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Sample records for small bowel mri

  1. MRI of the small bowel: can sufficient bowel distension be achieved with small volumes of oral contrast?

    International Nuclear Information System (INIS)

    Kinner, Sonja; Kuehle, Christiane A.; Ladd, Susanne C.; Barkhausen, Joerg; Herbig, Sebastian; Haag, Sebastian; Lauenstein, Thomas C.

    2008-01-01

    Sufficient luminal distension is mandatory for small bowel imaging. However, patients often are unable to ingest volumes of currently applied oral contrast compounds. The aim of this study was to evaluate if administration of low doses of an oral contrast agent with high-osmolarity leads to sufficient and diagnostic bowel distension. Six healthy volunteers ingested at different occasions 150, 300 and 450 ml of a commercially available oral contrast agent (Banana Smoothie Readi-Cat, E-Z-EM; 194 mOsmol/l). Two-dimensional TrueFISP data sets were acquired in 5-min intervals up to 45 min after contrast ingestion. Small bowel distension was quantified using a visual five-grade ranking (5 very good distension, 1 = collapsed bowel). Results were statistically compared using a Wilcoxon-Rank test. Ingestion of 450 ml and 300 ml resulted in a significantly better distension than 150 ml. The all-over average distension value for 450 ml amounted to 3.4 (300 ml: 3.0, 150 ml: 2.3) and diagnostic bowel distension could be found throughout the small intestine. Even 45 min after ingestion of 450 ml the jejunum and ileum could be reliably analyzed. Small bowel imaging with low doses of contrast leads to diagnostic distension values in healthy subjects when a high-osmolarity substance is applied. These findings may help to further refine small bowel MRI techniques, but need to be confirmed in patients with small bowel disorders. (orig.)

  2. Oral contrast agents for small bowel distension in MRI: influence of the osmolarity for small bowel distention

    International Nuclear Information System (INIS)

    Ajaj, Waleed; Kuehle, Christiane; Nuefer, Michael; Goehde, Susanne C.; Lauenstein, Thomas C.; Goyen, Mathias; Schneemann, Hubert; Ruehm, Stefan G.

    2005-01-01

    To assess the effect of the osmolarity for small bowel distension in MRI, ten volunteers ingested at two separate occasions negative oral contrast agents with different quantity and osmolarity: (1) a water solution combined with 2.0% sorbitol and 0.2% locus bean gum (LBG) with a quantity of 1500 ml and an osmolarity of 148 mOsmol/l, (2) a water solution combined with 2.0% sorbitol and 2.0% barium sulphate with a quantity of 1000 ml and an osmolarity of 194 mOsmol/l. Small bowel distension was quantified on coronal 2D-TrueFISP images by measuring the small bowel diameters. There were no statistically significant differences in mean small bowel diameter between both contrast agents. The mean small bowel distension was 19.2 mm after ingestion of 1500 ml of sorbitol-LBG solution and 19.0 mm after ingestion of 1000-ml sorbitol-barium sulphate solution. Furthermore, all volunteers found the ingestion of 1000-ml solution more pleasant than the 1500-ml solution. The ingestion of 1000 ml of sorbitol-barium sulphate solution led to a sufficient small bowel distension compared to 1500 ml of sorbitol-LBG solution. The side effect rate of both solutions was low. Based on these data, we recommend a quantity of 1000 ml of sorbitol-barium sulphate solution as an alternative for 1500-ml sorbitol-LBG solution for optimal bowel distension. (orig.)

  3. Value of cine MRI for better visualization of the proximal small bowel in normal individuals

    International Nuclear Information System (INIS)

    Torkzad, Michael R.; Blomqvist, Lennart; Vargas, Roberto; Tanaka, Chikako

    2007-01-01

    While enteroclysis seems to be the most efficacious method in achieving bowel distension, enterographic methods have become widespread due to the unpleasantness of enteroclysis and the radiation involved with positioning the catheter. Cine images in MRI can be done without radiation. Our aim is to see if and how cine MR imaging can improve visualization of bowel loops by capturing them while distended. Ten healthy individuals were asked to drink up to 2,000 ml of an oral solution made locally over a 60-min period. Then they underwent MRI using coronal balanced fast field echo (b-FFE) covering small bowel loops. If the initial exam revealed collapsed bowel loops an additional 50 mg of erythromycine was given intravenously with the subject still in the scanner and then cine imaging was performed. The degree of distension of different segments of the small bowel was measured before and after cine imaging and compared. The distension score was significantly higher after addition of the cine images as well, being only significant for depiction of the duodenum and jejunum. Our preliminary study suggests that cine MRI can give better image depiction of the proximal small bowel in healthy volunteers, perhaps circumventing the need for enteroclysis in some cases. There is a need for validation of these results in patients with small bowel disease. (orig.)

  4. Assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction using cine-MRI.

    Science.gov (United States)

    Ohkubo, Hidenori; Kessoku, Takaomi; Fuyuki, Akiko; Iida, Hiroshi; Inamori, Masahiko; Fujii, Tetsuro; Kawamura, Harunobu; Hata, Yasuo; Manabe, Noriaki; Chiba, Toshimi; Kwee, Thomas C; Haruma, Ken; Matsuhashi, Nobuyuki; Nakajima, Atsushi; Takahara, Taro

    2013-07-01

    Chronic intestinal pseudo-obstruction (CIPO) is a rare, serious motility disorder, with life-threatening complications over time. However, lack of an established, non-invasive diagnostic method has caused delays in the diagnosis of this intractable disease. Cine-magnetic resonance imaging (MRI) is an emerging technique, with a potential to evaluate the motility of the entire bowel. We compared small bowel motility in healthy volunteers, patients with irritable bowel syndrome (IBS), and those with CIPO, using cine-MRI, and evaluated the usefulness of cine-MRI as a novel diagnostic method for CIPO. Twelve healthy volunteers, IBS patients, and CIPO patients prospectively underwent cine-MRI at 1.5 T. Luminal diameter, contraction ratio, and contraction cycle were measured and compared between the groups. Cine-MRI provided sufficient dynamic images to assess the motility of the entire small bowel. Luminal diameter (mean±s.d.) in CIPO patients was significantly higher than that in healthy volunteers and IBS patients (43.4±14.1, 11.1±1.5, and 10.9±1.9 mm, respectively), and contraction ratio was significantly lower in CIPO patients than that in healthy volunteers and IBS patients (17.1±11.0%, 73.0±9.3%, and 74.6±9.4%, respectively). No significant differences were observed in the contraction cycle. This study is the first to assess the clinical utility of cine-MRI in CIPO patients. Cine-MRI clearly detected contractility impairments in CIPO patients. Cine-MRI is noninvasive, radiation-free, and can directly evaluate the entire small bowel peristalsis, and can detect the affected loops at a glance; therefore, it might be extremely useful for the diagnosis and follow-up of CIPO patients in clinical practice.

  5. MRI for chronic inflammatory bowel disease

    International Nuclear Information System (INIS)

    Hansmann, H.J.; Hess, T.; Hahmann, M.; Erb, G.; Richter, G.M.; Duex, M.; Elsing, C.

