1
|
Lopes Vendrami C, Kelahan L, Escobar DJ, Goodhartz L, Hammond N, Nikolaidis P, Yang GY, Hirano I, Miller FH. "Imaging Findings of Eosinophilic Gastrointestinal Diseases in Adults". Curr Probl Diagn Radiol 2023; 52:139-147. [PMID: 36517296 DOI: 10.1067/j.cpradiol.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
Eosinophilic gastrointestinal (GI) disorders are a group of conditions marked by pathologic eosinophilic infiltration of one or multiple locations in the GI tract. Conditions include eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis, and eosinophilic colitis. The site and depth of eosinophilic infiltration of the GI tract usually determines clinical presentation. These conditions should be considered in the differential diagnosis for several GI symptoms, such as food impaction or dysphagia. Histopathology is the gold standard for diagnosis of eosinophilic disorders. Nevertheless, findings from endoscopy, barium studies, computed tomography or magnetic resonance imaging, can aid in the diagnosis, by allowing for earlier diagnosis as well as proper management. Eosinophilic gastrointestinal disorders are typically managed with corticosteroids or dietary elimination. A high index of suspicion is required for diagnosis as it can often be challenging.
Collapse
Affiliation(s)
- Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda Kelahan
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David J Escobar
- Department of Pathology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lori Goodhartz
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nancy Hammond
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Paul Nikolaidis
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Guang-Yu Yang
- Department of Pathology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ikuo Hirano
- Department of Gastroenterology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL..
| |
Collapse
|
2
|
Yalon M, Tahboub Amawi AD, Kelm ZS, Wells ML, Teo LLS, Heiken JP, Sheedy SP, Torbenson MS, Fidler JL, Venkatesh SK. Eosinophilic Disorders of the Gastrointestinal Tract and Associated Abdominal Viscera: Imaging Findings and Diagnosis. Radiographics 2022; 42:1081-1102. [PMID: 35749291 DOI: 10.1148/rg.220004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Eosinophilic gastrointestinal disorders (EGIDs) are inflammatory conditions of the gastrointestinal tract that are characterized by tissue eosinophilia and end-organ dysfunction or damage. Primary EGIDs are associated with atopy and other allergic conditions, whereas secondary EGIDs are associated with underlying systemic diseases or hypereosinophilic syndrome. Within the spectrum of EGIDs, eosinophilic esophagitis is the most prevalent. Eosinophilic gastroenteritis and eosinophilic colitis are relatively uncommon. Eosinophilic infiltration of the liver, biliary tree, and/or pancreas also can occur and mimic other inflammatory and malignant conditions. Although endoscopic evaluation is the method of choice for eosinophilic esophagitis, radiologic evaluation of the esophagus plays an important role in the assessment of disease severity. CT and MR enterography are the modalities of choice for demonstrating specific forms of eosinophilic gastroenteritis. CT and MRI are important in the detection of abdominal visceral involvement in EGIDs. Diagnosis is often challenging and relies on symptoms, imaging findings, histologic confirmation of tissue eosinophilia, and correlation with peripheral eosinophilia. Imaging is crucial for identifying characteristic organ-specific findings, although imaging findings are not specific. When promptly treated, EGIDs usually have a benign clinical course. However, a delayed diagnosis and associated surgical interventions have been associated with morbidity. Therefore, a radiologist's knowledge of the imaging findings of EGIDs in the appropriate clinical settings may aid in early diagnosis and thereby improve patient care. An overview of the clinical features and imaging findings of EGIDs and the eosinophilic disorders of associated abdominal viscera is provided. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Mariana Yalon
- From the Department of Radiology (M.Y., A.D.T.A., Z.S.K., M.L.W., J.P.H., S.P.S., J.L.F., S.K.V.) and Department of Laboratory Medicine and Pathology (M.S.T.), Mayo Clinic, 200 2nd St SW, Rochester, MN 55905; and Department of Diagnostic Imaging, National University Health System, Singapore (L.L.S.T.)
