Computed tomography-guided endoscopic needle knife therapy for ileal pouch sinus

Ileal pouch-anal anastomosis surgery can be complicated by anastomotic leaks, leading to the formation of abscess and chronic sinus that have been routinely managed by a surgical approach. We developed the endoscopic needle knife sinusotomy (NKSi) technique, which has become a valid alternative. The basic principle of endoscopic NKSi is dissection and drainage of the sinus through its orifice internally into the lumen of pouch body. The success of NKSi requires an access to the sinus from the pouch side. One of the most challenging situations for NKSi is a closed orifice of the sinus, which leaves an isolated chronic abscess cavity. Here we report a case of complicated presacral sinus with a closed orifice that was not amenable to NKSi, necessitating a CT-guided guide wire placement and subsequent NKSi.

Amyand's hernia: a case report of prospective ct diagnosis in the emergency department

The diagnosis of Amyand's hernia, the development of acute appendicits within an inguinal hernia, is rarely made preoperatively and is often confused clinically with an incarcerated right inguinal hernia. The use of CT to prospectively diagnose Amyand's hernia and corresponding imaging findings are not well described in the literature. We report a case of Amyand's hernia, which was correctly diagnosed by CT in a female patient presented to the emergency department with right lower quadrant pain and clinical suspicion of a strangulated omentocele.