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Soliman M, Magnetta M, Salinas A, Feinn RS, Velichko YS, Miller FH, Kelahan LC. Evaluation of 18 CT signs in diagnosing cecal volvulus: a multi-reader retrospective study. Abdom Radiol (NY) 2024; 49:357-364. [PMID: 37989898 DOI: 10.1007/s00261-023-04092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To assess the diagnostic performance and reliability of 18 CT signs to diagnose cecal volvulus, a surgical emergency, versus a group of non-volvulus mimickers. MATERIALS AND METHODS Four radiologists retrospectively and independently assessed 18 CT signs in 191 patients with cecal volvulus (n = 63) or a non-volvulus control group ((n = 128), including cecal bascule (n = 19), mobile cecum (n = 95), and colonic pseudo-obstruction (n = 14)) at a single institution from 2013 to 2021. Fleiss' kappa coefficient was used to assess inter-reader agreement. For diagnostic performance metrics, we assessed sensitivity, specificity, and positive and negative predictive values. For predictive performance, all 18 signs were included in bivariate and stepwise lasso multivariate logistic regression models to diagnose cecal volvulus. Performance was assessed by ROC curves. RESULTS 191 patients (mean age: 63 years +/- 15.5 [SD]; 135 women) were included in the study. Nine of the 18 CT signs of cecal volvulus demonstrated good or better (> 0.6) inter-reader agreement. Individual CT signs with sensitivity, specificity, positive and negative predictive values all above 70% for diagnosing cecal volvulus were transition point, bird beak, and X-marks-the-spot. A lasso regression model determined four CT features: transition point, bird beak, coffee bean, and whirl had excellent prediction (AUC = .979) for cecal volvulus if all present. CONCLUSION CT signs for cecal volvulus that have high sensitivity and specificity include: transition point, bird beak, and X-marks-the-spot and were reliable in distinguishing non-volvulus mimickers. If the following four features were present: transition point, bird beak, coffee bean, and whirl, there was excellent prediction (AUC = .979) for cecal volvulus.
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Affiliation(s)
- Moataz Soliman
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Michael Magnetta
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Abraham Salinas
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | | | - Yuri S Velichko
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Linda C Kelahan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 800, Chicago, IL, 60611, USA.
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Kim BS, Park SY, Kim DH, Kim NI, Yoon JH, Ju JK, Park CH, Kim HS, Choi SK. Cytomegalovirus colitis induced segmental colonic hypoganglionosis in an immunocompetent patient: A case report. World J Clin Cases 2021; 9:5631-5636. [PMID: 34307618 PMCID: PMC8281438 DOI: 10.12998/wjcc.v9.i20.5631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/02/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) colitis is usually seen in immunocompromised patients with risk factors such as human immunodeficiency virus infection, solid organ transplant, inflammatory bowel disease, or malignancy. Therefore, many clinicians usually do not consider the possibility of CMV colitis in immunocompetent patients. We reported a rare case of segmental colonic hypoganglionosis associated with CMV colitis in an immunocompetent patient.
CASE SUMMARY A 48-year-old woman with no underlying disease was admitted to our hospital for severe abdominal pain and constipation. Computed tomography of the abdomen showed diffuse dilatation of the small intestine and the entire colon. Initial sigmoidoscopic findings and result of polymerase chain reaction (PCR) for CMV revealed the compatible findings of CMV colitis, the patient was treated with intravenous ganciclovir. After treatment, sigmoidoscopic findings and CMV PCR results improved. However the patient continued to suffered from constipation. Eight months after the initial admission, patient visited the emergency department with severe abdominal pain and imaging revealed aggravation of fecal impaction and bowel dilatation. We performed subtotal colectomy to control patient’s symptom. Histological examination of the resected specimen showed significantly reduced number of mature ganglion cells in the sigmoid colon compared to that in the proximal colon.
CONCLUSION Our case demonstrates that CMV colitis can develop even in patients with no other underlying disease, and that CMV colitis can be one of the causes for developing colonic hypoganglionosis.