    2001-01-01

    Chronic inflammatory bowel disease is diagnosed and monitored by the combination of colonoscopy and small bowel enteroklysis. Magnetic resonance imaging has become the gold standard for the imaging of perirectal and pelvic fistulas. With the advent of ultrafast MRI small and large bowel imaging has become highly attractive and is being advocated more and more in the diagnostic work up of inflammatory bowel disease. Imaging protocols include fast T 1 -weighted gradient echo and T 2 -weighted TSE sequences and oral or rectal bowel distension. Furthermore, dedicated imaging protocols are based on breath-hold imaging under pharmacological bowel paralysis and gastrointestinal MR contrast agents (Hydro-MRI). High diagnostic accuracy can be achieved in Crohn's disease with special reference to the pattern of disease, depth of inflammation, mesenteric reaction, sinus tract depiction and formation of abscess. In ulcerative colitis, the mucosa-related inflammation causes significantly less bowel wall thickening compared to Crohn's disease. Therefore with MRI, the extent of inflammatory changes is always underestimated compared to colonoscopy. According to our experience in more than 200 patients as well as the results in other centers, Hydro-MRI possesses the potential to replace enteroklysis in the diagnosis of chronic inflammatory bowel disease and most of the follow-up colonoscopies in Crohn's disease. Further technical improvements in 3D imaging will allow interactive postprocessing of the MR data. (orig.) [de

  6. Transabdominal Ultrasonography of the Small Bowel

    Directory of Open Access Journals (Sweden)

    Rudolf Kralik

    2013-01-01

    Full Text Available In the era of double balloon enteroscopy, capsule endoscopy, CT, and MRI enterography is transabdominal ultrasonography (TUS underestimated method for evaluation of small bowel pathology. As often initial imagine method in abdominal complaints, nowadays has TUS much better diagnostic potential than two decades ago. High-resolution ultrasound probes with harmonic imaging significantly improve resolution of bowel wall in real time, with possibility to asses bowel peristalsis. Color flow doppler enables evaluation of intramural bowel vascularisation, pulse wave doppler helps to quantificate flow in coeliac and superior mesenteric arteries. Small intestine contrast ultrasonography with oral contrast fluid, as well as contrast enhanced ultrasonography with intravenous microbubble contrast also improves small bowel imaging. We present a review of small intestine pathology that should be detected during ultrasound examinations, discuss technical requirements, advantages and limitations of TUS, typical ultrasound signs of Crohn's disease, ileus, celiac disease, intussusception, infectious enteritis, tumours, ischemic and haemorrhagic conditions of small bowel. In the hands of experienced investigator, despite some significant limitations(obesity, meteorism, is transabdominal ultrasonography reliable, noninvasive and inexpensive alternative method to computerised tomography (CT and magnetic resonance imaging (MRI in small bowel examination.

  7. Software-assisted small bowel motility analysis using free-breathing MRI: feasibility study.

    Science.gov (United States)

    Bickelhaupt, Sebastian; Froehlich, Johannes M; Cattin, Roger; Raible, Stephan; Bouquet, Hanspeter; Bill, Urs; Patak, Michael A

    2014-01-01

    To validate a software prototype allowing for small bowel motility analysis in free breathing by comparing it to manual measurements. In all, 25 patients (15 male, 10 female; mean age 39 years) were included in this Institutional Review Board-approved, retrospective study. Magnetic resonance imaging (MRI) was performed on a 1.5T system after standardized preparation acquiring motility sequences in free breathing over 69-84 seconds. Small bowel motility was analyzed manually and with the software. Functional parameters, measurement time, and reproducibility were compared using the coefficient of variance and paired Student's t-test. Correlation was analyzed using Pearson's correlation coefficient and linear regression. The 25 segments were analyzed twice both by hand and using the software with automatic breathing correction. All assessed parameters significantly correlated between the methods (P software (3.90%, standard deviation [SD] ± 5.69) than manual examinations (9.77%, SD ± 11.08). The time needed was significantly less (P software (4.52 minutes, SD ± 1.58) compared to manual measurement, lasting 17.48 minutes for manual (SD ± 1.75 minutes). The use of the software proves reliable and faster small bowel motility measurements in free-breathing MRI compared to manual analyses. The new technique allows for analyses of prolonged sequences acquired in free breathing, improving the informative value of the examinations by amplifying the evaluable data. Copyright © 2013 Wiley Periodicals, Inc.

  8. A prospective randomized comparison between two MRI studies of the small bowel in Crohn's disease, the oral contrast method and MR enteroclysis

    International Nuclear Information System (INIS)

    Negaard, Anne; Paulsen, Vemund; Lygren, Idar; Sandvik, Leiv; Berstad, Audun E.; Borthne, Arne; Try, Kirsti; Storaas, Tryggve; Klow, Nils-Einar

    2007-01-01

    The aim was to compare bowel distension and diagnostic properties of magnetic resonance imaging of the small bowel with oral contrast (MRI per OS) with magnetic resonance enteroclysis (MRE). Forty patients with suspected Crohn's disease (CD) were examined with both MRI methods. MRI per OS was performed with a 6% mannitol solution and MRE with nasojejunal intubation and a polyethylenglycol solution. MRI protocol consisted of balanced fast field echo (B-FFE), T2 and T1 sequences with and without gadolinium. Two experienced radiologists individually evaluated bowel distension and pathological findings including wall thickness (BWT), contrast enhancement (BWE), ulcer (BWU), stenosis (BWS) and edema (EDM). The diameter of the small bowel was smaller with MRI per OS than with MRE (difference jejunum: 0.55 cm, p < 0.001; ileum: 0.35 cm, p < 0.001, terminal ileum: 0.09 cm, p = 0.08). However, CD was diagnosed with high diagnostic accuracy (sensitivity, specificity, positive and negative predictive values: MRI per OS 88%, 89%, 89%, 89%; MRE 88%, 84%, 82%, 89%) and inter-observer agreement (MRI per OS k = 0.95; MRE k = 1). In conclusion, bowel distension was inferior in MRI per OS compared to MRE. However, both methods diagnosed CD with a high diagnostic accuracy and reproducibility. (orig.)

  9. Combined small and large bowel MR imaging in patients with Crohn's disease: a feasibility study

    International Nuclear Information System (INIS)

    Narin, Burcu; Ajaj, Waleed; Goehde, Susanne; Lauenstein, Thomas C.; Langhorst, Jost; Gerken, Guido; Akgoez, Haldun; Ruehm, Stefan G.

    2004-01-01

    MRI of the small bowel is a new method for the assessment of inflammatory bowel diseases. However, inflammatory bowel disease can affect both the small and large bowel. Therefore, our goal was to assess the feasibility of displaying the small bowel and colon simultaneously by MR imaging. Eighteen patients with inflammatory bowel disease were studied. For small bowel distension, patients ingested a solution containing mannitol and locust bean gum. Furthermore, the colon was rectally filled with water. MR examinations were performed on a 1.5-T system. Before and after intravenous gadolinium administration, a T1w data set was collected. All patients underwent conventional colonoscopy as a standard of reference. The oral ingestion and the rectal application of water allowed an assessment of the small bowel and colon in all patients. By means of MRI (endoscopy), 19 (13) inflamed bowel segments in the colon and terminal ileum were detected. Furthermore, eight additional inflammatory lesions in the jejunum and proximal ileum that had not been endoscopically accessible were found by MRI. The simultaneous display of the small and large bowel by MRI is feasible. Major advantages of the proposed MR concept are related to its non-invasive character as well as to the potential to visualize parts of the small bowel that cannot be reached by endoscopy. (orig.)

  10. Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension

    Energy Technology Data Exchange (ETDEWEB)

    Ajaj, Waleed; Goehde, Susanne C.; Ruehm, Stefan G.; Debatin, Joerg F.; Lauenstein, Thomas C. [Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, 45122, Essen (Germany); Schneemann, Hubert [Institute of Pharmacy and Pharmaceutical Sciences, University Hospital Essen, Essen (Germany)

    2004-03-01

    The purpose of this study was to compare two osmotic carbohydrate sugar alcohols (mannitol 2.5% and sorbitol 2.5%, 2.0%, and 1.5% watery solutions) in combination with 0.2% locust bean gum (LBG) for small bowel distension for MR imaging. Small bowel distension was quantified on coronal 2D TrueFISP images by measuring the diameters of 16 small bowel loops in each of 12 healthy subjects (age range 31-55 years). Additionally, the grade of small bowel distension was rated qualitatively. Patient acceptance concerning nausea, vomiting, flatulence, and diarrhea was noted for each solution, and all results were compared by a Wilcoxon test or t test, respectively. The ingestion of water combined with LBG and either 2.5% mannitol or 2.0% sorbitol showed the best distension of the small bowel. The lowest side effect rate was observed following ingestion of sorbitol in a concentration of 2.0 and 1.5%. Based on these data, we recommend a combination of LBG and 2% sorbitol use for optimal bowel distension and minimal side effects resulting in enhanced patient acceptance. (orig.)

