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Bitar R, Kaur M, Crandall I, McNamara R, Revzin MV. Ultrasound evaluation of portal venous gas and its mimics. Abdom Radiol (NY) 2024:10.1007/s00261-024-04328-2. [PMID: 38735019 DOI: 10.1007/s00261-024-04328-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024]
Abstract
Portal venous gas on abdominal ultrasound classically represents an indirect indicator of bowel ischemia, a critical condition which poses a high patient mortality and therefore warrants emergent corrective action. While the classic appearance of portal venous gas on ultrasound is well-described in the literature, the characteristic descriptors are nonspecific and may actually represent other less emergent mimics. Therefore, while radiologists should remain vigilant for the detection of findings corresponding to portal venous gas, they should also be aware of similar-appearing entities in order to provide the most accurate diagnosis. This pictorial essay will open with imaging examples of true portal venous gas attributable to bowel ischemia and describe the classic features which should alert radiologists to this specific diagnosis. Subsequently, this pictorial essay will provide imaging examples of other various other clinical entities which on ultrasound may share similar imaging characteristics. An important objective of this pictorial essay is to highlight distinguishing imaging features along with specific clinical circumstances for each pathological entity which can direct radiologists into identifying the correct diagnosis.
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Affiliation(s)
- Ryan Bitar
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Manroop Kaur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Ian Crandall
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert McNamara
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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2
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Xu J, Sun X, Qin F, Wang X, Chen Q, Yan R. Protective effects of salvianolic acid B on intestinal ischemia/reperfusion injury in rats by regulating the AhR/IL-22/STAT6 axis. J Recept Signal Transduct Res 2023; 43:73-82. [PMID: 37387514 DOI: 10.1080/10799893.2023.2204949] [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: 08/12/2022] [Accepted: 03/13/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Intestinal ischemia/reperfusion (I/R) injury (IIRI) is associated with high morbidity and mortality. Salvianolic acid B (Sal-B) could exert neuroprotective effects on reperfusion injury after cerebral vascular occlusion, but its effect on IIRI remains unclear. This study set out to investigate the protective effects of Sal-B on IIRI in rats. METHODS The rat IIRI model was established by occluding the superior mesenteric artery and reperfusion, and they were pretreated with Sal-B and aryl hydrocarbon receptor (AhR) antagonist CH-223191 before surgery. Pathological changes in rat ileum, IIRI degree, and intestinal cell apoptosis were evaluated through hematoxylin-eosin staining, Chiu's score scale, and TUNEL staining, together with the determination of caspase-3, AhR protein level in the nucleus, and STAT6 phosphorylation by Western blotting. The levels of inflammatory cytokines (IL-1β/IL-6/TNF-α) and IL-22 were determined by ELISA and RT-qPCR. The contents of superoxide dismutase (SOD), glutathione (GSH), and malondialdehyde (MDA) in intestinal tissues were determined by spectrophotometry. RESULTS Sal-B alleviated IIRI in rats, evidenced by slight villi shedding and villi edema, reduced Chiu's score, and diminished the number of TUNEL-positive cells and caspase-3 expression. SAL-B alleviated inflammation and oxidative stress (OS) responses induced by IIRI. Sal-B promoted IL-22 secretion by activating AhR in intestinal tissue after IIRI. Inhibition of AhR activation partially reversed the protective effect of Sal-B on IIRI. Sal-B promoted STAT6 phosphorylation by activating the AhR/IL-22 axis. CONCLUSION Sal-B plays a protective role against IIRI in rats by activating the AhR/IL-22/STAT6 axis, which may be achieved by reducing the intestinal inflammatory response and OS responses.
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Affiliation(s)
- Jinyao Xu
- Department of Gastrointestinal Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
- Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Xiangjun Sun
- Department of Gastrointestinal Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
- Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Feng Qin
- Department of Gastrointestinal Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
- Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Xufeng Wang
- Department of Gastrointestinal Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
- Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Qian Chen
- Department of Gastrointestinal Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
- Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Ruicheng Yan
- Department of Gastrointestinal Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
- Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
- Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
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Karaosmanoglu AD, Onder O, Kizilgoz V, Hahn PF, Kantarci M, Ozmen MN, Karcaaltincaba M, Akata D. Infarcts and ischemia in the abdomen: an imaging perspective with an emphasis on cross-sectional imaging findings. Abdom Radiol (NY) 2023; 48:2167-2195. [PMID: 36933024 PMCID: PMC10024022 DOI: 10.1007/s00261-023-03877-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
Infarcts and ischemia of abdominal organs may present with acute abdominal pain, and early diagnosis is crucial to prevent morbidity and mortality. Unfortunately, some of these patients present in poor clinical conditions to the emergency department, and imaging specialists are crucial for optimal outcomes. Although the radiological diagnosis of abdominal infarcts is often straightforward, it is vital to use the appropriate imaging modalities and correct imaging techniques for their detection. Additionally, some non-infarct-related abdominal pathologies may mimic infarcts, cause diagnostic confusion, and result in delayed diagnosis or misdiagnosis. In this article, we aimed to outline the general imaging approach, present cross-sectional imaging findings of infarcts and ischemia in several abdominal organs, including but not limited to, liver, spleen, kidneys, adrenals, omentum, and intestinal segments with relevant vascular anatomy, discuss possible differential diagnoses and emphasize important clinical/radiological clues that may assist radiologists in the diagnostic process.
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Affiliation(s)
| | - Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Volkan Kizilgoz
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Mecit Kantarci
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
- Department of Radiology, Atatürk University School of Medicine, 25240, Erzurum, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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Nakamura Y, Kondo S, Narita K, Maeda S, Fonseca D, Honda Y, Tani C, Fukumoto W, Mitani H, Ishibashi M, Chosa K, Tatsugami F, Awai K. Understanding CT imaging findings based on the underlying pathophysiology in patients with small bowel ischemia. Jpn J Radiol 2022. [PMID: 36472804 PMCID: PMC10066158 DOI: 10.1007/s11604-022-01367-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
AbstractBecause acute small bowel ischemia has a high mortality rate, it requires rapid intervention to avoid unfavorable outcomes. Computed tomography (CT) examination is important for the diagnosis of bowel ischemia. Acute small bowel ischemia can be the result of small bowel obstruction or mesenteric ischemia, including mesenteric arterial occlusion, mesenteric venous thrombosis, and non-occlusive mesenteric ischemia. The clinical significance of each CT finding is unique and depends on the underlying pathophysiology. This review describes the definition and mechanism(s) of bowel ischemia, reviews CT findings suggesting bowel ischemia, details factors involved in the development of small bowel ischemia, and presents CT findings with respect to the different factors based on the underlying pathophysiology. Such knowledge is needed for accurate treatment decisions.
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Sinz S, Schneider MA, Graber S, Alkadhi H, Rickenbacher A, Turina M. Prognostic factors in patients with acute mesenteric ischemia-novel tools for determining patient outcomes. Surg Endosc 2022; 36:8607-8618. [PMID: 36217056 PMCID: PMC9613727 DOI: 10.1007/s00464-022-09673-1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/24/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is a devastating disease with poor prognosis. Due to the multitude of underlying factors, prediction of outcomes remains poor. We aimed to identify factors governing diagnosis and survival in AMI and develop novel prognostic tools. METHODS This monocentric retrospective study analyzed patients with suspected AMI undergoing imaging between January 2014 and December 2019. Subgroup analyses were performed for patients with confirmed AMI undergoing surgery. Nomograms were calculated based on multivariable logistic regression models. RESULTS Five hundred and thirty-nine patients underwent imaging for clinically suspected AMI, with 216 examinations showing radiological indication of AMI. Intestinal necrosis (IN) was confirmed in 125 undergoing surgery, 58 of which survived and 67 died (median 9 days after diagnosis, IQR 22). Increasing age, ASA score, pneumatosis intestinalis, and dilated bowel loops were significantly associated with presence of IN upon radiological suspicion. In contrast, decreased pH, elevated creatinine, radiological atherosclerosis, vascular occlusion (versus non-occlusive AMI), and colonic affection (compared to small bowel ischemia only) were associated with impaired survival in patients undergoing surgery. Based on the identified factors, we developed two nomograms to aid in prediction of IN upon radiological suspicion (C-Index = 0.726) and survival in patients undergoing surgery for IN (C-Index = 0.791). CONCLUSION As AMI remains a condition with high mortality, we identified factors predicting occurrence of IN with suspected AMI and survival when undergoing surgery for IN. We provide two new tools, which combine these parameters and might prove helpful in treatment of patients with AMI.