| | - Ali D Tahboub Amawi
- From the Department of Radiology (M.Y., A.D.T.A., Z.S.K., M.L.W., J.P.H., S.P.S., J.L.F., S.K.V.) and Department of Laboratory Medicine and Pathology (M.S.T.), Mayo Clinic, 200 2nd St SW, Rochester, MN 55905; and Department of Diagnostic Imaging, National University Health System, Singapore (L.L.S.T.)
| | - Zachary S Kelm
- From the Department of Radiology (M.Y., A.D.T.A., Z.S.K., M.L.W., J.P.H., S.P.S., J.L.F., S.K.V.) and Department of Laboratory Medicine and Pathology (M.S.T.), Mayo Clinic, 200 2nd St SW, Rochester, MN 55905; and Department of Diagnostic Imaging, National University Health System, Singapore (L.L.S.T.)
| | - Michael L Wells
- From the Department of Radiology (M.Y., A.D.T.A., Z.S.K., M.L.W., J.P.H., S.P.S., J.L.F., S.K.V.) and Department of Laboratory Medicine and Pathology (M.S.T.), Mayo Clinic, 200 2nd St SW, Rochester, MN 55905; and Department of Diagnostic Imaging, National University Health System, Singapore (L.L.S.T.)
| | - Lynette L S Teo
- From the Department of Radiology (M.Y., A.D.T.A., Z.S.K., M.L.W., J.P.H., S.P.S., J.L.F., S.K.V.) and Department of Laboratory Medicine and Pathology (M.S.T.), Mayo Clinic, 200 2nd St SW, Rochester, MN 55905; and Department of Diagnostic Imaging, National University Health System, Singapore (L.L.S.T.)
| | - Jay P Heiken
- From the Department of Radiology (M.Y., A.D.T.A., Z.S.K., M.L.W., J.P.H., S.P.S., J.L.F., S.K.V.) and Department of Laboratory Medicine and Pathology (M.S.T.), Mayo Clinic, 200 2nd St SW, Rochester, MN 55905; and Department of Diagnostic Imaging, National University Health System, Singapore (L.L.S.T.)
| | - Shannon P Sheedy
- From the Department of Radiology (M.Y., A.D.T.A., Z.S.K., M.L.W., J.P.H., S.P.S., J.L.F., S.K.V.) and Department of Laboratory Medicine and Pathology (M.S.T.), Mayo Clinic, 200 2nd St SW, Rochester, MN 55905; and Department of Diagnostic Imaging, National University Health System, Singapore (L.L.S.T.)
| | - Michael S Torbenson
- From the Department of Radiology (M.Y., A.D.T.A., Z.S.K., M.L.W., J.P.H., S.P.S., J.L.F., S.K.V.) and Department of Laboratory Medicine and Pathology (M.S.T.), Mayo Clinic, 200 2nd St SW, Rochester, MN 55905; and Department of Diagnostic Imaging, National University Health System, Singapore (L.L.S.T.)
| | - Jeff L Fidler
- From the Department of Radiology (M.Y., A.D.T.A., Z.S.K., M.L.W., J.P.H., S.P.S., J.L.F., S.K.V.) and Department of Laboratory Medicine and Pathology (M.S.T.), Mayo Clinic, 200 2nd St SW, Rochester, MN 55905; and Department of Diagnostic Imaging, National University Health System, Singapore (L.L.S.T.)
| | - Sudhakar K Venkatesh
- From the Department of Radiology (M.Y., A.D.T.A., Z.S.K., M.L.W., J.P.H., S.P.S., J.L.F., S.K.V.) and Department of Laboratory Medicine and Pathology (M.S.T.), Mayo Clinic, 200 2nd St SW, Rochester, MN 55905; and Department of Diagnostic Imaging, National University Health System, Singapore (L.L.S.T.)