  11. Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension

    International Nuclear Information System (INIS)

    Ajaj, Waleed; Goehde, Susanne C.; Ruehm, Stefan G.; Debatin, Joerg F.; Lauenstein, Thomas C.; Schneemann, Hubert

    2004-01-01

    The purpose of this study was to compare two osmotic carbohydrate sugar alcohols (mannitol 2.5% and sorbitol 2.5%, 2.0%, and 1.5% watery solutions) in combination with 0.2% locust bean gum (LBG) for small bowel distension for MR imaging. Small bowel distension was quantified on coronal 2D TrueFISP images by measuring the diameters of 16 small bowel loops in each of 12 healthy subjects (age range 31-55 years). Additionally, the grade of small bowel distension was rated qualitatively. Patient acceptance concerning nausea, vomiting, flatulence, and diarrhea was noted for each solution, and all results were compared by a Wilcoxon test or t test, respectively. The ingestion of water combined with LBG and either 2.5% mannitol or 2.0% sorbitol showed the best distension of the small bowel. The lowest side effect rate was observed following ingestion of sorbitol in a concentration of 2.0 and 1.5%. Based on these data, we recommend a combination of LBG and 2% sorbitol use for optimal bowel distension and minimal side effects resulting in enhanced patient acceptance. (orig.)

  12. Modern MRI of the small bowell; Moderne MRT des Duenndarms

    Energy Technology Data Exchange (ETDEWEB)

    Scharitzer, M.; Ba-Ssalamah, A. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Wien (Austria)

    2015-12-15

    The radiological diagnostics of diseases of the small intestine have undergone a great change in the last two decades. Through rapid progress with new treatments and an increasing therapeutic focus on transmural healing, a complete evaluation of the gastrointestinal tract is now crucial. With the introduction of endoscopy, gastrointestinal imaging with a relatively high radiation exposure had only limited applications. The development of cross-sectional imaging allowed a much broader radiological evaluation of abdominal diseases. Due to rapid investigation techniques, excellent soft tissue contrast and the distinct advantage of eliminating exposure to radiation, magnetic resonance imaging (MRI) of the gastrointestinal tract has gained increasing importance. With sufficient filling of the intestinal lumen, simultaneous imaging of all the intestinal wall layers, the perienteric structures and associated abdominal pathologies is now possible. New MR sequences, such as diffusion-weighted sequences, dynamic contrast-enhanced sequences and MR fluoroscopy, enable the detection of morphological changes, with additional characterization of affected bowel loops as well as the assessment of functional pathologies with dynamic information about intestinal motility disturbances. Recent guidelines of European radiological and gastroenterological organizations have confirmed the importance of cross-sectional imaging and particularly of MRI for diagnostics and follow-up in patients with Crohn's disease. Due to the possibility of assessment of all the layers of the intestinal wall and the presence of extramural complications, MRI has a significant impact on further therapeutic treatment in patients with inflammatory bowel disease. Especially in patients with inflammatory bowel disease, MR enterography and MR enteroclysis should be the methods of choice for the evaluation of small bowel pathologies because of radiation issues and the great diagnostic value they provide. A

  13. Prenatal magnetic resonance and ultrasonographic findings in small-bowel obstruction: imaging clues and postnatal outcomes

    International Nuclear Information System (INIS)

    Rubio, Eva I.; Blask, Anna R.; Bulas, Dorothy I.; Badillo, Andrea T.

    2017-01-01

    Prenatal small-bowel obstruction can result from single or multiple atresias, and it can be an isolated abnormality or part of a syndrome. It is sometimes the first manifestation of cystic fibrosis. Accurate prediction of the level of obstruction and length of bowel affected can be difficult, presenting a challenge for counseling families and planning perinatal management. To review the prenatal US and MRI findings of small-bowel obstruction and to assess whether fetal MRI adds information that could improve prenatal counseling and perinatal management. We retrospectively reviewed 12 prenatally diagnosed cases of small-bowel obstruction evaluated by both US and MRI from 2005 to 2015. We analyzed gestational age at evaluation, US and MRI findings, gestational age at delivery and postnatal outcomes. The final diagnoses were jejunal atresia (7), ileal atresia (1), cystic fibrosis (3) and combined jejunal and anal atresia (1). Four of the eight with jejunal atresia were found to have multiple small-bowel atresias. Prenatal perforation was noted in three. We identified a trend of increasing complexity of bowel contents corresponding to progressively distal level of obstruction, as indicated by increasing US echogenicity and high T1 signal on MRI. Seven cases of jejunal atresia and one case of ileal atresia demonstrated small ascending, transverse and descending colon (microcolon) with filling of a normal-diameter rectum. In contrast, all three fetuses with cystic fibrosis and the fetus with jejunal-anal atresia demonstrated microcolon as well as abnormal paucity or absence of rectal meconium. Polyhydramnios was present in nine. Eight were delivered prematurely, of whom seven had polyhydramnios. The fetus with jejunal and anal atresia died in utero. Postnatally, three had short gut syndrome, all resulting from multiple jejunal atresias; these three were among a subset of four fetuses whose bowel diameter measured more than 3 cm. Eight infants had no further

  14. Prenatal magnetic resonance and ultrasonographic findings in small-bowel obstruction: imaging clues and postnatal outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Rubio, Eva I.; Blask, Anna R.; Bulas, Dorothy I. [Children' s National Medical System, Division of Diagnostic Imaging and Radiology, Washington, DC (United States); Badillo, Andrea T. [Children' s National Medical System, Division of General and Thoracic Surgery, Washington, DC (United States)

    2017-04-15

    Prenatal small-bowel obstruction can result from single or multiple atresias, and it can be an isolated abnormality or part of a syndrome. It is sometimes the first manifestation of cystic fibrosis. Accurate prediction of the level of obstruction and length of bowel affected can be difficult, presenting a challenge for counseling families and planning perinatal management. To review the prenatal US and MRI findings of small-bowel obstruction and to assess whether fetal MRI adds information that could improve prenatal counseling and perinatal management. We retrospectively reviewed 12 prenatally diagnosed cases of small-bowel obstruction evaluated by both US and MRI from 2005 to 2015. We analyzed gestational age at evaluation, US and MRI findings, gestational age at delivery and postnatal outcomes. The final diagnoses were jejunal atresia (7), ileal atresia (1), cystic fibrosis (3) and combined jejunal and anal atresia (1). Four of the eight with jejunal atresia were found to have multiple small-bowel atresias. Prenatal perforation was noted in three. We identified a trend of increasing complexity of bowel contents corresponding to progressively distal level of obstruction, as indicated by increasing US echogenicity and high T1 signal on MRI. Seven cases of jejunal atresia and one case of ileal atresia demonstrated small ascending, transverse and descending colon (microcolon) with filling of a normal-diameter rectum. In contrast, all three fetuses with cystic fibrosis and the fetus with jejunal-anal atresia demonstrated microcolon as well as abnormal paucity or absence of rectal meconium. Polyhydramnios was present in nine. Eight were delivered prematurely, of whom seven had polyhydramnios. The fetus with jejunal and anal atresia died in utero. Postnatally, three had short gut syndrome, all resulting from multiple jejunal atresias; these three were among a subset of four fetuses whose bowel diameter measured more than 3 cm. Eight infants had no further

  15. Non-small-bowel abnormalities identified during small bowel capsule endoscopy

    NARCIS (Netherlands)

    Hoedemakers, Reinier; Westerhof, Jessie; Weersma, Rinse K.; Koornstra, Jan J.

    2014-01-01

    AIM: To investigate the incidence of non-small-bowel abnormalities in patients referred for small bowel capsule endoscopy, this single center study was performed. METHODS: Small bowel capsule endoscopy is an accepted technique to investigate obscure gastrointestinal bleeding. This is defined as

  16. Differentiation between active and chronic Crohn's disease using MRI small-bowel motility examinations — Initial experience

    International Nuclear Information System (INIS)

    Bickelhaupt, S.; Froehlich, J.M.; Cattin, R.; Patuto, N.; Tutuian, R.; Wentz, K.U.; Culmann, J.L.; Raible, S.; Bouquet, H.; Bill, U.; Patak, M.A.