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Affiliation(s)
- Stefanie Sinz
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Marcel A Schneider
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Simon Graber
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Andreas Rickenbacher
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Matthias Turina
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
- Section of Colorectal Surgery, Department of Surgery, University Hospital of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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Xu WX, Zhong QH, Cai Y, Zhan CH, Chen S, Wang H, Lin L, Geng YQ, Hou P, Chen XQ, Zhang JR. Prediction and management of strangulated bowel obstruction: a multi-dimensional model analysis. BMC Gastroenterol 2022; 22:304. [PMID: 35733109 PMCID: PMC9219133 DOI: 10.1186/s12876-022-02363-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Distinguishing strangulated bowel obstruction (StBO) from simple bowel obstruction (SiBO) still poses a challenge for emergency surgeons. We aimed to construct a predictive model that could distinctly discriminate StBO from SiBO based on the degree of bowel ischemia. METHODS The patients diagnosed with intestinal obstruction were enrolled and divided into SiBO group and StBO group. Binary logistic regression was applied to identify independent risk factors, and then predictive models based on radiological and multi-dimensional models were constructed. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were calculated to assess the accuracy of the predicted models. Via stratification analysis, we validated the multi-dimensional model in the prediction of transmural necrosis both in the training set and validation set. RESULTS Of the 281 patients with SBO, 45 (16.0%) were found to have StBO, while 236(84.0%) with SiBO. The AUC of the radiological model was 0.706 (95%CI, 0.617-0.795). In the multivariate analysis, seven risk factors including pain duration ≤ 3 days (OR = 3.775), rebound tenderness (OR = 5.201), low-to-absent bowel sounds (OR = 5.006), low levels of potassium (OR = 3.696) and sodium (OR = 3.753), high levels of BUN (OR = 4.349), high radiological score (OR = 11.264) were identified. The AUC of the multi-dimensional model was 0.857(95%CI, 0.793-0.920). In the stratification analysis, the proportion of patients with transmural necrosis was significantly greater in the high-risk group (24%) than in the medium-risk group (3%). No transmural necrosis was found in the low-risk group. The AUC of the validation set was 0.910 (95%CI, 0.843-0.976). None of patients in the low-risk and medium-risk score group suffered with StBO. However, all patients with bowel ischemia (12%) and necrosis (24%) were resorted into high-risk score group. CONCLUSION The novel multi-dimensional model offers a useful tool for predicting StBO. Clinical management could be performed according to the multivariate score.
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Affiliation(s)
- Wei-Xuan Xu
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Qi-Hong Zhong
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Yong Cai
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Can-Hong Zhan
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Shuai Chen
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Hui Wang
- Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Lin Lin
- Department of Radiology, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Ying-Qian Geng
- Department of Radiology, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
| | - Ping Hou
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China.,Immunotherapy Institute, Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China
| | - Xian-Qiang Chen
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China. .,Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
| | - Jun-Rong Zhang
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, 350122, Fujian Province, China. .,Department of General Surgery (Emergency Surgery), Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
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Modir R, Hadhazy E, Teuteberg J, Hiesinger W, Tulu Z, Hill C. Improving nutrition practices for postoperative high-risk heart transplant and ventricular assist device implant patients in circulatory compromise: A quality improvement pre- and post-protocol intervention outcome study. Nutr Clin Pract 2022; 37:677-697. [PMID: 35606342 DOI: 10.1002/ncp.10854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients undergoing heart transplant (HT) and ventricular assist device (VAD) implant may experience intra- and postoperative complications requiring high-dose vasopressor agents and/or mechanical circulatory support. These complications increase the risk of nonocclusive bowel ischemia (NOBI) and inadequate enteral nutrition (EN) delivery, and guidance for this high-risk patient population is limited. To optimize nutrition support practices in this patient population at our institution, we created the High-Risk Nutrition Support Protocol (HRNSP) to improve nutrient delivery and promote safer EN practices in the setting of NOBI risk factors after HT and VAD implant. METHODS We developed and implemented a nutrition support protocol as a quality improvement (QI) initiative. Data were obtained before (n = 62) and after (n = 52) protocol initiation. We compared nutrition and clinical outcomes between the pre- and post-intervention groups. RESULTS Fewer calorie deficits (P < 0.001), fewer protein deficits (P < 0.001), a greater proportion of calorie/protein needs met (P < 0.001), zero NOBI cases (0%), and decreased intensive care unit (ICU) length of stay (LOS) (P = 0.005) were observed with 100% (n = 52 of 54) HRNSP implementation success. Increased use of parenteral nutrition did not increase central line-associated bloodstream infections (P = 0.46). There was no difference in hospital LOS (P = 0.44) or 90-day and 1-year mortality (P = 0.56, P = 0.35). CONCLUSION This single-center, QI pre- and post-protocol intervention outcome study suggests that implementing and adhering to a nutrition support protocol for VAD implant/HT patients with hemodynamic complications increases nutrient delivery and is associated with reduced ICU LOS and NOBI.
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Affiliation(s)
- Ranna Modir
- Clinical Nutrition, Advanced Heart Failure/Mechanical Circulatory Support/Heart Transplant, Stanford Healthcare, Stanford, California, USA
| | - Eric Hadhazy
- Critical Care Quality, Stanford Healthcare, Stanford, California, USA
| | - Jeffrey Teuteberg
- Cardiovascular Medicine, Stanford University Medical Center, Stanford, California, USA
| | - William Hiesinger
- Cardiothoracic Surgery - Adult Cardiac Surgery, Stanford University Medical center, Stanford, California
| | - Zeynep Tulu
- Solid Organ Transplant Quality, Stanford Healthcare, Stanford, California, USA
| | - Charles Hill
- Anesthesia - Cardiac, Stanford University Medical Center, Stanford, California, USA
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Atre ID, Eurboonyanun K, O'Shea A, Lahoud RM, Shih A, Kalva S, Harisinghani MG, Hedgire S. Predictors of transmural intestinal necrosis in patients presenting with acute mesenteric ischemia on computed tomography. Abdom Radiol (NY) 2022; 47:1636-1643. [PMID: 32382818 DOI: 10.1007/s00261-020-02558-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this study was to identify the significant imaging predictors of transmural intestinal necrosis in patients with acute mesenteric ischemia (AMI). METHODS The medical records and CT imaging of 48 patients between 2011 and 2019 suspected of having AMI that underwent exploratory laparotomy with bowel resection and pathological confirmation of ischemic bowel injury were retrospectively reviewed. Using histopathology as a gold standard, various parameters related to vascular insufficiency and bowel injury were analyzed and correlated with outcome of ischemic bowel necrosis using nonparametric tests. Univariate analysis was performed using Fisher's exact test followed by binary logistic regression test for multivariate analysis. RESULTS 48 Patients (19 females, 40%) with a median age of 68.5 years (IQR of 17 years) built our retrospective cohort. 26 (54%) patients were found to have transmural intestinal necrosis on histopathology (case group) whereas 22 (46%) patients had partial mucosal injury (control group). Pneumatosis intestinalis (p = 0.005, odd's ratio of 2.07-63.14) and severity (> 70% or complete occlusion) of vascular narrowing (p = 0.019, odd's ratio of 1.39-42.30) were identified as the most significant predictors of transmural ischemic necrosis on imaging. Dilatation of bowel did not approach the statistical significance on multivariate analysis although it was found significant on univariate analysis (p = 0.041). CONCLUSION Pneumatosis intestinalis and severity of vascular luminal narrowing are the most important imaging predictors of transmural ischemic bowel necrosis in patients presenting with AMI. The presence of these findings on CT scan should raise high index of suspicion for irreversible transmural ischemic necrosis. In the absence of these factors, endovascular management might be beneficial.