| |
Collapse
|
3
|
Hentschel F. Chronic fibrosing esophagitis with diffuse esophageal intramural pseudo‐diverticulosis. JGH OPEN 2022; 6:287-291. [PMID: 35601128 PMCID: PMC9120889 DOI: 10.1002/jgh3.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/24/2022] [Accepted: 04/23/2022] [Indexed: 12/01/2022]
Abstract
Diffuse esophageal intramural pseudo‐diverticulosis (DEIPD) is a chronic fibrosing inflammation of the esophagus of unknown origin. Its name derives from the characteristic pseudo‐diverticula formed by dilated ducts of submucosal glands. With an assumed prevalence of approximately 5–50/100 000, DEIPD is more frequent than previously estimated. It preferentially affects men between 50 and 70 years of age with a history of alcohol and tobacco abuse. Key symptoms are chronic dysphagia and food impactions. Typical endoscopic findings are multiple small, longitudinally aligned pseudo‐diverticle openings and trachealization of the esophagus. Additionally, the usually gray mucosa may show a fine‐grained pattern of very small red dots that merge into a pink tint, called “faux uni pattern.” Once established, clinical symptoms and endoscopic changes persist throughout life. Although there is no known causal therapy, complications like bolus impactions, candida infections, or reflux can and should be treated.
Collapse
Affiliation(s)
- Florian Hentschel
- Department of Gastroenterology and Hepatology Brandenburg Medical School (Theodor Fontane) Brandenburg Germany
| |
Collapse
|
4
|
Hentschel F, Schreyer AG, Lüth S. Recurrent food impactions. Gut 2021; 70:1631-1690. [PMID: 32620548 DOI: 10.1136/gutjnl-2020-321623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Florian Hentschel
- Department of Gastroenterology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Andreas Georg Schreyer
- Department of Radiology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Stefan Lüth
- Department of Gastroenterology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| |
Collapse
|
5
|
Khan S, Guo X, Liu T, Iqbal M, Jiang K, Zhu L, Chen X, Wang BM. An Update on Eosinophilic Esophagitis: Etiological Factors, Coexisting Diseases, and Complications. Digestion 2021; 102:342-356. [PMID: 32570246 DOI: 10.1159/000508191] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is an immune-mediated clinicopathological condition characterized by esophageal infiltration with eosinophils resulting in chronic inflammation and stricture. SUMMARY The recent increase in the incidence of EoE and the characteristic presentation of symptoms with difficulty swallowing and food bolus impaction has raised key concerns of clinicians as well as researchers. EoE often presents with dysphagia, food impaction, nausea, regurgitation or vomiting, and decreased appetite. It is more common in males, affecting both adults and children. The causative manner of this condition is complex and multifactorial. Throughout recent years, researchers have made a significant contribution to understanding the pathogenesis of EoE, genetic background, natural history, work on allergy, and standardization in the evaluation of disease activity. There is relatively high prevalence of EoE among the population, emphasizing the importance of this disease. Key messages: Esophageal involvement with eosinophils may be manifested as isolated or with coexisting conditions and should be taken into consideration in the differential diagnosis. This study aimed to provide gastroenterologists with novel insights into the evaluation of esophageal involvement with eosinophils and to pay special attention to the etiological factors, coexisting clinical diseases, and complications.
Collapse
Affiliation(s)
- Samiullah Khan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaopei Guo
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Tianyu Liu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Muhammad Iqbal
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kui Jiang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lanping Zhu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Chen
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Bang-Mao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China,
| |
Collapse
|
6
|
Frieling T, Kreysel C, Blank M, Mülle D, Euler P, Melchior I. Not always eosinophilic esophagitis – intramural pseudodiverticulosis of the esophagus – a case report and literature review. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 58:1201-1207. [DOI: 10.1055/a-1288-1521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Background Intramural pseudodiverticulosis of the esophagus (EIPD) is a rare disease leading to dysphagia, chest pain, and weight loss. The diagnosis is difficult, and the disease can be confounded with eosinophilic esophagitis (EoE). We present a patient with esophageal intramural pseudodiverticulosis and a literature review.