    2013-01-01

    Aim: To evaluate the influence of locally active Crohn's disease on systemic small-bowel motility in patients with chronic Crohn's disease compared to healthy individuals. Material and methods: Fifteen healthy individuals (11 men, four women; mean age 37 years) and 20 patients with histopathologically proven active (n = 15; 10 women, 5 men; mean age 45 years) or chronic (n = 5; four women, one man; mean age 48 years) Crohn's disease were included in this institutional review board-approved, retrospective study. Magnetic resonance imaging (MRI; 1.5 T) was performed after standardized preparation. Two-dimensional (2D) cine sequences for motility acquisition were performed in apnoea (27 s). Motility assessment was performed using dedicated software in three randomly chosen areas of the small-bowel outside known Crohn's disease-affected hotspots. The main quantitative characteristics (frequency, amplitude, occlusion rate) were compared using Student's t-test and one-way analysis of variance (ANOVA). Results: Three randomly chosen segments were analysed in each participant. Patients with active Crohn's disease had significantly (p < 0.05) reduced contraction frequencies (active Crohn's disease: 2.86/min; chronic: 4.14/min; healthy: 4.53/min) and luminal occlusion rates (active: 0.43; chronic: 0.70; healthy: 0.73) compared to healthy individuals and patients with chronic Crohn's disease. Contraction amplitudes were significantly reduced during active Crohn's disease (6.71 mm) compared to healthy participants (10.14 mm), but this only reached borderline significance in comparison to chronic Crohn's disease (8.87 mm). Mean bowel lumen diameter was significantly (p = 0.04) higher in patients with active Crohn's disease (16.91 mm) compared to healthy participants (14.79 mm) but not in comparison to patients with chronic Crohn's disease (13.68). Conclusion: The findings of the present study suggest that local inflammatory activity of small-bowel segments in patients with

  17. MRI-guided percutaneous cryoablation of renal tumors: Use of external manual displacement of adjacent bowel loops

    International Nuclear Information System (INIS)

    Tuncali, Kemal; Morrison, Paul R.; Tatli, Servet; Silverman, Stuart G.

    2006-01-01

    Purpose: We sought to investigate retrospectively the safety and effectiveness of using external hand compression to displace adjacent bowel loops during MRI-guided percutaneous cryoablation of renal tumors. Materials and methods: Fourteen patients (six women, eight men; mean age: 72 years) with 15 renal tumors (mean diameter: 2.4 cm; range: 1.4-4.6 cm) adjacent to bowel were treated with MRI-guided percutaneous cryoablation during which bowel was displaced manually. Bowel loop of concern was ascending colon (n 5), descending colon (n = 8), descending colon and small bowel (n = 1), ascending colon and small bowel (n = 1). To analyze effectiveness of the maneuver, mean distance between tumor margin and bowel before and after the maneuver were compared and analyzed using paired Student's t-test. Minimum distance between iceball edge and adjacent bowel with external manual displacement during freezing was also measured. Safety was assessed by analyzing post-procedural MR imaging for adjacent bowel wall thickening and focal fluid collections as well as patients' clinical and imaging follow-up. Results: Mean distance between tumor margin and closest adjacent bowel increased from 0.8 cm (range: 0-2 cm) before external manual compression to 2.6 cm (range: 1.6-4.1 cm) with manual displacement (p < 0.01). Mean minimum distance between iceball edge and closest adjacent bowel during the procedures was 1.6 cm (range: 0.5-3.5 cm). No evidence of bowel injury was encountered. Twelve of 15 tumors had follow-up (mean: 10 months) that showed no tumor recurrence. Conclusion: MRI-guided percutaneous cryoablation of renal tumors adjacent to bowel can be done safely and effectively using external hand compression to displace bowel loops

  18. Software-assisted quantitative analysis of small bowel motility compared to manual measurements

    International Nuclear Information System (INIS)

    Bickelhaupt, S.; Froehlich, J.M.; Cattin, R.; Raible, S.; Bouquet, H.; Bill, U.; Patak, M.A.

    2014-01-01

    Aim: To validate a newly developed software prototype that automatically analyses small bowel motility by comparing it directly with manual measurement. Material and methods: Forty-five patients with clinical indication for small bowel magnetic resonance imaging (MRI) were retrospectively included in this institutional review board-approved study. MRI was performed using a 1.5 T system following a standard MR-enterography protocol. Small bowel motility parameters (contractions-per-minute, luminal diameter, amplitude) were measured three times each in identical segments using the manual and the semiautomatic software-assisted method. The methods were compared for agreement, repeatability, and time needed for each measurement. All parameters were compared between the methods. Results: A total of 91 small-bowel segments were analysed. No significant intra-individual difference (p > 0.05) was found for peristaltic frequencies between the methods (mean: 4.14/min manual; 4.22/min software-assisted). Amplitudes (5.14 mm; 5.57 mm) and mean lumen diameters (17.39 mm; 14.68) differed due to systematic differences in the definition of the bowel wall. Mean duration of single measurement was significantly (p < 0.01) shorter with the software (6.25 min; 1.30 min). The scattering of repeated measurements was significantly (p < 0.05) lower using the software. Conclusion: The software-assisted method accomplished highly reliable, fast and accurate measurement of small bowel motility. Measurement precision and duration differed significantly between the two methods in favour of the software-assisted technique

  19. Target tailoring and proton beam therapy to reduce small bowel dose in cervical cancer radiotherapy. A comparison of benefits

    International Nuclear Information System (INIS)

    Boer, Peter de; Westerveld, Henrike; Smit, Mark; Bel, Arjan; Rasch, Coen R.N.; Stalpers, Lukas J.A.; Schoot, Agustinus J.A.J. van de; Buist, Marrije R.

    2018-01-01

    The aim of the study was to investigate the potential clinical benefit from both target tailoring by excluding the tumour-free proximal part of the uterus during image-guided adaptive radiotherapy (IGART) and improved dose conformity based on intensity-modulated proton therapy (IMPT). The study included planning CTs from 11 previously treated patients with cervical cancer with a >4-cm tumour-free part of the proximal uterus on diagnostic magnetic resonance imaging (MRI). IGART and robustly optimised IMPT plans were generated for both conventional target volumes and for MRI-based target tailoring (where the non-invaded proximal part of the uterus was excluded), yielding four treatment plans per patient. For each plan, the V 15Gy , V 30Gy , V 45Gy and D mean for bladder, sigmoid, rectum and bowel bag were compared, and the normal tissue complication probability (NTCP) for ≥grade 2 acute small bowel toxicity was calculated. Both IMPT and MRI-based target tailoring resulted in significant reductions in V 15Gy , V 30Gy , V 45Gy and D mean for bladder and small bowel. IMPT reduced the NTCP for small bowel toxicity from 25% to 18%; this was further reduced to 9% when combined with MRI-based target tailoring. In four of the 11 patients (36%), NTCP reductions of >10% were estimated by IMPT, and in six of the 11 patients (55%) when combined with MRI-based target tailoring. This >10% NTCP reduction was expected if the V 45Gy for bowel bag was >275 cm 3 and >200 cm 3 , respectively, during standard IGART alone. In patients with cervical cancer, both proton therapy and MRI-based target tailoring lead to a significant reduction in the dose to surrounding organs at risk and small bowel toxicity. (orig.) [de

  20. SU-C-BRA-01: Interactive Auto-Segmentation for Bowel in Online Adaptive MRI-Guided Radiation Therapy by Using a Multi-Region Labeling Algorithm

    International Nuclear Information System (INIS)