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Affiliation(s)
- Isha D Atre
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 217, White Building, Boston, MA, 02114, USA.
| | - Kulyada Eurboonyanun
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Aileen O'Shea
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Rita Maria Lahoud
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Angela Shih
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Sanjeeva Kalva
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Mukesh G Harisinghani
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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Sinha D, Kale S, Kundaragi NG, Sharma S. Mesenteric ischemia: a radiologic perspective. Abdom Radiol (NY) 2022; 47:1514-1528. [PMID: 33230592 DOI: 10.1007/s00261-020-02867-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 02/08/2023]
Abstract
Mesenteric ischemia is a broad term encompassing several clinical conditions leading to impaired vascularity of bowel loops. Absence of specific clinical presentation and a definitive laboratory marker often lead to delayed diagnosis with high morbidity and mortality in the acute setting. Imaging plays a crucial role in the diagnosis and management. Multi-detector CT (MDCT) is the first line imaging modality for the evaluation of patients with suspected mesenteric ischemia and plays an important role for assessing its severity and complications. This review article highlights the causes, pathophysiology, imaging features and possible endovascular treatment options of mesenteric ischemia.
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Srisajjakul S, Prapaisilp P, Bangchokdee S. Comprehensive review of acute small bowel ischemia: CT imaging findings, pearls, and pitfalls. Emerg Radiol 2022; 29:531-544. [PMID: 35122558 DOI: 10.1007/s10140-022-02028-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 01/03/2022] [Accepted: 01/31/2022] [Indexed: 01/12/2023]
Abstract
Acute small bowel ischemia is a life-threatening condition with a high mortality rate due to its lack of specific symptoms and laboratory profile, which render difficulty in establishing early diagnosis. The etiology of acute small bowel ischemia includes occlusive forms (arterial embolism, arterial thrombosis, and venous thrombosis) and nonocclusive mesenteric ischemia, of which arterial causes are far more common than venous causes. CT, the mainstay of accurate diagnoses, allows the identification of the features of vascular abnormalities and intestinal ischemic injuries, and helps clinicians to restore intestinal blood flow. Without treatment, the prognosis for acute small bowel ischemia is poor. A high index of suspicion and familiarity with the CT spectral findings of bowel ischemia are required to ensure rapid recognition of this condition.
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Affiliation(s)
- Sitthipong Srisajjakul
- Department of Radiology, Faculty of Medicine, Division of Diagnostic Radiology, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Patcharin Prapaisilp
- Department of Radiology, Faculty of Medicine, Division of Diagnostic Radiology, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Sirikan Bangchokdee
- Department of Internal Medicine, Pratumthani Hospital, 7 Ladlumkaew Muang District, Pratumthani, 12000, Thailand
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de Holanda GS, dos Santos Valença S, Carra AM, Lichtenberger RCL, de Castilho B, Franco OB, de Moraes JA, Schanaider A. Translational Application of Fluorescent Molecular Probes for the Detection of Reactive Oxygen and Nitrogen Species Associated with Intestinal Reperfusion Injury. Metabolites 2021; 11:metabo11120802. [PMID: 34940560 PMCID: PMC8705498 DOI: 10.3390/metabo11120802] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023] Open
Abstract
Acute mesenteric ischemia, caused by an abrupt interruption of blood flow in the mesenteric vessels, is associated with high mortality. When treated with surgical interventions or drugs to re-open the vascular lumen, the reperfusion process itself can inflict damage to the intestinal wall. Ischemia and reperfusion injury comprise complex mechanisms involving disarrangement of the splanchnic microcirculatory flow and impairment of the mitochondrial respiratory chain due to initial hypoxemia and subsequent oxidative stress during the reperfusion phase. This pathophysiologic process results in the production of large amounts of reactive oxygen (ROS) and nitrogen (RNS) species, which damage deoxyribonucleic acid, protein, lipids, and carbohydrates by autophagy, mitoptosis, necrosis, necroptosis, and apoptosis. Fluorescence-based systems using molecular probes have emerged as highly effective tools to monitor the concentrations and locations of these often short-lived ROS and RNS. The timely and accurate detection of both ROS and RNS by such an approach would help to identify early injury events associated with ischemia and reperfusion and increase overall clinical diagnostic sensitivity. This abstract describes the pathophysiology of intestinal ischemia and reperfusion and the early biological laboratory diagnosis using fluorescent molecular probes anticipating clinical decisions in the face of an extremely morbid disease.
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Affiliation(s)
- Gustavo Sampaio de Holanda
- Centre of Experimental Surgery, Post Graduate Program in Surgical Sciences, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 219491-590, Brazil; (A.M.C.); (R.C.L.L.); (B.d.C.); (O.B.F.); (A.S.)
- Correspondence: ; Tel.: +55-21-9657-13794
| | - Samuel dos Santos Valença
- Redox Biology Laboratory, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil; (S.d.S.V.); (J.A.d.M.)
| | - Amabile Maran Carra
- Centre of Experimental Surgery, Post Graduate Program in Surgical Sciences, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 219491-590, Brazil; (A.M.C.); (R.C.L.L.); (B.d.C.); (O.B.F.); (A.S.)
| | - Renata Cristina Lopes Lichtenberger
- Centre of Experimental Surgery, Post Graduate Program in Surgical Sciences, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 219491-590, Brazil; (A.M.C.); (R.C.L.L.); (B.d.C.); (O.B.F.); (A.S.)
| | - Bianca de Castilho
- Centre of Experimental Surgery, Post Graduate Program in Surgical Sciences, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 219491-590, Brazil; (A.M.C.); (R.C.L.L.); (B.d.C.); (O.B.F.); (A.S.)
| | - Olavo Borges Franco
- Centre of Experimental Surgery, Post Graduate Program in Surgical Sciences, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 219491-590, Brazil; (A.M.C.); (R.C.L.L.); (B.d.C.); (O.B.F.); (A.S.)
| | - João Alfredo de Moraes
- Redox Biology Laboratory, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil; (S.d.S.V.); (J.A.d.M.)
| | - Alberto Schanaider
- Centre of Experimental Surgery, Post Graduate Program in Surgical Sciences, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 219491-590, Brazil; (A.M.C.); (R.C.L.L.); (B.d.C.); (O.B.F.); (A.S.)
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12
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Davarpanah AH, Ghamari Khameneh A, Khosravi B, Mir A, Saffar H, Radmard AR. Many faces of acute bowel ischemia: overview of radiologic staging. Insights Imaging 2021; 12:56. [PMID: 33914188 PMCID: PMC8085211 DOI: 10.1186/s13244-021-00985-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
Acute bowel ischemia (ABI) can be life threatening with high mortality rate. In spite of the advances made in diagnosis and treatment of ABI, no significant change has occurred in the mortality over the past decade. ABI is potentially reversible with prompt diagnosis. The radiologist plays a central role in the initial diagnosis and preventing progression to irreversible intestinal ischemic injury or bowel necrosis. The most single imaging findings described in the literature are either non-specific or only present in the late stages of ABI, urging the use of a constellation of features to reach a more confident diagnosis. While ABI has been traditionally categorized based on the etiology with a wide spectrum of imaging findings overlapped with each other, the final decision for patient’s management is usually made on the stage of the ABI with respect to the underlying pathophysiology. In this review, we first discuss the pathologic stages of ischemia and then summarize the various imaging signs and causes of ABI. We also emphasize on the correlation of imaging findings and pathological staging of the disease. Finally, a management approach is proposed using combined clinical and radiological findings to determine whether the patient may benefit from surgery or not.
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Affiliation(s)
- Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, USA
| | - Afshar Ghamari Khameneh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bardia Khosravi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, 14117, North Kargar St., Tehran, Iran
| | - Ali Mir
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hiva Saffar
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, 14117, North Kargar St., Tehran, Iran.