Case report The 45-year-old white caucasian woman with a history of nicotine and alcohol abuse had progressive hoarseness and severe dysphagia for solid food. Esophagogastroduodenoscopy (EGD) showed proximal esophageal stenosis, thrush esophagitis, and mucosal alteration with trachealization suspicious of EoE. However, repeated bouginage EGD and barium swallow revealed typical signs of esophageal intramural pseudodiverticulosis (EIPD). The patient was treated successfully by bougingage, acid suppression, and antifungal therapy. The literature analysis revealed the characteristics of EIPD according to age, sex, risk factors, and therapy modalities.
Conclusion The case report and the literature overview suggest that EIPD can be confounded with EoE.
Collapse
Affiliation(s)
- Thomas Frieling
- Department of Internal Medicine and Gastroenterology, HELIOS Clinic Krefeld, Germany
| | - Christian Kreysel
- Department of Internal Medicine and Gastroenterology, HELIOS Clinic Krefeld, Germany
| | - Michael Blank
- Department of Internal Medicine and Gastroenterology, HELIOS Clinic Krefeld, Germany
| | - Dorothee Mülle
- Department of Internal Medicine and Gastroenterology, HELIOS Clinic Krefeld, Germany
| | - Philipp Euler
- Department of Internal Medicine and Gastroenterology, HELIOS Clinic Krefeld, Germany
| | - Ilka Melchior
- Department of Internal Medicine and Gastroenterology, HELIOS Clinic Krefeld, Germany
| |
Collapse
|
7
|
Hentschel F, Lüth S. Clinical and endoscopic characteristics of diffuse esophageal intramural pseudo-diverticulosis. Esophagus 2020; 17:492-501. [PMID: 32162106 PMCID: PMC7497296 DOI: 10.1007/s10388-020-00729-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/24/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION With 250 published cases worldwide, diffuse esophageal intramural pseudo-diverticulosis (DEIPD) is a poorly understood disease. The aim of this study was to determine the prevalence of DEIPD in our own population, identify risk factors and clinical symptoms, and characterize its typical endoscopic signs. METHODS Retrospective search in our center's endoscopic and clinical database. Reviewing of all cases by re-examining stored endoscopic photographs. Reviewing of all cases regarding age, sex, risk factors, comorbidities, histology, and clinical symptoms. RESULTS In a population of 150.000 we found 21 cases of DEIPD. Mean age was 56 ± 10 years. 86% were males, 76% had alcohol abuse, 57% had nicotine abuse, 38% had arteriosclerosis, 33% had COPD, 29% had malignancies, 24% had liver cirrhosis, 19% had impaired kidney function, and 15% had diabetes. Dysphagia was present in 62% and food bolus impaction (single or repeated) in 48%. Endoscopically, 95% of patients had multiple (> 4), small (0.25-2.5 mm) pseudodiverticle openings in the esophageal wall. In 62%, openings were aligned longitudinally. 86% showed edematous swelling of mucosa ("frosted glass look"), 76% showed a fine-grained pattern of small (10-100 µm) red dots ("faux uni pattern"), and 76% had a rigid, narrow lumen with multiple rings ("trachealization"). CONCLUSION With a prevalence of approximately 5 to 50/100.000, DEIPD may be more frequent than previously estimated. It preferably affects middle-aged male alcoholics. Key symptoms are chronic dysphagia and food impaction. Typical endoscopic findings are multiple, small, longitudinally aligned pseudodiverticle openings, frosted glass look, faux uni pattern, and trachealization of the esophagus.