    Lu, Y; Chen, I; Kashani, R; Wan, H; Maughan, N; Muccigrosso, D; Parikh, P

    2016-01-01

    Purpose: In MRI-guided online adaptive radiation therapy, re-contouring of bowel is time-consuming and can impact the overall time of patients on table. The study aims to auto-segment bowel on volumetric MR images by using an interactive multi-region labeling algorithm. Methods: 5 Patients with locally advanced pancreatic cancer underwent fractionated radiotherapy (18–25 fractions each, total 118 fractions) on an MRI-guided radiation therapy system with a 0.35 Tesla magnet and three Co-60 sources. At each fraction, a volumetric MR image of the patient was acquired when the patient was in the treatment position. An interactive two-dimensional multi-region labeling technique based on graph cut solver was applied on several typical MRI images to segment the large bowel and small bowel, followed by a shape based contour interpolation for generating entire bowel contours along all image slices. The resulted contours were compared with the physician’s manual contouring by using metrics of Dice coefficient and Hausdorff distance. Results: Image data sets from the first 5 fractions of each patient were selected (total of 25 image data sets) for the segmentation test. The algorithm segmented the large and small bowel effectively and efficiently. All bowel segments were successfully identified, auto-contoured and matched with manual contours. The time cost by the algorithm for each image slice was within 30 seconds. For large bowel, the calculated Dice coefficients and Hausdorff distances (mean±std) were 0.77±0.07 and 13.13±5.01mm, respectively; for small bowel, the corresponding metrics were 0.73±0.08and 14.15±4.72mm, respectively. Conclusion: The preliminary results demonstrated the potential of the proposed algorithm in auto-segmenting large and small bowel on low field MRI images in MRI-guided adaptive radiation therapy. Further work will be focused on improving its segmentation accuracy and lessening human interaction.

  1. SU-C-BRA-01: Interactive Auto-Segmentation for Bowel in Online Adaptive MRI-Guided Radiation Therapy by Using a Multi-Region Labeling Algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Y; Chen, I; Kashani, R; Wan, H; Maughan, N; Muccigrosso, D; Parikh, P [Washington University School of Medicine, Saint Louis, MO (United States)

    2016-06-15

    Purpose: In MRI-guided online adaptive radiation therapy, re-contouring of bowel is time-consuming and can impact the overall time of patients on table. The study aims to auto-segment bowel on volumetric MR images by using an interactive multi-region labeling algorithm. Methods: 5 Patients with locally advanced pancreatic cancer underwent fractionated radiotherapy (18–25 fractions each, total 118 fractions) on an MRI-guided radiation therapy system with a 0.35 Tesla magnet and three Co-60 sources. At each fraction, a volumetric MR image of the patient was acquired when the patient was in the treatment position. An interactive two-dimensional multi-region labeling technique based on graph cut solver was applied on several typical MRI images to segment the large bowel and small bowel, followed by a shape based contour interpolation for generating entire bowel contours along all image slices. The resulted contours were compared with the physician’s manual contouring by using metrics of Dice coefficient and Hausdorff distance. Results: Image data sets from the first 5 fractions of each patient were selected (total of 25 image data sets) for the segmentation test. The algorithm segmented the large and small bowel effectively and efficiently. All bowel segments were successfully identified, auto-contoured and matched with manual contours. The time cost by the algorithm for each image slice was within 30 seconds. For large bowel, the calculated Dice coefficients and Hausdorff distances (mean±std) were 0.77±0.07 and 13.13±5.01mm, respectively; for small bowel, the corresponding metrics were 0.73±0.08and 14.15±4.72mm, respectively. Conclusion: The preliminary results demonstrated the potential of the proposed algorithm in auto-segmenting large and small bowel on low field MRI images in MRI-guided adaptive radiation therapy. Further work will be focused on improving its segmentation accuracy and lessening human interaction.

  2. Small Bowel Bleeding

    Science.gov (United States)

    ... pouchings in the wall of the colon), or cancer. Upper GI (esophagus, stomach, or duodenum) bleeding is most often due ... begins transmitting images of the inside of the esophagus, stomach, and small bowel to a ... Bowel Disease Irritable Bowel Syndrome ...

  3. Minimization of small bowel volume within treatment fields using customized small bowel displacement system (SBDS)

    International Nuclear Information System (INIS)

    Lim, D. H.; Huh, S. J.; Ahn, Y. C.; Kim, D. Y.; Wu, H. G.; Kim, M. K.; Choi, D. R.; Shin, K. H.

    1997-01-01

    Authors designed a customized Small Bowel Displacement System(SBDS) to displace the small bowel from the pelvic radiation fields and minimize treatment-related bowel morbidities. From August 1995 to May 1996, 55 consecutive patients who received pelvic radiation therapy with the SBDS were included in this study. The SBDS consists of a customized styrofoam compression device which can displace the small bowel from the radiation fields and an individualized immobilization abdominal board for easy daily setup in prone position. After opacifying the small bowel with Barium, the patients were laid prone and posterior-anterior (PA) and lateral (LAT) simulation films were taken with and without the SBDS. The areas of the small bowel included in the radiation fields with and without the SBDS were compared. Using the SBDS, the mean small bowel area was reduced by 59% on PA and 51% on LAT films (P=0.0001). In six patients (6/55, 11%), it was possible that no small bowel was included within the treatment fields. The mean upward displacement of the most caudal small bowel was 4.8 cm using the SBDS. Only 15% (8/55) of patients treated with the SBDS manifested diarrhea requiring medication. The SBDS is a novel method that can be used to displace the small bowel away from the treatment portal effectively and reduce the radiation therapy morbidities. Compliance with setup is excellent when the SBDS is used. (author)

  4. The value of MR enteroclysis with air infusion in the diagnosis of small bowel disease

    International Nuclear Information System (INIS)

    Zhang Shizheng; Ren Xiaojun; Zhang Qiaowei

    2004-01-01

    Objective: To investigate the value of MR enteroclysis with air infusion in the diagnosis of small bowel disease. Methods: Sixteen patients with suspected small bowel disease, but without acute inflammatory disease or bowel obstruction, received MR enteroclysis with air infusion. There were 12 males and 4 females, and their age ranged from 17 to 75 years. 10 patients had abdominal pain, 4 with melena or blood stool, and 2 with diarrhea. The longest course was 7 years, and the shortest 1 week. Before MR imaging, a nasoenteric catheter was inserted into the distal part of duodenum, and about 1000 ml of air was infused through the tube to distend the small bowel. 20 mg of IV anisodamine was given to reduce small-bowel peristalsis. All patients were imaged with fat-saturated Gd-DTPA enhanced coronal and axial T 1 -weighted spin-echo (SE) sequence and fast spoiled gradient echo (FSPGR) sequence. Comparison between the diagnosis of MRI and the results of surgery, pathology or clinic was performed to assess the sensitivity and specificity of MRI. Results: 5 cases were normal, 6 with Crohn disease, 2 with gastric intestinal stromal tumor (GIST), and 1 each of lymphoma, tuberculosis and irritable bowel syndrome. The lumen of normal small bowel in MR enteroclysis was no signal, the wall was outlined as middle signal by intraluminal air and surrounding air-distended bowel and was between 1-3 mm thick, and the diameter of the lumen was between 17-28 mm. Crohn disease showed segmental mural thickening, increased enhancement, luminal stricture, and even extraluminal inflammatory mass or fistula. Intestinal tuberculosis invaded the distal section of ileum, cecum, and the proximal ascending colon, the wall thickened and enhanced apparently, and cecum and proximal ascending colon shortened. GIST showed a mass that was iso-signal on T 1 WI, high signal on T 2 WI, and enhanced significantly after IV Gd-DTPA. 1 recurrent lymphoma of ileum showed mural thickening and increased

  5. Adenocarcinoma of the small bowel

    International Nuclear Information System (INIS)

    Savli, M.; Jamar, B.