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13
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Fitzpatrick LA, Rivers-Bowerman MD, Thipphavong S, Clarke SE, Rowe JA, Costa AF. Pearls, Pitfalls, and Conditions that Mimic Mesenteric Ischemia at CT. Radiographics 2021; 40:545-561. [PMID: 32125953 DOI: 10.1148/rg.2020190122] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Acute mesenteric ischemia (AMI) is a life-threatening condition with a high mortality rate. The diagnosis of AMI is challenging because patient symptoms and laboratory test results are often nonspecific. A high degree of clinical and radiologic suspicion is required for accurate and timely diagnosis. CT angiography of the abdomen and pelvis is the first-line imaging test for suspected AMI and should be expedited. A systematic "inside-out" approach to interpreting CT angiographic images, beginning with the bowel lumen and proceeding outward to the bowel wall, mesentery, vasculature, and extraintestinal viscera, provides radiologists with a practical framework to improve detection and synthesis of imaging findings. The subtypes of AMI are arterial and venoocclusive disease, nonocclusive ischemia, and strangulating bowel obstruction; each may demonstrate specific imaging findings. Chronic mesenteric ischemia is more insidious at onset and almost always secondary to atherosclerosis. Potential pitfalls in the diagnosis of AMI include mistaking pneumatosis as a sign that is specific for AMI and not an imaging finding, misinterpretation of adynamic ileus as a benign finding, and pseudopneumatosis. Several enterocolitides can mimic AMI at CT angiography, such as inflammatory bowel disease, infections, angioedema, and radiation-induced enterocolitis. Awareness of pitfalls, conditions that mimic AMI, and potential distinguishing clinical and imaging features can assist radiologists in making an early and accurate diagnosis of AMI. ©RSNA, 2020.
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Affiliation(s)
- Laura A Fitzpatrick
- From the Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 1276 S Park St, 3rd Floor, Halifax, NS, Canada B3H 2Y9 (L.A.F., M.D.R.B., S.E.C., J.A.R., A.F.C.); and Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada (S.T.)
| | - Michael D Rivers-Bowerman
- From the Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 1276 S Park St, 3rd Floor, Halifax, NS, Canada B3H 2Y9 (L.A.F., M.D.R.B., S.E.C., J.A.R., A.F.C.); and Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada (S.T.)
| | - Seng Thipphavong
- From the Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 1276 S Park St, 3rd Floor, Halifax, NS, Canada B3H 2Y9 (L.A.F., M.D.R.B., S.E.C., J.A.R., A.F.C.); and Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada (S.T.)
| | - Sharon E Clarke
- From the Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 1276 S Park St, 3rd Floor, Halifax, NS, Canada B3H 2Y9 (L.A.F., M.D.R.B., S.E.C., J.A.R., A.F.C.); and Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada (S.T.)
| | - Judy A Rowe
- From the Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 1276 S Park St, 3rd Floor, Halifax, NS, Canada B3H 2Y9 (L.A.F., M.D.R.B., S.E.C., J.A.R., A.F.C.); and Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada (S.T.)
| | - Andreu F Costa
- From the Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 1276 S Park St, 3rd Floor, Halifax, NS, Canada B3H 2Y9 (L.A.F., M.D.R.B., S.E.C., J.A.R., A.F.C.); and Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada (S.T.)
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14
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Martin S, Pierce J, Kikano EG, Vos D, Tirumani SH, Ramaiya N. Considerations in imaging interpretations for colitis in critically ill patients during the COVID-19 era. Emerg Radiol 2021; 28:699-704. [PMID: 33728564 PMCID: PMC7963684 DOI: 10.1007/s10140-021-01925-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/08/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The study aims to demonstrate risk factors for colitis in intensive care unit patients with and without coronavirus disease 2019 (COVID-19). METHODS Retrospective review was performed to identify intensive care unit (ICU) patients with the diagnosis of COVID-19 with computed tomography (CT) between March 20 and December 31, 2020. ICU patients without COVID-19 diagnosis with CT between March 20 and May 10, 2020 were also identified. CT image findings of colitis or terminal ileitis as well as supportive treatment including ventilator, vasopressors, or extracorporeal membrane oxygenation (ECMO) were recorded. Statistical analysis was performed to determine if clinical factors differed in patients with and without positive CT finding. RESULTS Total 61 ICU patients were selected, including 32 (52%) COVID-19-positive patients and 29 (48%) non-COVID-19 patients. CT findings of colitis or terminal ileitis were identified in 27 patients (44%). Seventy-four percent of the patients with positive CT findings (20/27) received supportive therapies prior to CT, while 56% of the patients without abnormal CT findings (19/34) received supportive therapies. Vasopressor treatment was significantly associated with development of colitis and/or terminal ileitis (p = 0.04) and COVID-19 status was not significantly different between these groups (p = 0.07). CONCLUSIONS In our study, there was significant correlation between prior vasopressor therapy and imaging findings of colitis or terminal ileitis in ICU patients, independent of COVID-19 status. Our observation raises a possibility that the reported COVID-19-related severe gastrointestinal complications and potential poor outcome could have been confounded by underlying severe critically ill status, and warrants a caution in diagnosis of gastrointestinal complication.
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Affiliation(s)
- Sooyoung Martin
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Jonathan Pierce
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Elias G Kikano
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Derek Vos
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
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15
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Miller AS, Boyce K, Box B, Clarke MD, Duff SE, Foley NM, Guy RJ, Massey LH, Ramsay G, Slade DAJ, Stephenson JA, Tozer PJ, Wright D. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery. Colorectal Dis 2021; 23:476-547. [PMID: 33470518 PMCID: PMC9291558 DOI: 10.1111/codi.15503] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
AIM There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence-based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. METHODS Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology-based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence-based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. RESULTS All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence-based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.
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Affiliation(s)
- Andrew S. Miller
- Leicester Royal InfirmaryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Benjamin Box
- Northumbria Healthcare Foundation NHS TrustNorth ShieldsUK
| | | | - Sarah E. Duff
- Manchester University NHS Foundation TrustManchesterUK
| | | | | | | | | | | | | | - Phil J. Tozer
- St Mark’s Hospital and Imperial College LondonHarrowUK
| | - Danette Wright
- Western Sydney Local Health DistrictSydneyNew South WalesAustralia
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16
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Morris RS, Murphy P, Boyle K, Somberg L, Webb T, Milia D, Tignanelli CJ, de Moya M, Trevino C. Bowel Ischemia Score Predicts Early Operation in Patients With Adhesive Small Bowel Obstruction. Am Surg 2021; 88:205-211. [PMID: 33502222 DOI: 10.1177/0003134820988820] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nonoperative management of adhesive small bowel obstruction (SBO) is successful in up to 80% of patients. Current recommendations advocate for computed tomography (CT) scan in all patients with SBO to supplement surgical decision-making. The hypothesis of this study was that cumulative findings on CT would predict the need for operative intervention in the setting of SBO. METHODS This is an analysis of a retrospectively and prospectively collected adhesive SBO database over a 6-year period. A Bowel Ischemia Score (BIS) was developed based on the Eastern Association for the Surgery of Trauma guidelines of CT findings suggestive of bowel ischemia. One point was assigned for each of the six variables. Early operation was defined as surgery within 6 hours of CT scan. RESULTS Of the 275 patients in the database, 249 (90.5%) underwent CT scan. The operative rate was 28.3% with a median time from CT to operation of 21 hours (Interquartile range 5.2-59.2 hours). Most patients (166/217, 76.4%) with a BIS of 0 or 1 were successfully managed nonoperatively, whereas the majority of those with a BIS of 3 required operative intervention (5/6, 83.3%). The discrimination (area under the receiver operating characteristic curve) of BIS for early surgery, any operative intervention, and small bowel resection were 0.83, 0.72, and 0.61, respectively. CONCLUSION The cumulative signs of bowel ischemia on CT scan represented by BIS, rather than the presence or absence of any one finding, correlate with the need for early operative intervention.
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Affiliation(s)
- Rachel S Morris
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Surgery, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Patrick Murphy
- Department of Surgery, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kelly Boyle
- Department of Surgery, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Louis Somberg
- Department of Surgery, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Travis Webb
- Department of Surgery, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - David Milia
- Department of Surgery, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher J Tignanelli
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Surgery, North Memorial Medical Center, Robbinsdale, MN, USA.,Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Marc de Moya
- Department of Surgery, 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Colleen Trevino
- Department of Surgery, 5506Medical College of Wisconsin, Milwaukee, WI, USA
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17
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Zheng Y, Shabana A, Elsayes KM, Hamid A, Abdelaziz A, Menias CO, Shaaban AM, Liu P, Gaballah AH. Cross-Sectional Imaging Evaluation of Vascular Lesions in the Gastrointestinal Tract and Mesentery. J Comput Assist Tomogr 2020; 44:870-81. [PMID: 33196596 DOI: 10.1097/RCT.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gastrointestinal (GI) tract and mesenteric vascular lesions can have various clinical presentations, of which GI bleeding is the most common. This collection of pathology is highly variable in etiology ranging from occlusive disease to vascular malformations to trauma to neoplasms which makes for a challenging workup and diagnosis. The advent of multiple imaging modalities and endoscopic techniques makes the diagnosis of these lesions more achievable, and familiarity with their various imaging findings can have a significant impact on patient management. In this article, we review the gamut of GI tract and mesenteric vascular lesions and their associated imaging findings.
