Diagnosis of duodenal leaks from kidney-pancreas transplants in patients with duodenovesical anastomoses: value of CT cystography

OBJECTIVE

This study was undertaken to assess the value of CT cystography, using scans made with full bladder distention by a combination of iodinated contrast material and air and scans made after active voiding, for detecting duodenal segment leaks in patients with kidney transplants and pancreas transplants associated with small duodenal segments and duodenovesical anastomoses.

SUBJECTS AND METHODS

18 patients with such kidney-pancreas transplants underwent CT cystography for clinically suspected leaks from the duodenal segment. Six patients had two examinations, resulting in 24 CT cystograms. The CT protocol consisted of an initial series of pelvic scans (plain CT) without oral, IV, or bladder contrast material; CT cystogram with the bladder fully distended by iodinated contrast material and air; and, if the findings were negative, CT after voiding. If no leak was demonstrated, the remainder of the abdomen to the liver dome was examined. Diagnoses were proved by surgery or cystoscopy (n = 11) and clinical follow-up examinations (n = 13).

RESULTS

Overall, bladder-duodenal segment leaks were demonstrated in 11 of 12 studies: one by plain CT, seven by full CT cystography, and four by CT after voiding following negative findings on full CT cystography. One surgically proved leak was missed by CT cystography owing to a large amount of pelvic fluid. In 12 studies without a leak, CT cystography results correlated well with clinical follow-up studies. There were no false-positive results. Sensitivity was 92%, specificity was 100%, and accuracy was 96%.

CONCLUSION

CT cystography with a dedicated protocol is an accurate way to diagnose leaks of the duodenal segment in patients with bladder-drained kidney-pancreas transplants if administration of air combined with contrast material into the bladder and CT after voiding are used.

[Magnetic resonance tomography of the hand: current status]

Magnetic resonance imaging (MRI) is an established imaging method in abnormalities of the wrist. Inherent advantages of this imaging method such as the lack of ionizing irradiation, the free choice of imaging planes and its excellent contrast resolution have been enhanced by the introduction of surface coils and new sequences. These developments result in an improved spatial resolution, allowing imaging of small structures such as the triangular fibrocartilage. There is a number of established indications for MRI of the wrist, e.g. diagnosis of avascular necrosis, follow-up after carpal tunnel surgery and imaging of soft tissue masses. Increasingly, MRI can be used for the diagnosis of intercarpal ligament tears as well. The diagnostic capabilities of MRI of the wrist are discussed, based on personal experience and a review of the literature.

[Is the "classical" release of the flexor retinaculum in carpal tunnel syndrome obsolete?]

Carpal tunnel release used to be the standard treatment for carpal tunnel syndrome. However, some authors now prefer reconstruction of the transverse carpal ligament, due to suspected palmar dislocation of the median nerve in wrist flexion after simple ligament release. In this retrospective study the topographic location of the median nerve after release is investigated and an attempt made to find a correlation with the postoperative clinical outcome. In computed tomography no palmar subluxation of the nerve was found, even in a patient with a poor clinical result.