    2007-01-01

    Adenocarcinoma of small bowel is generally a rather rare primary tumour of small bowel with a prevalence rate of 0.5 - 3.0 / 100.000 population, but the most frequent tumour of small intestine. It more often involves the duodenum and jejunum than the ileum. The aim of this paper is also to point out the value of small bowel follow through (SBFT) in the diagnosis of stenosing lesions. An 83 - year old male patient suffered from abdominal pain, malaise, vomiting, cachexia and diarrhoea for 3 months. The result of occult blood testing was negative. Haemoglobin level was normal. Proctoscopy, colonoscopy, upper gastrointestinal (GI) endoscopy, and ultrasonography (US) did not explain the patient's problems. Ileus of the small bowel was established with abdominal plain film. Small bowel follow through (SBFT) and computer tomography (CT) showed a stenosing tumour in the jejunum. Adenocarcinoma of the small bowel was established with histological examination after resection of the tumor. SBFT, with manual compression of all segments of the small bowel, can be a very accurate diagnostic investigation for evaluation of stenosing lesions in this part of the intestine. (author)

  6. Adenocarcinoma of the small bowel

    Energy Technology Data Exchange (ETDEWEB)

    Savli, M; Jamar, B [Inst. of Clinical Radiology, Univ. Medical Centre, Ljubljana (Slovenia)

    2007-06-15

    Adenocarcinoma of small bowel is generally a rather rare primary tumour of small bowel with a prevalence rate of 0.5 - 3.0 / 100.000 population, but the most frequent tumour of small intestine. It more often involves the duodenum and jejunum than the ileum. The aim of this paper is also to point out the value of small bowel follow through (SBFT) in the diagnosis of stenosing lesions. An 83 - year old male patient suffered from abdominal pain, malaise, vomiting, cachexia and diarrhoea for 3 months. The result of occult blood testing was negative. Haemoglobin level was normal. Proctoscopy, colonoscopy, upper gastrointestinal (GI) endoscopy, and ultrasonography (US) did not explain the patient's problems. Ileus of the small bowel was established with abdominal plain film. Small bowel follow through (SBFT) and computer tomography (CT) showed a stenosing tumour in the jejunum. Adenocarcinoma of the small bowel was established with histological examination after resection of the tumor. SBFT, with manual compression of all segments of the small bowel, can be a very accurate diagnostic investigation for evaluation of stenosing lesions in this part of the intestine. (author)

  7. Effects of a 5-HT(3) antagonist, ondansetron, on fasting and postprandial small bowel water content assessed by magnetic resonance imaging.

    Science.gov (United States)

    Marciani, L; Wright, J; Foley, S; Hoad, C L; Totman, J J; Bush, D; Hartley, C; Armstrong, A; Manby, P; Blackshaw, E; Perkins, A C; Gowland, P A; Spiller, R C

    2010-09-01

    5-HT(3) antagonists have been shown to be effective in relieving the symptoms of irritable bowel syndrome with diarrhoea (IBS-D). Using a recently validated magnetic resonance imaging (MRI) method, we have demonstrated reduced fasting small bowel water content (SBWC) in IBS-D associated with accelerated small bowel transit. We hypothesized that slowing of transit with ondansetron would lead to an increase in SBWC by inhibiting fasting motility. To assess the effects of ondansetron compared with placebo in healthy volunteers on SBWC and motility in two different groups of subjects, one studied using MRI and another using manometry. Healthy volunteers were given either a placebo or ondansetron on the day prior to and on the study day. Sixteen volunteers underwent baseline fasting and postprandial MRI scans for 270 min. In a second study, a separate group of n = 18 volunteers were intubated and overnight migrating motor complex (MMC) recorded. Baseline MRI scans were carried out after the tube was removed. Fasting SBWC was markedly increased by ondansetron (P fasting SBWC (P fasting small bowel water. This was associated with reduced fasting antroduodenal Motility Index which may explain the clinical benefit of such drugs. 2010 Blackwell Publishing Ltd.

  8. Primary malignant small bowel tumor

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Kyung Seung; Suh, Ho Jong; Kim, So Sun; Kim, Ho Joon; Chun, Byung Hee; Joh, Young Duk [Kosin College, Pusan (Korea, Republic of)

    1990-07-15

    Small bowel tumors are rarely detected unless there is intestinal obstruction or bleeding. In the seven years 1982-1988, at Kosin Medical Center, 25 primary malignant small bowel tumors were studied radiographically with barium and / or computed tomography (CT). CT revealed gastrointestinal abnormalities in 20 patients. In ten, lesion were identified by upper G-I series, in 15 by small bowel series, and in addition, in 3 by colon enema. The most common malignant small bowel tumor was adenocarcinoma (N=15) and was next common lymphoma (N=7). On barium study, primary adenocarcinoma appeared as an irregular stricture (66.7%) and polypoid mass with intussusception was most prominent finding in lymphoma. Leiomyosarcoma appeared as an exophytic mass with excavation or ulceration. CT was found to be accurate in detecting wall thickening, complications and other associated findings. In conclusion, barium study was useful in the diagnosis of primary malignant small bowel tumor and CT was more accurate in detecting secondary findings.

  9. Primary malignant small bowel tumor

    International Nuclear Information System (INIS)

    Oh, Kyung Seung; Suh, Ho Jong; Kim, So Sun; Kim, Ho Joon; Chun, Byung Hee; Joh, Young Duk

    1990-01-01

    Small bowel tumors are rarely detected unless there is intestinal obstruction or bleeding. In the seven years 1982-1988, at Kosin Medical Center, 25 primary malignant small bowel tumors were studied radiographically with barium and / or computed tomography (CT). CT revealed gastrointestinal abnormalities in 20 patients. In ten, lesion were identified by upper G-I series, in 15 by small bowel series, and in addition, in 3 by colon enema. The most common malignant small bowel tumor was adenocarcinoma (N=15) and was next common lymphoma (N=7). On barium study, primary adenocarcinoma appeared as an irregular stricture (66.7%) and polypoid mass with intussusception was most prominent finding in lymphoma. Leiomyosarcoma appeared as an exophytic mass with excavation or ulceration. CT was found to be accurate in detecting wall thickening, complications and other associated findings. In conclusion, barium study was useful in the diagnosis of primary malignant small bowel tumor and CT was more accurate in detecting secondary findings

  10. Clinical importance of cine-MRI assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction: a retrospective study of 33 patients.

    Science.gov (United States)

    Fuyuki, Akiko; Ohkubo, Hidenori; Higurashi, Takuma; Iida, Hiroshi; Inoh, Yumi; Inamori, Masahiko; Nakajima, Atsushi

    2017-05-01

    Although chronic intestinal pseudo-obstruction (CIPO) is a rare and extremely severe functional digestive disorder, its clinical course and severity show various patterns. We assessed small bowel peristalsis in CIPO patients using cine-MRI (video-motion MRI) and their clinical characteristics to evaluate the clinical importance of performing cine-MRI in patients with this intractable disease. The medical records of 131 patients referred to our institution with a suspected diagnosis of CIPO between 2010 and 2015 were retrospectively evaluated. Thirty-three patients (22 female/11 male; age range 16-79 years) who met the criteria for CIPO and underwent cine-MRI were enrolled. Mean luminal diameter (MLD), contraction ratio (CR), and contraction cycle (CC) were determined and compared with these parameters in healthy volunteers. Clinical outcomes in patients with CIPO were also evaluated. The median follow-up time was 25.2 months (range, 1-65 months). Of the 33 patients with CIPO, 23 (70 %) showed apparently disturbed small intestinal peristalsis, whereas 10 (30 %) did not. The percentage of patients requiring intravenous alimentation was significantly higher (p = 0.03), and the mean serum albumin level was significantly lower (p = 0.04), in patients with than without impaired small intestinal peristalsis. Although both cine-MRI and CT findings in the latter ten cases were within the normal range, MLD and CR differed significantly from healthy volunteers. Cine-MRI is useful in predicting severe clinical features in patients with CIPO, and in detecting slightly impaired small contractility that cannot be detected on CT.

  11. Spectrum of imaging findings on MDCT enterography in patients with small bowel tuberculosis

    International Nuclear Information System (INIS)

    Kalra, N.; Agrawal, P.; Mittal, V.; Kochhar, R.; Gupta, V.; Nada, R.; Singh, R.; Khandelwal, N.

