Italy
| | - Ionut Negoi
- Emergency Hospital of Bucharest, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
| | - Zurabs Kecbaja
- General and Emergency Surgery Department, Riga East University Hospital “Gailezers”, Riga, Latvia
| | - Abdelkarim H Omari
- Department of General Surgery, King Abdalla University Hospital, Irbid, Jordan
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jakub Kenig
- 3rd Department of Generał Surgery, Narutowicz Hospital, Krakow, Połand
| | - Norio Sato
- Department of Primary Care & Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Andras Vereczkei
- Department of Surgery, Medical School University of Pécs, Pécs, Hungary
| | - Matej Skrovina
- Department of Surgery Hospital and Oncological Centre Novy Jicin, Novy Jicin, Czech Republic
| | - Koray Das
- Department of General Surgery, Numune Training and Research Hospital, Adana, Turkey
| | | | | | | | - Victor Kong
- Department of Surgery, Edendale Hospital, Pietermaritzburg, South Africa
| | - Kenneth Y Kok
- Department of Surgery, Ripas Hospital, Bandar Seri Begawan, Brunei
| | - Damien Massalou
- Department of Surgery, University Hospital of Nice, University of Nice Sophia-Antipolis, Sophia-Antipolis, France
| | - Dmitry Smirnov
- Department of Surgical Diseases, South Ural State Medical University, Chelyabinsk City, Russian Federation
| | - Mahir Gachabayov
- Department of Surgery, Clinical Hospital of Emergency Medicine, Vladimir City, Russian Federation
| | - Georgios Gkiokas
- 2nd Department of Surgery, Aretaieio University Hospital, Athens, Greece
| | | | | | | | | | - Jaan Tepp
- Department of General Surgery, North Estonia Medical Center, Tallinn, Estonia
| | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand
| | - Elif Çolak
- Department of Surgery, Samsun Education and Research Hospital, Samsun, Turkey
| | - Arda Isik
- Department of Surgery, Mengucek Gazi Training Research Hospital, Erzincan, Turkey
| | - Daniel Rios-Cruz
- Department of Surgery, Hospital de Alta Especialidad de Veracruz, Veracruz, Mexico
| | - Rodolfo Soto
- Department of Emergency Surgery and Critical Care, Centro Medico Imbanaco, Cali, Colombia
| | - Ashraf Abbas
- Emergency Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Cristian Tranà
- Department of Emergency Medicine and Surgery, Macerata Hospital, Macerata, Italy
| | | | - Darija Soldatenkova
- General and Emergency Surgery Department, Riga East University Hospital “Gailezers”, Riga, Latvia
| | - Francesco Corcione
- Department of Laparoscopic and Robotic Surgery, Colli-Monaldi Hospital, Naples, Italy
| | - Diego Piazza
- Division of Surgery, Vittorio Emanuele Hospital, Catania, Italy
| | - Fausto Catena
- Emergency Department, Maggiore University Hospital, Parma, Italy
| |
Collapse
|
42
|
Garcia DAA, Froes TR. Importance of fasting in preparing dogs for abdominal ultrasound examination of specific organs. J Small Anim Pract 2014; 55:630-4. [PMID: 25377227 DOI: 10.1111/jsap.12281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/27/2014] [Accepted: 09/03/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the effect of fasting on the technical success of abdominal ultrasonography specifically in respect of examination of the gall bladder, duodenum, pancreas, adrenal glands and portal vein in dogs. METHODS Randomised, prospective study of 150 dogs with a variety of physical characteristics. Animals were divided into two groups of 75 dogs each. Dogs in Group 1 were fasted for 8 to 12 hours before ultrasonographic evaluation and those in Group 2 were not but received food anytime between 10 minutes and 2 hours before the procedure. RESULTS Intraluminal gas can influence the visibility of organs, but intraluminal gas accumulation occurred independently of fasting status. The assessment of abdominal organs was not affected by whether or not an animal was fasted. CLINICAL SIGNIFICANCE Routine fasting of dogs before abdominal ultrasonography is not essential.