Collapse
Affiliation(s)
- Florian Hentschel
- Center for Internal Medicine II, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
- Zentrum für Innere Medizin II, Hochschulklinikum Brandenburg der MHB, Hochstr. 29, 14770, Brandenburg an der Havel, Germany.
| | - Stefan Lüth
- Center for Internal Medicine II, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| |
Collapse
|
8
|
Concomitant esophageal intramural pseudodiverticulosis and eosinophilic esophagitis: a diagnosis that needs to be histologically proved. Gastrointest Endosc 2020; 92:794-795. [PMID: 32838918 DOI: 10.1016/j.gie.2020.03.3861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/28/2020] [Indexed: 12/11/2022]
|
9
|
Kathi PR, Tama M, Thammineni N, Ehrinpreis M. Pseudodiverticulosis: a rare presentation of eosinophilic esophagitis. Clin J Gastroenterol 2020; 13:170-172. [DOI: 10.1007/s12328-019-01044-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022]
|
10
|
Hernandez PV, Amer S, Lam-Himlin DM, DiSantis DJ, Menias CO, Horsley-Silva JL. Eosinophilic esophagitis: imaging features with endoscopic and pathologic correlation. Abdom Radiol (NY) 2020; 45:591-600. [PMID: 31894379 DOI: 10.1007/s00261-019-02374-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We aim to review the imaging features of eosinophilic esophagitis on fluoroscopy and present how they can correlate with endoscopic and pathologic findings. RESULTS Eosinophilic esophagitis is a chronic immune-mediated disease that results in esophageal dysfunction. Upper esophagogastroduodenoscopy is high yield and required for biopsies to demonstrate the hallmark histologic findings of eosinophil-predominant inflammation. While esophagogastroduodenoscopy is currently mandatory for diagnosis, imaging findings can provide valuable information regarding the structural and functional properties of the esophagus. In addition, fluoroscopic studies may be very helpful in the setting of subtle findings and to evaluate fibrotic remodeling changes. CONCLUSION Radiologic examinations are a valuable tool in the assessment of eosinophilic esophagitis and can highlight changes of fibrostenotic disease, as overall narrowing can be more conspicuous fluoroscopically than endoscopically. As the disease increases in prevalence, it is critical that physicians recognize this condition and facilitate diagnosis and treatment.
Collapse
|
11
|
Akkari I, Jazia EB, Mrabet S, Jemni I. Candida albicans: a cause or a consequence of esophageal intramural pseudo-diverticulosis. Pan Afr Med J 2019; 33:280. [PMID: 31692736 PMCID: PMC6815468 DOI: 10.11604/pamj.2019.33.280.19601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 11/11/2022] Open
Abstract
Esophageal intramural pseudo-diverticulosis is a rare disease of unknown etiology. It is characterized by multiple pseudodiverticula with segmental or diffuse involvement of the esophagus. We report, the case of a 78-year-old male who suffered from severe dysphagia. Diagnosis of esophageal intramural pseudo-diverticulosis was based on endoscopic and radiologic explorations. Histological analysis of esophageal mucosal biopsies has shown the presence of candida albicans. Antifungal treatment leads to spectacular improvement of dysphasia. Subsequently, the patient presented a cardio-respiratory failure and died despite adequate treatment.
Collapse
Affiliation(s)
- Imen Akkari
- Gastroenterology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Elhem Ben Jazia
- Gastroenterology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Soumaya Mrabet
- Gastroenterology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Imen Jemni
- Gastroenterology Department, Farhat Hached Hospital, Sousse, Tunisia
| |
Collapse
|
12
|
McQuillan P, Cheah S, Arnold D, Wills V. Complex oesophageal disease in a 72-year-old male. ANZ J Surg 2019; 90:E32-E33. [PMID: 30974515 DOI: 10.1111/ans.15114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 01/13/2019] [Accepted: 01/15/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Patrick McQuillan
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Sheryn Cheah
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - David Arnold
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Vanessa Wills
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| |
Collapse
|