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18
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Chew KKY, Law C, Lee D. Stercoral colitis: a rare cause of bowel ischaemia. ANZ J Surg 2020; 91:E225-E226. [PMID: 32886414 DOI: 10.1111/ans.16293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/29/2020] [Accepted: 08/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Kenneth Keen Yip Chew
- Department of General Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Cameron Law
- Department of General Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Daniel Lee
- Department of General Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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19
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Navas-campo R, Moreno-caballero L, Ezponda Casajús A, Ibáñez Muñoz D. Acute mesenteric ischemia: A review of the main imaging techniques and signs. Radiología (English Edition) 2020; 62:336-348. [DOI: 10.1016/j.rxeng.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Navas-campo R, Moreno-caballero L, Ezponda Casajús A, Muñoz DI. Isquemia mesentérica aguda: Revisión de las principales técnicas y signos radiológicos. Radiología 2020; 62:336-48. [DOI: 10.1016/j.rx.2020.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 01/15/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
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21
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Khan MS, Walter T, Buchanan-Hughes A, Worthington E, Keeber L, Feuilly M, Grande E. Differential diagnosis of diarrhoea in patients with neuroendocrine tumours: A systematic review. World J Gastroenterol 2020; 26:4537-4556. [PMID: 32874063 PMCID: PMC7438200 DOI: 10.3748/wjg.v26.i30.4537] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Received: 03/05/2020] [Revised: 05/22/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Approximately 20% of patients with neuroendocrine tumours (NETs) develop carcinoid syndrome (CS), characterised by flushing and diarrhoea. Somatostatin analogues or telotristat can be used to control symptoms of CS through inhibition of serotonin secretion. Although CS is often the cause of diarrhoea among patients with gastroenteropancreatic NETs (GEP-NETs), other causes to consider include pancreatic enzyme insufficiency (PEI), bile acid malabsorption and small intestinal bacterial overgrowth. If other causes of diarrhoea unrelated to serotonin secretion are mistaken for CS diarrhoea, these treatments may be ineffective against the diarrhoea, risking detrimental effects to patient quality of life.
AIM To identify and synthesise qualitative and quantitative evidence relating to the differential diagnosis of diarrhoea in patients with GEP-NETs.
METHODS Electronic databases (MEDLINE, Embase and the Cochrane Library) were searched from inception to September 12, 2018 using terms for NETs and diarrhoea. Congresses, systematic literature review bibliographies and included articles were also hand-searched. Any study designs and publication types were eligible for inclusion if relevant data on a cause(s) of diarrhoea in patients with GEP-NETs were reported. Studies were screened by two independent reviewers at abstract and full-text stages. Framework synthesis was adapted to synthesise quantitative and qualitative data. The definition of qualitative data was expanded to include all textual data in any section of relevant publications.
RESULTS Forty-seven publications (44 studies) were included, comprising a variety of publication types, including observational studies, reviews, guidelines, case reports, interventional studies, and opinion pieces. Most reported on PEI on/after treatment with somatostatin analogs; 9.5%-84% of patients with GEP-NETs had experienced steatorrhoea or confirmed PEI. Where reported, 14.3%–50.7% of patients received pancreatic enzyme replacement therapy. Other causes of diarrhoea reported in patients with GEP-NETs included bile acid malabsorption (80%), small intestinal bacterial overgrowth (23.6%-62%), colitis (20%) and infection (7.1%). Diagnostic approaches included faecal elastase, breath tests, tauroselcholic (selenium-75) acid (SeHCAT) scan and stool culture, although evidence on the effectiveness or diagnostic accuracy of these approaches was limited. Assessment of patient history or diarrhoea characteristics was also reported as initial approaches for investigation. From the identified evidence, if diarrhoea is assumed to be CS diarrhoea, consequences include uncontrolled diarrhoea, malnutrition, and perceived ineffectiveness of CS treatment. Approaches for facilitating differential diagnosis of diarrhoea include improving patient and clinician awareness of non-CS causes and involvement of a multidisciplinary clinical team, including gastroenterologists.
CONCLUSION Diarrhoea in GEP-NETs can be multifactorial with misdiagnosis leading to delayed patient recovery and inefficient resource use. This systematic literature review highlights gaps for further research on prevalence of non-CS diarrhoea and suitability of diagnostic approaches, to determine an effective algorithm for differential diagnosis of GEP-NET diarrhoea.
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Affiliation(s)
- Mohid S Khan
- Department of Gastroenterology and Neuroendocrine Tumours, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Thomas Walter
- Department d'Oncologie Médicale, Hospices Civils de Lyon, Lyon 69003, France
| | | | - Emma Worthington
- Evidence Development, Costello Medical, Cambridge CB1 2JH, United Kingdom
| | - Lucie Keeber
- Medical Affairs, Ipsen, Slough SL1 3XE, United Kingdom
| | - Marion Feuilly
- Health Economics and Outcomes Research, Ipsen, Boulogne-Billancourt 92100, France
| | - Enrique Grande
- Oncology Department, MD Anderson Cancer Center, Madrid 28033, Spain
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22
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Shah V, Magesh M. Non occlusive mesentric ischemia. Radiopaedia.org 2020. [DOI: 10.53347/rid-80109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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23
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Sharma P, Hegde R, Kulkarni A, Soin P, Kochar P, Rotem E. Imaging right lower quadrant pain: Not always appendicitis. Clin Imaging 2020; 63:65-82. [PMID: 32163846 DOI: 10.1016/j.clinimag.2020.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/31/2018] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
Although acute appendicitis (AA) is one of the commonest causes of right lower quadrant abdominal pain (RLQP), there are numerous other conditions in the abdomen and pelvis that can simulate the clinical presentation of AA for which imaging is essential in detection. We discuss the approach to evaluation of patients presenting with acute onset RLQP and the choice of various imaging modalities that can be utilized. Although CT remains the workhorse in evaluation, US and MRI, given lack of radiation, play an important ancillary role, particularly in the pediatric and pregnant patients. We present a spectrum of conditions presenting with RLQP which we have classified systematically ranging from conditions affecting the bowel, mesentery/omentum/peritoneum, vasculature, urinary and reproductive systems to give the reader a checklist of conditions to consider when evaluating a case of RLQP.
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Affiliation(s)
- Pranav Sharma
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, United States of America
| | - Rahul Hegde
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, United States of America.