Collapse
Affiliation(s)
- D A A Garcia
- Department of Veterinary Medicine, School of Veterinary Medicine, Federal University of Paraná, Curitiba, Paraná, Brazil
| | | |
Collapse
|
43
|
Mazzei MA, Volterrani L. Nonocclusive mesenteric ischaemia: think about it. Radiol Med 2014; 120:85-95. [DOI: 10.1007/s11547-014-0460-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/11/2014] [Indexed: 01/16/2023]
|
44
|
Humes DJ, Spiller RC. Review article: The pathogenesis and management of acute colonic diverticulitis. Aliment Pharmacol Ther 2014; 39:359-70. [PMID: 24387341 DOI: 10.1111/apt.12596] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 07/18/2013] [Accepted: 12/09/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Acute diverticulitis, defined as acute inflammation associated with a colonic diverticulum, is a common emergency presentation managed by both surgeons and physicians. There have been advances in both the medical and the surgical treatments offered to patients in recent years. AIM To review the current understanding of the aetiology and treatment of acute diverticulitis. METHODS A search of PubMed and Medline databases was performed to identify articles relevant to the aetiology, pathogenesis and management of acute diverticulitis. RESULTS There are 75 hospital admissions per year for acute diverticulitis per 100,000 of the population in the United States. Recent reports suggest a 26% increase in admissions over a 7-year period. Factors predisposing to the development of acute diverticulitis include obesity, smoking, diet, lack of physical activity and medication use such as aspirin and nonsteroidal anti-inflammatory drugs. The condition is associated with a low mortality of about 1% following medical therapy, rising to 4% in-hospital mortality in those requiring surgery. There is limited evidence on the efficacy of individual antibiotic regimens, and antibiotic treatment may not be required in all patients. The rates of recurrence reported for patients with acute diverticulitis following medical management vary from 13% to 36%. The surgical management of those patients who fail medical treatment has moved towards a laparoscopic nonresectional approach; however, the evidence supporting this is limited. CONCLUSIONS Further high-quality randomised controlled trials are required of both medical and surgical treatments in patients with acute diverticulitis, if management is to be evidence-based.
Collapse
Affiliation(s)
- D J Humes
- Nottingham Digestive Diseases Centre and Biomedical Research Unit, Nottingham University Hospital NHS Trust, Nottingham, UK
| | | |
Collapse
|
45
|
Bjørsum-Meyer T, Schmidt TA. Consequences of peritonism in an emergency department setting. Open Access Emerg Med 2014; 6:9-13. [PMID: 27147873 PMCID: PMC4753981 DOI: 10.2147/oaem.s47798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In patients who were referred to the emergency department (ED) with abdominal pain, it is crucial to determine the presence of peritonism to allow for appropriate handling and subsequent referral to stationary departments. We aimed to assess the incidence of perceived peritonism in a contemporary ED and to make a comparable characterization on specified endpoints, including hospital stay, performed acute surgery, and ordered imaging. Methods A single-center study was performed during 2010 in a contemporary Danish ED. We evaluated 1,270 patients consecutively admitted to the ED and focused on the patients with abdominal pain. Following a physical examination, the patients with abdominal pain were divided into those who had clinical signs of peritonism and those who did not. Results Among the 1,270 patients admitted to the ED, 10% had abdominal pain. In addition, 41% of these patients were found to have signs indicative of peritonism, and 90% were admitted to the Department of Surgery (DS). Also, 24% of those patients with signs of peritonism and admission to the DS underwent surgical intervention in terms of laparotomy/laparoscopy. Five of the patients without peritonism underwent surgery. The patients perceived to have peritonism were younger at 34±3.0 years (mean ± standard error of the mean) than the patients who were not perceived to have peritonism, 52±2.8 years (P<0.05). They also had a shorter length of stay of 38.2±6.0 hours at the DS versus 95.3±18.2 hours (P<0.05). No differences with statistical significance were found regarding a stay in the emergency room (ER) or ordered imaging from the ER. Conclusion Peritonism was a common finding in our setting. Peritonism did not require more acute surgery or imaging. The duration of the patient’s stay in the ER was not influenced by a finding of peritonism. The evaluation of peritonism needs to be improved in the ED.
Collapse
Affiliation(s)
| | - Thomas A Schmidt
- Emergency Department, Holbaek Hospital, Smedelundsgade, Holbaek, Denmark
| |
Collapse
|