    2014-01-01

    Abdominal tuberculosis (TB) is the sixth most common extrapulmonary site of involvement. The sites of involvement in abdominal tuberculosis, in descending order of frequency, are lymph nodes, genitourinary tract, peritoneal cavity, and gastrointestinal tract. The radiological armamentarium for evaluating tuberculosis of the small bowel (SBTB) includes barium studies (small bowel follow-through, SBFT), CT (multidetector CT, CT enterography, and CT enteroclysis), ultrasound (sonoenteroclysis), and magnetic resonance imaging (MRI; enterography and enteroclysis). In this review, we illustrate the abnormalities at MDCT enterography in 20 consecutive patients with SB TB and also describe extraluminal findings in these patients. MDCT enterography allows non-invasive good-quality assessment of well-distended bowel loops and the adjacent soft tissues. It displays the thickness and enhancement of the entire bowel wall in all three planes and allows examination of all bowel loops, especially the ileal loops, which are mostly superimposed. The terminal ileum and ileocaecal junction are the most common sites of small bowel involvement in intestinal TB. The most common abnormality is short-segment strictures with symmetrical concentric mural thickening and homogeneous mural enhancement. Other findings include lymphadenopathy, ascites, enteroliths, peritoneal thickening, and enhancement. In conclusion, MDCT enterography is a comprehensive technique for the evaluation of SB TB

  12. Advanced imaging techniques for small bowel Crohn's disease: what does the future hold?

    Science.gov (United States)

    Pita, Inês; Magro, Fernando

    2018-01-01

    Treatment of Crohn's disease (CD) is intrinsically reliant on imaging techniques, due to the preponderance of small bowel disease and its transmural pattern of inflammation. Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are the most widely employed imaging methods and have excellent diagnostic accuracy in most instances. Some limitations persist, perhaps the most clinically relevant being the distinction between inflammatory and fibrotic strictures. In this regard, several methodologies have recently been tested in animal models and human patients, namely US strain elastography, shear wave elastography, contrast-enhanced US, magnetization transfer MRI and contrast dynamics in standard MRI. Technical advances in each of the imaging methods may expand their indications. The addition of oral contrast to abdominal US appears to substantially improve its diagnostic capabilities compared to standard US. Ionizing dose-reduction methods in CT can decrease concern about cumulative radiation exposure in CD patients and diffusion-weighted MRI may reduce the need for gadolinium contrast. Clinical indexes of disease activity and severity are also increasingly relying on imaging scores, such as the recently developed Lémann Index. In this review we summarize some of the recent advances in small bowel CD imaging and how they might affect clinical practice in the near future.

  13. Small bowel volvulus in children

    International Nuclear Information System (INIS)

    Siegel, M.J.; Shackelford, G.D.; McAlister, W.H.

    1980-01-01

    Two children with small bowel volvulus diagnosed on barium enema examination are reported. In one patient the volvulus was associated with malrotation and in the other patient there was a post-operative peritoneal adhesion. In both cases the diagnosis was based on beaking of the head of the barium column at the site of volvulus. Radiographic demonstration of a beak sign in the small bowel on barium enema examination should suggest a diagnosis of small bowel volvulus, and indicates the need for immediate surgery. (orig.) [de

  14. Diagnostic accuracy of three different MRI protocols in patients with inflammatory bowel disease

    International Nuclear Information System (INIS)

    Jesuratnam-Nielsen, Kayalvily; Løgager, Vibeke Berg; Munkholm, Pia; Thomsen, Henrik S

    2015-01-01

    Magnetic resonance imaging (MRI) is used for workup and control of inflammatory bowel disease (IBD); however, disagreement remains as to how the MRI should be performed. To compare prospectively the diagnostic accuracy of MRI with neither oral nor intravenous contrast medium (plain MRI), magnetic resonance follow-through (MRFT) and MR enteroclysis (MRE) using MRE as the reference standard in patients with inflammatory bowel disease. Plain MRI and MRE were carried out in addition to MRFT. All patients underwent both plain MR and MRFT on the same day and MRE within seven days. For the evaluation, the bowel was divided into nine segments. One radiologist, blinded to clinical findings, evaluated bowel wall thickness, diffusion weighted imaging (DWI), mural hyperenhancement, and other inflammatory changes in each bowel segment. Twenty patients (6 men, 14 women; median age, 43.5 years; age range, 26–76 years) underwent all three examinations; 10 with Crohn’s disease (CD), three with ulcerative colitis (UC), and seven with IBD unclassified (IBD-U). Sensitivity, specificity, and accuracy were in the range of 0–75%, 81–96%, and 75–95% for wall thickening, and 0–37%, 59–89%, and 50–86% for DWI in plain MRI, respectively. Sensitivity, specificity, and accuracy were in the range of 0–50%, 96–100%, and 90–100% for wall thickening, 0–50%, 84–97%, and 82–95% for DWI, and 0–71%, 94–100%, and 85–100% for mural hyperenhancement in MRFT, respectively. The use of oral and intravenous contrast agent improves detection of bowel lesions resulting in MRFT remaining the superior choice over plain MRI for diagnostic workup in patients with IBD

  15. Small-bowel permeability in collagenous colitis

    DEFF Research Database (Denmark)

    Wildt, Signe; Madsen, Jan L; Rumessen, Jüri J

    2006-01-01

    Collagenous colitis (CC) is a chronic inflammatory bowel disease that affects the colon. However, some patients with CC present with accompanying pathologic small-bowel manifestations such as coeliac disease, defects in bile acid absorption and histopathologic changes in small-intestinal biopsies......, indicating that CC is a pan-intestinal disease. In small-intestinal disease, the intestinal barrier function may be impaired, and the permeability of the small intestine altered. The purpose of this research was to study small-bowel function in patients with CC as expressed by intestinal permeability....

  16. Contrast enema depiction of small-bowel volvulus in complicated neonatal bowel obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Navarro, Oscar M.; Daneman, Alan; Miller, Stephen F. [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

    2004-12-01

    About one-half of patients with meconium ileus (MI) present with a complication such as volvulus, atresia, meconium peritonitis or giant cystic meconium peritonitis. The treatment of these complications requires surgery. However, the preoperative diagnosis of complicated MI is difficult. We describe two neonates with complicated small-bowel obstruction, one with MI related to cystic fibrosis and the other not related to cystic fibrosis. In both, contrast enema depicted a spiral appearance of the distal small bowel, which at surgery proved to be the result of volvulus associated with antenatal bowel perforation. This appearance of the small bowel on contrast enema in this clinical setting has not been previously described. The recognition of this spiral appearance of the distal small bowel suggests the need for surgery. (orig.)

  17. Contrast enema depiction of small-bowel volvulus in complicated neonatal bowel obstruction

    International Nuclear Information System (INIS)

    Navarro, Oscar M.; Daneman, Alan; Miller, Stephen F.

    2004-01-01

    About one-half of patients with meconium ileus (MI) present with a complication such as volvulus, atresia, meconium peritonitis or giant cystic meconium peritonitis. The treatment of these complications requires surgery. However, the preoperative diagnosis of complicated MI is difficult. We describe two neonates with complicated small-bowel obstruction, one with MI related to cystic fibrosis and the other not related to cystic fibrosis. In both, contrast enema depicted a spiral appearance of the distal small bowel, which at surgery proved to be the result of volvulus associated with antenatal bowel perforation. This appearance of the small bowel on contrast enema in this clinical setting has not been previously described. The recognition of this spiral appearance of the distal small bowel suggests the need for surgery. (orig.)

  18. Visualization and quantification of large bowel motility with functional cine-MRI

    International Nuclear Information System (INIS)

    Buhmann, S.; Wielage, C.; Fischer, T.; Reiser, M.; Lienemann, A.; Kirchhoff, C.; Mussack, T.