| | - Ashwini Kulkarni
- Department of Radiology, University of Massachusetts, Worcester, MA, United States of America
| | - Priti Soin
- Department of Pathology, Penn State College of Medicine, Hershey, PA, United States of America
| | - Puneet Kochar
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, United States of America
| | - Eran Rotem
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, United States of America
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24
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Lippi G, Mattiuzzi C, Sanchis-Gomar F. Large-scale epidemiological data on vascular disorders of the intestine. Scand J Gastroenterol 2020; 55:621-625. [PMID: 32301364 DOI: 10.1080/00365521.2020.1752300] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives: This article aims to provide updates on the worldwide epidemiology of vascular disorders of the intestine.Methods: A comprehensive search for obtaining worldwide epidemiologic information on the burden of vascular disorders of the intestine was carried out in the Global Health Data Exchange (GHDx) repository. The condition 'vascular intestinal disorders' was associated with other epidemiologic variables such as year, sex, age, location and socioeconomic status.Results: The current global incidence and mortality of vascular disorders of the intestine are 8.11 per 100,000 cases/year and 1.26 per 100,000 deaths/year, respectively, translating into a death rate of 15.5%. Both global incidence and mortality are 32% higher in the female sex and have both displayed a continuous increase during the past 20 years (+29.3% and +18.4% since 1998, respectively). Incidence and mortality curves appear similar between sexes, with the incidence increasing after the age of 40 years and mortality after the age of 50 years, respectively. The peak of both worldwide incidence and mortality was seen in very elderly people. The death rate increased in parallel with incidence and mortality, from ∼1% to 3% in childhood up to ∼50% after the age of 95 years. Both incidence and mortality displayed a positive association with socioeconomic status. Future projections suggest that incidence and mortality will display 44% and 24% growths by the year 2050.Conclusions: Our analysis demonstrates that the clinical and societal burden of vascular disorders of the intestine is especially higher in women, in the elderly and in people with higher socioeconomic status.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Camilla Mattiuzzi
- Service of Clinical Governance, Provincial Agency for Social and Sanitary Services, Trento, Italy
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
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Patel K, Zha N, Neumann S, Tembelis MN, Juliano M, Samreen N, Hussain J, Moshiri M, Patlas MN, Katz DS. Computed Tomography of Common Bowel Emergencies. Semin Roentgenol 2020; 55:150-169. [DOI: 10.1053/j.ro.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Nakhaei M, Mojtahedi A, Brook OR. Split-bolus CTA for mesenteric ischemia with a single scan opacifying arterial and mesenteric venous systems. Eur Radiol 2020; 30:3987-95. [PMID: 32157410 DOI: 10.1007/s00330-020-06769-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of split-bolus single-scan computed tomography angiography (CTA) protocol for evaluation of acute mesenteric ischemia and alternate diagnoses. MATERIALS AND METHODS In this IRB-approved, HIPAA-compliant retrospective study, consecutive patients from 21 October 2016 to 6 May 2018 evaluated for mesenteric ischemia with split-bolus CTA (a single scan in concurrent arterial and portal venous phase) in a single tertiary academic institution were included. Intravenous contrast was administered on weight-based basis. Quantitative and qualitative assessments of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) attenuation and patency were performed by two independent reviewers. CT imaging findings were correlated with clinical reference outcomes. RESULTS One hundred fifty-four patients (age 66.3 ± 14.1 years, BMI 27.3 ± 6, 86 (56%) female) were included. CTA studies were performed with a volumetric CT dose index of 15.9 ± 5.5 mSv and dose length product of 1042.9 ± 389.4 mGy cm. Average intravenous contrast volume administered was 164.3 ± 12.1 cc. SMA attenuation was 263.6 ± 92.4HU, SMV was 190 ± 50.2HU. Qualitative assessment of SMA and SMV showed good opacification in all patients. 17/154 (11%) patients were diagnosed on CT with mesenteric ischemia; in 6/154 (4%), CTA studies were indeterminate; in 131/154 (85%), CTA confidently ruled out mesenteric ischemia. Alternate diagnoses were made in 38/154 (25%) patients. Using composite clinical outcomes as a reference standard, sensitivity of split-bolus CTA protocol for diagnosis of mesenteric ischemia is 100% (95% CI 79-100%), and specificity is 99% (95% CI 96-100%). CONCLUSIONS Split-bolus CTA has high sensitivity and specificity for diagnosis of acute mesenteric ischemia. KEY POINTS • Split-bolus CTA protocol for mesenteric ischemia has great diagnostic accuracy with lower radiation exposure and fewer images to interpret compared with standard multiphasic CTA.
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Alabousi M, Mellnick VM, Kashef Al-Ghetaa R, Patlas MN. Imaging of blunt bowel and mesenteric injuries: Current status. Eur J Radiol 2020; 125:108894. [PMID: 32092685 DOI: 10.1016/j.ejrad.2020.108894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/26/2022]
Abstract
Blunt abdominal trauma often presents a diagnostic challenge. Clinical examination demonstrates low reliability in detecting abdominal injury (16 %) when there is a history of head injury or loss of consciousness. This can prove detrimental, as delays in the diagnosis of traumatic bowel injury of 8 h or less can result in increased morbidity and mortality, as well as prolonged hospitalization. Although hemodynamically unstable patients will require an urgent laparotomy following clinical assessment, MDCT is the modality of choice for comprehensive imaging of blunt abdominal trauma in hemodynamically stable patients. Despite the use of MDCT, blunt injury to the bowel and mesentery, which accounts for up to 5% of injuries in cases of trauma, may be difficult to detect. The use of a constellation of direct and indirect signs on MDCT can help make the diagnosis and guide clinical management. Direct signs on MDCT, such as bowel wall discontinuity, and extraluminal gas may assist in the diagnosis of traumatic bowel injury. However, these signs are not sensitive. Therefore, the astute radiologist may have to rely on indirect signs of injury, such as free fluid, bowel wall thickening, and abnormal bowel wall enhancement to make the diagnosis. This review will focus on MDCT imaging findings of bowel and mesenteric injuries secondary to blunt abdominal trauma.
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Affiliation(s)
- Mostafa Alabousi
- Department of Radiology, McMaster University, Hamilton, ON, Canada.
| | - Vincent M Mellnick
- Abdominal Imaging Section, Mallinckrodt Institute of Radiology, Washington University, St Louis, MO, USA.
| | - Rayeh Kashef Al-Ghetaa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Michael N Patlas
- Department of Radiology, McMaster University, Hamilton, ON, Canada.
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Dalla Pria HR, Torres US, Velloni F, Santiago RA, Zacarias MS, Silva LF, Tamamoto F, Walsh D, von Atzingen AC, Coffey JC, D'Ippolito G. The Mesenteric Organ: New Anatomical Concepts and an Imaging-based Review on Its Diseases. Semin Ultrasound CT MR 2019; 40:515-532. [DOI: 10.1053/j.sult.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Wilkie B, Buckle A, Allan C, Richardson M, Keong B. Acute superior mesenteric vein thrombosis with ischaemic bowel in Klinefelter syndrome. ANZ J Surg 2019; 90:1171-1173. [PMID: 31625218 DOI: 10.1111/ans.15507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Bruce Wilkie
- Department of Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Andrew Buckle
- Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Cancer Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carolyn Allan
- Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia.,Department of Clinical Andrology, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Matthew Richardson
- Department of Medical Imaging, Eastern Health, Melbourne, Victoria, Australia
| | - Benjamin Keong
- Department of Surgery, Eastern Health, Melbourne, Victoria, Australia
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Abstract
Abdominal and pelvic computed tomography (CT) scans can be complex to interpret but sometimes significant abnormalities are relatively easy to recognize. In emergencies it is beneficial if physicians and surgeons can identify significant pathology that may immediately change patient management. Early image interpretation will allow clinicians to alert radiologists to provide prompt urgent reports, facilitate early referral to other specialities or expedite emergency surgery. This article provides non-radiologists with a systematic approach to identifying emergency pathology on abdominal and pelvic CT scans. It reviews the relevant cross-sectional anatomy and discusses the CT appearances of bowel perforation, bowel obstruction, bowel ischaemia (gangrene), bleeding, appendicitis and hydronephrosis using illustrative examples from the authors' clinical practice. Underlying causes for these conditions and the importance of interpreting the radiological appearances in conjunction with the patient's clinical condition and history are discussed. The authors hope that by using the POGBAH acronym and a systematic approach readers will be able to identify emergency pathology on abdominal and pelvic CT which may improve patient care.
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Affiliation(s)
- Oscar Evans
- ST2 Radiology, Department of Medical Imaging and Medical Physics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU
| | - Benjamin Rea
- ST2 Radiology, Department of Medical Imaging and Medical Physics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU
| | - Twana Shareef
- Consultant Gastrointestinal Radiologist, Department of Medical Imaging and Medical Physics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
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Whitworth J, James R, Hopkins J. Diagnostic conundrum: simultaneous gallstone ileus and a gas-filled inguinal hernia in a patient with lower abdominal pain. BMJ Case Rep 2019; 12:12/8/e230422. [PMID: 31473637 DOI: 10.1136/bcr-2019-230422] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Gallstone ileus and small bowel diverticulosis are uncommon pathologies. However, the simultaneous presentation of both in this patient provided a diagnostic puzzle for the surgical and radiological teams at our institution. The imaging also demonstrated several typical features for the pathologies in question. Ultimately the management of the patient was not compromised by the diagnostic dilemma, but the imaging findings represent a useful learning opportunity for all radiologists and general surgeons.
