A combination of small bowel imaging methods: conventional enteroclysis with complementary magnetic resonance enteroclysis

AIM

The aim of this prospective study was to evaluate the overall findings of conventional enteroclysis (CE) with complementary magnetic resonance enteroclysis (MRE) in small bowel disease.

METHODS

The study included 32 patients referred from various clinical departments, with known or suspected small bowel disease and abnormalities on CE. Immediately after CE, true fast imaging with steady-state precession (true FISP), and unenhanced and gadolinium-enhanced T1-weighted fast low-angle shot (FLASH) sequences with fat saturation were obtained. Mucosal, mural and luminal changes of the small bowel were evaluated by each technique. In addition, bowel wall thickening, bowel wall enhancement and perienteric changes were assessed by MRE. The radiological findings obtained were evaluated together as a combination, and the role of MRE in the determination of the activity and complications of the small bowel disease was assessed. Radiological findings were correlated with clinical evaluation and follow-up in all cases, including endoscopy in 14 cases and surgery in 5 cases.

RESULTS

MRE provided important supplementary mural and extramural information, including degree of pathological wall thickness, mural enhancement pattern associated with disease activity, perivisceral collection, abscess formation, mesenteric fibrofatty proliferation, lymphadenopathy and increase in perienteric vascularity. Short strictures were not revealed on MRE; however, for patients with a history of abdominal malignancy, MRE helped characterize the level of any obstruction and the extent of the disease.

CONCLUSION

We recommend MRE for patients who have findings of advanced inflammatory bowel disease or neoplasm on CE examination. The combination of these two techniques can provide important information on the degree and extent of the disorder.

Enteroclysis findings of intestinal Behcet disease: a comparative study with Crohn disease

BACKGROUND

The aim of this study was threefold; to define the enteroclysis (EC) findings of intestinal involvement in Behcet disease (BD), to compare these findings with those seen in Crohn disease (CD), and to determine the relation between the duration of BD and severity of the EC findings.

METHODS

From 1997 to 2000, 17 BD and 50 CD cases were examined by EC examination. EC was performed with a 13-F balloon catheter via transnasal entubation. Mucosal and mural changes were evaluated. Statistical analysis was performed with the Mann-Whitney U test to determine the relation between duration of BD and severity of the EC findings. P </= 0.05 was considered statistically significant.

RESULTS

In 12 (70.58%) of 17 BD cases, EC demonstrated intestinal pathologic findings such as ulcerations, fold thickening, granular pattern, pseudopolyp formation, and bowel wall thickening. No statistical correlation between the severity of EC findings and the duration of BD was found.

CONCLUSION

EC should be the radiologic method to evaluate the intestinal pathology in symptomatic BD patients. The main EC finding in BD was ulceration mostly in the aphthous form. The EC findings in BD, even in longstanding cases, are usually mild when compared with those seen in CD.

Laparoscopic repair of congenital diaphragmatic hernias

Bochdalek and Morgagni hernias are the least common congenital diaphragmatic hernias, with the prevalence of Bochdalek hernia being 1/2200 births and the prevalence of Morgagni hernia being 1/1 million births. Although they are usually asymptomatic, congenital diaphragmatic hernias, especially Bochdalek and Morgagni hernias, are diagnosed in early childhood. In adulthood, they are diagnosed incidentally or when they become symptomatic. The repair of congenital diaphragmatic hernia is indicated in all children and symptomatic adults. We present three cases of congenital diaphragmatic hernia, two Morgagni and one Bochdalek hernias, repaired laparoscopically. We describe the operational methods. The results of the operations were satisfactory, with cure defined with radiological images after 1 month. We propose the use of laparoscopy in the repair procedure because it is a safe and effective method. Benefits include that it provides an excellent view of the surgical field, ease of execution, minimal surgical trauma, excellent cosmetic results, rapid recovery, and shorter hospitalization stay.

Radiological workup in mesenteric cysts: insight of a case report

Mesenteric cysts are rare intra-abdominal tumors. The absence of characteristic clinical findings makes diagnosis cumbersome. In this report, the significance of the preoperative radiological workup was discussed in an adult patient with a mesenteric cyst. The complete resection of the cyst is treatment of choice.

Rare complication of intestinal Crohn's disease: giant fibroid polyp

A 25-year-old male patient who had a brother with Crohn's disease was referred to our clinic with bloody diarrhea and crampy abdominal pain. After a plain erect abdominal X-ray, enteroclysis was performed, followed by abdominopelvic CT. Besides the radiological features of CD, both enteroclysis and CT revealed a big polypoid filling defect in the small intestine. The patient was surgically treated and the histopathology of the specimen revealed a giant fibroid polyp superimposed on CD, an extremely rare complication heretofore unmentioned in the radiology literature. In this report we discuss the role of enteroclysis in the diagnosis of complicated cases of long-standing CD. In addition, we also shed light on the importance of both enteroclysis and CT, with their complementary findings, in the radiological diagnosis of rare complicated cases of CD.

Radiologic evaluation of gastrointestinal leiomyosarcomatosis

A 68-year-old woman who had previously undergone small intestinal resection because of leiomyosarcoma was referred to our clinic with epigastric pain. A double-contrast barium study and the subsequent abdominopelvic CT and abdominal MRI examinations demonstrated multiple extraluminal growing tumors arising from the walls of stomach, small bowel, and colon. A CT-guided aspiration biopsy revealed malignant mesenchymal tumor. The presence of disseminated intra-abdominal masses without concomitant ascites and invasion of tissue planes on CT in a patient operated on prior because of a leiomyosarcoma led to the diagnosis of gastrointestinal leiomyosarcomatosis. In this report we discuss the radiological approach to this rare entity.

Closed perforation of the small intestine showing continuity and the diagnostic role of enteroclysis

BACKGROUND

Conventional abdominal CT and Ultrasonography were not adequate for the immediate assessment of a closed perforation of the small intestine showing continuity. For definitive diagnosis of the main pathology, we advise enteroclysis.

METHODS

All patients had non-traumatic small bowel perforation and had many diagnostic procedures including conventional abdominal CT and ultrasonography, but did not get a positive result from them. Following the enteroclysis, it was obvious that there existed a closed small bowel perforation with continuity.

RESULTS

The first patient had fistula and interloop pouch filled with contrast in pelvis minor and perforations in small intestine and cecum. The second patient had closed perforation showing continuity in the level of ileum and the third patient had a pouch showing continuity in the ileum and a fistula in ileum. All patients had operation; the first one had a Crohn's disease and discharged postoperatively on 16th day, but the second one having ileal tumor was lost postoperatively due to pulmonary embolism and the third one having Non-Hodgkin Lymphoma was lost postoperatively due to sepsis.

CONCLUSION

Conventional techniques were not sufficient to classify the main pathology in these cases, but enteroclysis revealed good results in diagnosis of the main event, and does not cause a delay in diagnosis.

Cavernous hemangioma of the kidney. Case report

Renal hemangiomas are rare neoplasms of the kidney, and the number of cases reported in the literature are about 200 since the original description by Virchow in 1867. Among these, only a few have been examined by the combination of ultrasound, computed tomography, and angiography. We present a demonstrative case diagnosed at our clinic and review the corresponding literature.