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Affiliation(s)
- Ban Seok Kim
- Department of Gastroenterology, Chonnam National University Hospital, Gwangju 501-757, South Korea
| | - Seon-Young Park
- Department of Gastroenterology, Chonnam National University Hospital, Gwangju 501-757, South Korea
| | - Dong Hyun Kim
- Department of Gastroenterology, Chonnam National University Hospital, Gwangju 501-757, South Korea
| | - Nah Ihm Kim
- Department of Pathology, Chonnam National University Hospital, Gwangju 501-757, South Korea
| | - Jae Hyun Yoon
- Department of Gastroenterology, Chonnam National University Hospital, Gwangju 501-757, South Korea
| | - Jae Kyun Ju
- Department of Surgery, Chonnam University Hospital, Gwangju 501-757, South Korea
| | - Chang Hwan Park
- Department of Gastroenterology, Chonnam National University Hospital, Gwangju 501-757, South Korea
| | - Hyun Soo Kim
- Department of Gastroenterology, Chonnam National University Hospital, Gwangju 501-757, South Korea
| | - Sung Kyu Choi
- Department of Gastroenterology, Chonnam National University Hospital, Gwangju 501-757, South Korea
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Ryu SJ, Lee JY, Lee JH. [Acute Colonic Pseudo-obstruction Induced by Neuroleptic Malignant Syndrome]. Korean J Gastroenterol 2021; 77:313-316. [PMID: 34158453 DOI: 10.4166/kjg.2021.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 11/03/2022]
Abstract
A colonic pseudo-obstruction is a disorder that causes abdominal distension and abdominal pain similar to a mechanical obstruction, but there are no structural lesions that can obstruct the gastrointestinal tract. This condition can be acute or chronic. An acute colonic pseudo-obstruction, also called Ogilvie's syndrome, is believed to be a condition induced by other causes that are different from a chronic colonic pseudo-obstruction. The pathogenesis involves abnormalities in the autonomic nervous system induced by systemic diseases or medications, and it often improves when the primary causes are treated. On the other hand, a chronic colonic pseudo-obstruction can occur repeatedly without a particular cause. The authors encountered neuroleptic malignant syndrome that caused acute colonic pseudo-obstruction. This paper reports a case with a review of the relevant literature. This is the first case reported in Korea. This case shows that physicians should consider neuroleptic malignant syndrome as a cause of an acute colonic pseudo-obstruction.
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Affiliation(s)
- Sung Ju Ryu
- Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Jong Yoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Jong Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
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Lee A, Suhardja TS, Simpson I, Lim JTH. Rare case of adult intestinal hypoganglionosis and review of the literature. Clin J Gastroenterol 2021; 14:599-607. [PMID: 33502729 DOI: 10.1007/s12328-021-01342-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
Intestinal hypoganglionosis is a rare condition in adults. We report a case of intestinal hypoganglionosis in the mid-distal transverse colon to splenic flexure in a 65-year-old female patient presenting with altered bowel habit and abdominal distension, and reviewed the current literature on this topic. Our patient had a medical history of neurofibromatosis type 1. A preoperative computed tomography (CT) scan demonstrated a grossly dilated transverse colon without obstruction. A laparotomy for subtotal colectomy was performed, with histopathology demonstrating intestinal hypoganglionosis.