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Affiliation(s)
| | - Richard James
- Radiology, Royal United Hospital Bath NHS Trust, Bath, UK
| | - James Hopkins
- Radiology, Royal United Hospital Bath NHS Trust, Bath, UK
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Abstract
Acute mesenteric ischemia (AMI) is a life-threatening condition that often presents with abdominal pain. Early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI. This article reviews practical etiological classification, pathophysiology of imaging manifestations and common pitfalls in intestinal ischemia.
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Affiliation(s)
| | | | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Affiliation(s)
- Dario Giambelluca
- Section of Radiological Sciences, Bi.N.D, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Giuseppe Cutaia
- Section of Radiological Sciences, Bi.N.D, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Massimo Midiri
- Section of Radiological Sciences, Bi.N.D, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Giuseppe Salvaggio
- Section of Radiological Sciences, Bi.N.D, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
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Guerri S, Danti G, Frezzetti G, Lucarelli E, Pradella S, Miele V. Clostridium difficile colitis: CT findings and differential diagnosis. Radiol Med 2019; 124:1185-1198. [PMID: 31302848 DOI: 10.1007/s11547-019-01066-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 02/23/2019] [Accepted: 07/07/2019] [Indexed: 12/17/2022]
Abstract
Clostridium difficile infection (CDI) is a severe and potentially deadly infectious colitis whose incidence is dramatically increasing in the last decades, with more virulent strains. CDI should be suspected in case of unexplained diarrhea and abdominal pain in patients with a recent history of antibiotic use and healthcare exposures; diagnosis is based on a combination of clinical and laboratory findings with demonstration of C. difficile toxins by stool test. The advantages of contrast-enhanced computed tomography (CECT) are the noninvasiveness and the ability to evaluate both the colonic wall and the adjacent soft tissues. Considerable overlap exists between the CECT findings of CDI and those of colitis of other origins, such as typhlitis, ischemic colitis, graft-versus-host disease, radiation colitis and inflammatory bowel diseases; however, some features may help distinguish between these conditions. This paper provides a comprehensive overview of the imaging features of Clostridium difficile colitis and its mimics, with a view to assist the radiologist in reaching the correct diagnosis.
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Affiliation(s)
- Sara Guerri
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Gianluca Frezzetti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Edvige Lucarelli
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Silvia Pradella
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy.
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy
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Noh SM, Shin JH, Kim HI, Lee SH, Chang K, Song EM, Hwang SW, Yang DH, Ye BD, Myung SJ, Yang SK, Byeon JS. [Clinical Outcomes of Angiography and Transcatheter Arterial Embolization for Acute Gastrointestinal Bleeding: Analyses according to Bleeding Sites and Embolization Types]. Korean J Gastroenterol 2018; 71:219-228. [PMID: 29684971 DOI: 10.4166/kjg.2018.71.4.219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background/Aims The clinical outcomes of angiography and transcatheter arterial embolization (TAE) for acute gastrointestinal bleeding (GIB) have not been completely assessed, especially according to bleeding sites. This study aimed to assess the efficacy of angiography and safety of TAE in acute GIB. Methods This was a retrospective study evaluating the records of 321 patients with acute GIB who underwent angiography with or without TAE. Targeted TAE was conducted in 134 patients, in whom angiography showed bleeding sources. Prophylactic TAE was performed in 29 patients when the bleeding source was not detected but a specific vessel was strongly suspected by other examinations. The rate of technical success, clinical success, and complications were analyzed. Results The detection rate of bleeding source via angiography was 50.8% (163/321), which was not different according to the bleeding sites. The detection rate was higher if the probable bleeding source had already been found by another investigation (59.7% vs. 35.8%, p<0.001). TAE sites were upper GIB in 67, mid GIB in 74, and lower GIB in 22. The technical success rate was 99.3% (133/134), and the clinical success rate was 63.0% (104/163). The prophylactic embolization group showed lower clinical success rate than the targeted embolization group (44.8% vs. 67.9%, p=0.06). The TAE-related complication rate was 12.9% (21/163). Ischemia and/or infarction was more common after TAE for mid and lower GIB than for upper GIB (15.6% vs. 3.0%, p=0.007). Conclusions Angiography with or without TAE was an effective method for acute GIB. Targeted embolization should be performed if possible given that it has a higher clinical success rate.
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Affiliation(s)
- Soo Min Noh
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hoon Shin
- Departments of Internal Medicine and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ha Il Kim
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Ho Lee
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kiju Chang
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Mi Song
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Wook Hwang
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hoon Yang
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Jae Myung
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Kyun Yang
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Sik Byeon
- Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Élthes EE, Cozlea AL, Török Á. Factors Associated With in-Hospital Death in Patients with Acute Mesenteric Artery Ischemia. Journal Of Cardiovascular Emergencies 2018; 4:133-9. [DOI: 10.2478/jce-2018-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
ABSTRACT
Objective: The aim of the study was to assess the factors associated with increased mortality in patients with acute mesenteric ischemia, emphasizing the importance of an early diagnosis and a prompt surgical intervention in order to avoid lesion progression. Materials and method: A retrospective analytical study was conducted on a study population of 50 male and female patients with acute ischemia of the mesenteric arteries, aged between 36-92 years. Demographic and pathological history characteristics were assessed, together with presented symptoms, laboratory and CT findings, as well as surgical outcome and time-related aspects between presentation in the emergency department and time of surgery, as well as the hospitalization period until discharge or death. Results: Muscular defense (OR = 23.05) and shock (OR = 13.24) as symptoms were strongly associated with a poor prognosis, while elevated values of lactate dehydrogenase (p = 0.0440) and creatine kinase (p = 0.0025) were associated with higher death rates. The time elapsed during investigations in the emergency room was significantly higher in patients who deceased (p = 0.0023), similarly to the total time from the onset of symptoms to the beginning of surgery (p = 0.0032). Surgical outcomes showed that patients with segmental ischemia of the small bowel had significantly higher chances of survival (p <0.0001). Conclusion: Increased mortality rates in patients presenting in the emergency department for acute mesenteric ischemia were observed in patients with occlusion of the superior mesenteric artery, with higher levels of CK and LDH, as well as with longer periods of stay in the emergency department for diagnostic procedures until the commencement of the surgical intervention. Therefore, proper investigations in a timely manner followed by a specific and prompt surgical intervention may avoid unfavorable evolution of patients towards death.
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Affiliation(s)
- Mark D. Sugi
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Christine O. Menias
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Meghan G. Lubner
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Vincent M. Mellnick
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Matt H. Kwon
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Douglas S. Katz
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
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Mohammed MF, Elbanna KY, Mohammed AME, Murray N, Azzumea F, Almazied G, Nicolaou S. Practical Applications of Dual-Energy Computed Tomography in the Acute Abdomen. Radiol Clin North Am 2018; 56:549-563. [PMID: 29936947 DOI: 10.1016/j.rcl.2018.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With new developments in workflow automation, as well as technological advances enabling faster imaging with improved image quality and dose profile, dual-energy computed tomography is being used more often in the imaging of the acutely ill and injured patient. Its ability to identify iodine, differentiate it from hematoma or calcification, and improve contrast resolution has proven invaluable in the assessment of organ perfusion, organ injury, and inflammation.
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Affiliation(s)
- Mohammed F Mohammed
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia.
| | - Khaled Y Elbanna
- Department of Medical Imaging, Emergency and Trauma Radiology Division, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Abdelazim M E Mohammed
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Nicolas Murray
- Department of Radiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, British Columbia V5Z1M9, Canada
| | - Fahad Azzumea
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Ghassan Almazied
- Medical Imaging Department, Abdominal Imaging Section, Ministry of the National Guard, Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Road, Ar Rimayah, Riyadh 14611, Saudi Arabia
| | - Savvas Nicolaou
- Department of Radiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, British Columbia V5Z1M9, Canada
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Emara DM, Moghazy KM, Abo Elnagah GM, Mohamed DA. The role of multi detector computed tomography in diagnosis of mesenteric vascular occlusion. The Egyptian Journal of Radiology and Nuclear Medicine 2018. [DOI: 10.1016/j.ejrnm.2017.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Firetto MC, Sala F, Petrini M, Lemos AA, Canini T, Magnone S, Fornoni G, Cortinovis I, Sironi S, Biondetti PR. Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients’ management. Emerg Radiol 2018; 25:461-467. [PMID: 29700647 DOI: 10.1007/s10140-018-1608-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/18/2018] [Indexed: 01/09/2023]
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Torres US, Fortes CD, Salvadori PS, Tiferes DA, D′Ippolito G. Pneumatosis From Esophagus to Rectum: A Comprehensive Review Focusing on Clinico-Radiological Differentiation Between Benign and Life-Threatening Causes. Semin Ultrasound CT MR 2018; 39:167-182. [DOI: 10.1053/j.sult.2017.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
Non-invasive cross-sectional imaging techniques play a crucial role in the assessment of the varied manifestations of vascular disease. Vascular imaging encompasses a wide variety of pathology. Designing vascular imaging protocols can be challenging owing to the non-uniform velocity of blood in the aorta, differences in cardiac output between patients, and the effect of different disease states on blood flow. In this review, we provide the rationale behind—and a practical guide to—designing and implementing straightforward vascular computed tomography (CT) and magnetic resonance imaging (MRI) protocols. Teaching Points • There is a wide range of vascular pathologies requiring bespoke imaging protocols. • Variations in cardiac output and non-uniform blood velocity complicate vascular imaging. • Contrast media dose, injection rate and duration affect arterial enhancement in CTA. • Iterative CT reconstruction can improve image quality and reduce radiation dose. • MRA is of particular value when imaging small arteries and venous studies.
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Nishiwada S, Nakamura S, Tanaka T, Kirihataya Y, Nezu D, Sawa N, Fujita N, Ikegami H, Yoshimura A. Ileo-ileal fistula with severe malnutrition caused by strangulated ileus surgery while preserving ischemic ileum: A case report. Int J Surg Case Rep 2018; 43:4-8. [PMID: 29414503 PMCID: PMC5908384 DOI: 10.1016/j.ijscr.2018.01.008] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 01/13/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Entero-enteric fistulas are rare complications that occur in patients with inflammatory bowel disease and other intestinal diseases. In this report, we present an ileo-ileal fistula accompanied by severe malnutrition caused by strangulated ileus surgery while preserving the ischemic ileum in a very elderly patient. CASE PRESENTATION A 90-year-old woman underwent emergency surgery without bowel resection for strangulated ileus in another hospital. Minor abdominal pain and slight fever persisted after surgery. She lost weight, losing approximately 10 kg within half a year. She gradually became difficult to move due to dyspnea upon exertion and generalized edema and visited at our hospital. Pleural effusions, ascites and severe malnutrition were observed. An elastic hard mass with mild tenderness was palpated in her abdomen. Computed tomography showed a loop-like ileum and ileo-ileal fistula with adjacent fat stranding. We performed a partial small bowel resection. The resected specimen demonstrated an ileo-ileal fistula and circumferential ulceration in the loop-like adhesion. After the operation, the nutrition status was resolved immediately without any medications. DISCUSSION In cases of strangulated ileus, there are no deterministic criteria for evaluating intestinal blood flow. This is the first report of ileo-ileal fistula onset after surgery for strangulated ileus without intestinal resection. Furthermore, this fistula caused severe malnutrition duo to chronic inflammation, ulcer formation, and the blind-loop syndrome. CONCLUSIONS When preserving the intestinal tract in the operation of strangulated ileus, the occurrence of entero-enteric fistulas should be considered. Since malnutrition in the elderly is a serious problem, it should be treated promptly.
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Affiliation(s)
- Satoshi Nishiwada
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino, 638-8551 Nara, Japan.
| | - Shinji Nakamura
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino, 638-8551 Nara, Japan.
| | - Tetsuya Tanaka
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino, 638-8551 Nara, Japan.
| | - Yuki Kirihataya
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino, 638-8551 Nara, Japan; Department of General Internal Medicine, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino, 638-8551 Nara, Japan.
| | - Daiki Nezu
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino, 638-8551 Nara, Japan.
| | - Nobuhiro Sawa
- Department of General Internal Medicine, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino, 638-8551 Nara, Japan.
| | - Naoki Fujita
- Department of General Internal Medicine, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino, 638-8551 Nara, Japan.
| | - Haruka Ikegami
- Department of General Internal Medicine, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino, 638-8551 Nara, Japan.
| | - Atsushi Yoshimura
- Department of Surgery, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino, 638-8551 Nara, Japan.
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Pasquali M, Leonardo S, Morsiani M, Zompatori M. Oesophageal pneumatosis in a case of bowel ischaemia. BJR Case Rep 2017; 3:20170039. [PMID: 30363192 PMCID: PMC6159176 DOI: 10.1259/bjrcr.20170039] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/21/2017] [Accepted: 07/03/2017] [Indexed: 12/18/2022] Open
Abstract
Pneumatosis intestinalis (PI) is a condition in which cystic collections of gas develop within the gastrointestinal wall, forming submucosal or subserosal "bubbles". The radiologic manifestations are often dramatic and most notably are associated with life-threatening bowel ischaemia. PI may occur as a primary type but is usually secondary in nature, attributable to a wide spectrum of causes (benign and fulminant), ranging from immunosuppression to bowel infarction. Herein, we report a case of massive and extensive PI in a patient with small bowel ischaemia, having both benign and serious clinical origins.
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Affiliation(s)
- Milena Pasquali
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Division of Radiology, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Leonardo
- Department of Radiology, Santa Maria della Scaletta Hospital, Imola, Bologna, Italy
| | - Miria Morsiani
- Department of Radiology, Santa Maria della Scaletta Hospital, Imola, Bologna, Italy
| | - Maurizio Zompatori
- Department of Radiology, Cardiothoracic section, Policlinico Sant Orsola-Malpighi, Bologna, Italy
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Kwon JH, Han YH, Lee JK. Conservative Management of Spontaneous Isolated Dissection of the Superior Mesenteric Artery. Gastroenterol Res Pract 2017; 2017:9623039. [PMID: 28791045 DOI: 10.1155/2017/9623039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/08/2017] [Indexed: 02/03/2023] Open
Abstract
Purpose We report the clinical outcomes of patients with spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) who were treated conservatively. Materials and Methods A retrospective review was performed in 14 patients from 2006 to 2016 with SIDSMA. Their clinical features and computed tomographic angiography (CTA) characteristics, treatment methods, and clinical outcomes were analyzed. The mean age was 53.6 (range, 41–73) years, and the mean follow-up duration was 20.6 (range, 1–54) months. Conservative management was the primary treatment if no bowel ischemia or arterial rupture was noted. Results The mean initial abdominal visual analog pain score was 7 (range, 5–9) in seven patients. The mean total duration of abdominal pain was 10.2 days (range, 2–42 days) in 10 patients. The mean percentage stenosis of the dissected SMA at the initial presentation was 78.8% in 14 patients. Complete obstruction of the SMA at the initial presentation was evident in 4 of the 14 patients (28.6%). Conservative management was successful in all 14 patients. None of the 14 patients developed bowel ischemia or an infarction. Abdominal pain did not recur in any patient during follow-up (mean, 20.6 months; range, 1–54 months). Conclusion Conservative management was successful for all SIDSMA patients, even those with severe compression of the true lumen or complete obstruction of the dissected SMA.
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Ali IT, Thomas C, Elbanna KY, Mohammed MF, Berger FH, Khosa F. Gastrointestinal Imaging: Emerging Role of Dual-Energy Computed Tomography. Curr Radiol Rep 2017. [DOI: 10.1007/s40134-017-0227-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Bates DDB, Wasserman M, Malek A, Gorantla V, Anderson SW, Soto JA, LeBedis CA. Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury. Radiographics 2017; 37:613-625. [DOI: 10.1148/rg.2017160092] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- David D. B. Bates
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
| | - Michael Wasserman
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
| | - Anita Malek
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
| | - Varun Gorantla
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
| | - Stephan W. Anderson
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
| | - Jorge A. Soto
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
| | - Christina A. LeBedis
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
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