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Affiliation(s)
- Alice Lee
- Colorectal Surgery Unit, Dandenong Hospital, Monash Health, 135 David Street, Dandenong, VIC, Australia
| | - Thomas Surya Suhardja
- Colorectal Surgery Unit, Dandenong Hospital, Monash Health, 135 David Street, Dandenong, VIC, Australia. .,Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
| | - Ian Simpson
- Department of Anatomical Pathology, Monash Medical Centre, Monash Health, Clayton, VIC, Australia
| | - James Tow-Hing Lim
- Colorectal Surgery Unit, Dandenong Hospital, Monash Health, 135 David Street, Dandenong, VIC, Australia
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Song EM, Kim JW, Lee SH, Chang K, Hwang SW, Park SH, Yang DH, Jung KW, Ye BD, Byeon JS, Yang SK, Lee HJ, Yu CS, Kim CW, Park SH, Kim J, Myung SJ. Colonic Pseudo-obstruction With Transition Zone: A Peculiar Eastern Severe Dysmotility. J Neurogastroenterol Motil 2019; 25:137-147. [PMID: 30646485 PMCID: PMC6326194 DOI: 10.5056/jnm18121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/19/2018] [Accepted: 09/28/2018] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Previous studies from Korea have described chronic intestinal pseudo-obstruction (CIPO) patients with transition zone (TZ) in the colon. In this study, we evaluated the pathological characteristics and their association with long-term outcomes in Korean colonic pseudo-obstruction (CPO) patients with TZ. Methods We enrolled 39 CPO patients who were refractory to medical treatment and underwent colectomy between November 1989 and April 2016 (median age at symptoms onset: 45 [interquartile range, 29–57] years, males 46.2%). The TZ was defined as a colonic segment connecting a proximally dilated and distally non-dilated segment. Detailed pathologic analysis was performed. Results Among the 39 patients, 37 (94.9%) presented with TZ and 2 (5.1%) showed no definitive TZ. Median ganglion cell density in the TZ adjusted for the colonic circumference was significantly decreased compared to that in proximal dilated and distal non-dilated segments in TZ (+) patients (9.2 vs 254.3 and 150.5, P < 0.001). Among the TZ (+) patients, 6 showed additional pathologic findings including eosinophilic ganglionitis (n = 2), ulcers with combined cytomegalovirus infection (n = 2), diffuse ischemic changes (n = 1), and heterotropic myenteric plexus (n = 1). During follow-up (median, 61 months), 32 (82.1%) TZ (+) patients recovered without symptom recurrence after surgery. The presence of pathological features other than hypoganglionosis was an independent predictor of symptom recurrence after surgery (P = 0.046). Conclusions Hypoganglionosis can be identified in the TZ of most Korean CPO patients. Detection of other pathological features in addition to TZ-associated hypoganglionosis was associated with poor post-operative outcomes.
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Affiliation(s)
- Eun Mi Song
- Departments of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Wook Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, Korea
| | - Sun-Ho Lee
- Departments of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kiju Chang
- Departments of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung Wook Hwang
- Departments of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Hyoung Park
- Departments of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong-Hoon Yang
- Departments of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kee Wook Jung
- Departments of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byong Duk Ye
- Departments of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong-Sik Byeon
- Departments of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Suk-Kyun Yang
- Departments of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyo Jeong Lee
- Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
| | - Chang Sik Yu
- Departments of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chan Wook Kim
- Departments of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong Ho Park
- Departments of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jihun Kim
- Departments of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jae Myung
- Departments of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Vianello A, Arcaro G, Peditto P, Iovino S, Marchese-Ragona R. Acute colonic distension in a patient with severe muscular dystrophy receiving non-invasive positive pressure ventilation. Neuromuscul Disord 2017; 28:60-61. [PMID: 29195749 DOI: 10.1016/j.nmd.2017.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 09/20/2017] [Accepted: 09/24/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Andrea Vianello
- Respiratory Intensive Care Unit, University-City Hospital of Padova, Via Giustiniani 2, Padova, Italy.
| | - Giovanna Arcaro
- Respiratory Intensive Care Unit, University-City Hospital of Padova, Via Giustiniani 2, Padova, Italy
| | - Piera Peditto
- Respiratory Intensive Care Unit, University-City Hospital of Padova, Via Giustiniani 2, Padova, Italy
| | - Silvia Iovino
- Respiratory Intensive Care Unit, University-City Hospital of Padova, Via Giustiniani 2, Padova, Italy
| | - Rosario Marchese-Ragona
- Institute of Otorlaryngology, Department of Neurosciences, University-City Hospital of Padova, Via Giustiniani 2, Padova, Italy
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Núñez-García E, Valencia-García LC, Sordo-Mejía R, Kajomovitz-Bialostozky D, Chousleb-Kalach A. [Drug related colonic perforation: Case report]. CIR CIR 2016; 84:65-8. [PMID: 26242822 DOI: 10.1016/j.circir.2015.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 11/19/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute pseudo-obstruction of the colon is a disorder characterised by an increase in intra-luminal pressure that leads to ischaemia and necrosis of the intestinal wall. The mechanism that produces the lesion is unknown, although it has been associated with: trauma, anaesthesia, or drugs that alter the autonomic nervous system. The pathophysiology of medication induced colon toxicity can progress to a perforated colon and potentially death. OBJECTIVE Present a case of a colonic pseudo-obstruction in a patient with polypharmacy as the only risk factor and to review the medical literature related to the treatment of this pathology. CLINICAL CASE The case is presented of a 67 year old woman with colonic pseudo-obstruction who presented with diffuse abdominal pain and distension. The pain progressed and reached an intensity of 8/10, and was accompanied by fever and tachycardia. There was evidence of free intraperitoneal air in the radiological studies. The only risk factor was the use of multiple drugs. The colonic pseudo-obstruction progressed to intestinal perforation, requiring surgical treatment, which resolved the problem successfully. CONCLUSION It is important to consider drug interaction in patients with multiple diseases, as it may develop complications that can be avoided if detected on time.
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Abstract
We report a case of hypokalemia resulting from colonic pseudo-obstruction or Ogilvie's syndrome. Colonic pseudo-obstruction is characterized by profuse watery diarrhea that has a low sodium and high potassium concentration. It is seen in a variety of medical and surgical conditions, but its exact cause remains unknown. It is thought to result from an imbalance of sympathetic and parasympathetic input in the distal colon. The diarrhea is secretory and driven by potassium secretion rather than the inhibition of sodium reabsorption or chloride secretion, which are the most common pathophysiologic mechanisms of secretory diarrhea. Affected patients often lose >100 mmol of potassium daily. Colonic pseudo-obstruction is associated with a dramatic upregulation of the maxiK or BK potassium channel. This channel plays a prominent role in flow-mediated potassium secretion in the connecting tubule and collecting duct and is also upregulated in the distal colon in patients with advanced chronic kidney disease and end-stage renal disease. In vitro studies show that the channel is regulated by catecholamine binding to the β receptor and cyclic AMP upregulation, somatostatin and aldosterone, insights that can be used to help guide pharmacologic therapy. Nephrologists should be aware of colonic pseudo-obstruction as a cause of extrarenal potassium loss.
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Affiliation(s)
- Naseem Sunnoqrot
- Section of Nephrology, The University of Texas Southwestern Medical Center, VA North Texas Health Care System, Dallas, Tex., USA ; Department of Medicine, The University of Texas Southwestern Medical Center, VA North Texas Health Care System, Dallas, Tex., USA
| | - Robert F Reilly
- Department of Medicine, The University of Texas Southwestern Medical Center, VA North Texas Health Care System, Dallas, Tex., USA
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Bertolini D, De Saussure P, Chilcott M, Girardin M, Dumonceau JM. Severe delayed complication after percutaneous endoscopic colostomy for chronic intestinal pseudo-obstruction: A case report and review of the literature. World J Gastroenterol 2007; 13:2255-7. [PMID: 17465514 PMCID: PMC4146857 DOI: 10.3748/wjg.v13.i15.2255] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Percutaneous endoscopic colostomy (PEC) is increasingly proposed as an alternative to surgery to treat various disorders, including acute colonic pseudo-obstruction, chronic intestinal pseudo-obstruction and relapsing sigmoid volvulus. We report on a severe complication that occurred two months after PEC placement. A 74-year-old man with a history of chronic intestinal pseudo-obstruction evolving since 8 years was readmitted to our hospital and received PEC to provide long-standing relief. The procedure was uneventful and greatly improved the patient’s quality of life. Two months later, the patient developed acute stercoral peritonitis. At laparotomy, the colostomy flange was embedded in the abdominal wall but no pressure necrosis was found at the level of the colonic wall. This complication was likely related to inadvertent traction of the colostomy tube. Subtotal colectomy with terminal ileostomy was performed. We review the major features of 60 cases of PEC reported to date, including indications and complications.
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Affiliation(s)
- David Bertolini
- Divisions of Gastroenterology and Hepatology, Geneva University Hospitals, Micheli-du-Crest street 24, 1205 Geneva, Switzerland
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