    2005-01-01

    Purpose: to develop and evaluate a method to visualize and quantify large bowel motility using functional cine MRI. Methods: fifteen healthy individuals (8males, 7 females, 20 to 45 years old) with no history or present symptoms of bowel disorders were enrolled in a functional cine MRI examination at 6 a. m. after a starving phase for at least eight hours before and after oral administration of Senna tea (mild stimulating purgative). Two consecutive sets of repeated measurements of the entire abdomen were performed using a 1.5T MRI system with coronal T2-weighted HASTE sequences anatomically adjusted to the course of the large bowel. A navigator technique was used for respiratory gating at the level of the right dorsal diaphragm. The changes in diameter (given in cm) were measured at 5 different locations of the ascending (AC), transverse (TC) and descending colon (DC), and assessed as parameters for the bowel motility. Results: the mean values as a statistical measure for large bowel relaxation were determined. Before ingestion of Senna tea, the mean diameter measured 3.41 cm (ascending colon), 3 cm (transverse colon) and 2.67 cm (descending colon). After the ingestion of Senna tea, the mean diameter increased to 3.69 cm (ascending colon) to 3.4 cm (transverse colon) and to 2.9 cm (descending colon). A statistically significant difference was demonstrated with the Wilcoxon test (level of confidence 0.05). For the determination of dynamic increase, the changes of the statistical scatter amplitude to the mean value were expressed as percentage before and after the ingestion of Senna tea. Thereby, an increase in variation and dynamic range was detected for the AC (112.9%) and DC (100%), but a decrease in the dynamics for the TC (69%). Conclusion: a non-invasive method for the assessment of bowel motility was developed for the first time. The use of functional cine MRI utilizing a prokinetic stimulus allowed visualisation and quantification of large bowel motility

  19. An immunoglobulin G-4 related sclerosing disease of the small bowel: CT and small bowel series findings

    International Nuclear Information System (INIS)

    Ko, Young Hwan; Hwang, Dae Hyun; Min, Seon Jeong; Woo, Ji Young; Kim, Jeong Won; Hong, Hye Sook; Yang, Ik; Lee, Yul

    2013-01-01

    Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation.

  20. Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Ya-Cheng; Liu, Chang-Hsien; Hsu, Hsian-He; Yu, Chih-Yung [Tri-Service General Hospital, National Defense Medical Center, Department of Radiology, Taipei (China); Wang, Hong-Hau [Tri-Service General Hospital, National Defense Medical Center, Department of Radiology, Taipei (China); Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Department of Radiology, Taipei (China); Fan, Hsiu-Lung [Tri-Service General Hospital, National Defense Medical Center, Division of General Surgery, Department of Surgery, Taipei (China); Chen, Ran-Chou [Taipei City Hospital, Department of Radiology, Taipei (China); National Yang-Ming Univeristy, Department of Biochemical Imaging and Radiological Sciences, Taipei (China); Chang, Wei-Chou [Tri-Service General Hospital, National Defense Medical Center, Department of Radiology, Taipei (China); National Yang-Ming Univeristy, Department of Biochemical Imaging and Radiological Sciences, Taipei (China)

    2015-04-01

    The objective is to use multidetector computed tomography (MDCT) to differentiate phytobezoar impaction and small-bowel faeces in patients with small-bowel obstruction (SBO). We retrospectively reviewed 91 consecutive SBO patients with surgically proven phytobezoars (n = 31) or adhesion with small-bowel faeces (n = 60). Two readers blinded to the diagnosis recorded the following MDCT features: degree of obstruction, transition point, mesenteric fatty stranding, intraperitoneal fluid, air-fluid level, pneumatosis intestinalis, and portal venous gas. MDCT measurements of the food debris length, attenuation, luminal diameter, and wall thickness of the obstructed bowel were also compared. A higher grade of obstruction with an absence of mesenteric fatty stranding and intraperitoneal fluid was more commonly seen in the phytobezoar group than in the small-bowel faeces group (p < 0.01). The food debris length (phytobezoar, 5.7 ± 2.8 cm; small-bowel feces, 20.3 ± 7.9 cm, p < 0.01) and mean attenuation (phytobezoar, -59.6 ± 43.3 Hounsfield units (HU); small-bowel faeces, 8.5 ± 7.7 HU, p <0.01) were significantly different between the two groups. The ROC curve showed that food debris length <9.5 cm and mean attenuation value < -11.75 HU predicted phytobezoar impaction. MDCT features with measurements of the food debris length and mean attenuation assist the differentiation of phytobezoar impaction and small-bowel faeces. (orig.)

  1. Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction

    International Nuclear Information System (INIS)

    Chen, Ya-Cheng; Liu, Chang-Hsien; Hsu, Hsian-He; Yu, Chih-Yung; Wang, Hong-Hau; Fan, Hsiu-Lung; Chen, Ran-Chou; Chang, Wei-Chou

    2015-01-01

    The objective is to use multidetector computed tomography (MDCT) to differentiate phytobezoar impaction and small-bowel faeces in patients with small-bowel obstruction (SBO). We retrospectively reviewed 91 consecutive SBO patients with surgically proven phytobezoars (n = 31) or adhesion with small-bowel faeces (n = 60). Two readers blinded to the diagnosis recorded the following MDCT features: degree of obstruction, transition point, mesenteric fatty stranding, intraperitoneal fluid, air-fluid level, pneumatosis intestinalis, and portal venous gas. MDCT measurements of the food debris length, attenuation, luminal diameter, and wall thickness of the obstructed bowel were also compared. A higher grade of obstruction with an absence of mesenteric fatty stranding and intraperitoneal fluid was more commonly seen in the phytobezoar group than in the small-bowel faeces group (p < 0.01). The food debris length (phytobezoar, 5.7 ± 2.8 cm; small-bowel feces, 20.3 ± 7.9 cm, p < 0.01) and mean attenuation (phytobezoar, -59.6 ± 43.3 Hounsfield units (HU); small-bowel faeces, 8.5 ± 7.7 HU, p <0.01) were significantly different between the two groups. The ROC curve showed that food debris length <9.5 cm and mean attenuation value < -11.75 HU predicted phytobezoar impaction. MDCT features with measurements of the food debris length and mean attenuation assist the differentiation of phytobezoar impaction and small-bowel faeces. (orig.)

  2. Non-enhanced magnetic resonance imaging of the small bowel at 7 Tesla in comparison to 1.5 Tesla: First steps towards clinical application.

    Science.gov (United States)

    Hahnemann, Maria L; Kraff, Oliver; Maderwald, Stefan; Johst, Soeren; Orzada, Stephan; Umutlu, Lale; Ladd, Mark E; Quick, Harald H; Lauenstein, Thomas C

    2016-06-01

    To perform non-enhanced (NE) magnetic resonance imaging (MRI) of the small bowel at 7 Tesla (7T) and to compare it with 1.5 Tesla (1.5T). Twelve healthy subjects were prospectively examined using a 1.5T and 7T MRI system. Coronal and axial true fast imaging with steady-state precession (TrueFISP) imaging and a coronal T2-weighted (T2w) half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequence were acquired. Image analysis was performed by 1) visual evaluation of tissue contrast and detail detectability, 2) measurement and calculation of contrast ratios and 3) assessment of artifacts. NE MRI of the small bowel at 7T was technically feasible. In the vast majority of the cases, tissue contrast and image details were equivalent at both field strengths. At 7T, two cases revealed better detail detectability in the TrueFISP, and better contrast in the HASTE. Susceptibility artifacts and B1 inhomogeneities were significantly increased at 7T. This study provides first insights into NE ultra-high field MRI of the small bowel and may be considered an important step towards high quality T2w abdominal imaging at 7T MRI. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Stricturoplasty—a bowel-sparing option for long segment small bowel Crohn's disease

    OpenAIRE

    Limmer, Alexandra M.; Koh, Hoey C.; Gilmore, Andrew

    2017-01-01

    Abstract Stricturoplasty is a surgical option for management of severe stricturing Crohn's disease of the small bowel. It avoids the need for small bowel resection and the associated metabolic complications. This report contrasts the indications and technical aspects of two different stricturoplasty techniques. Case 1 describes an extensive Michelassi (side-to-side isoperistaltic) stricturoplasty performed for a 100 cm segment of diseased small bowel in a 45-year-old patient. Case 2 describes...

  4. Volvulus of the Small Bowel and Colon

    Science.gov (United States)

    Kapadia, Muneera R.

    2017-01-01

    Volvulus of the intestines may involve either the small bowel or colon. In the pediatric population, small bowel volvulus is more common, while in the adult population, colonic volvulus is more often seen. The two most common types of colonic volvulus include sigmoid and cecal volvulus. Prompt diagnosis and treatment is imperative, otherwise bowel ischemia may ensue. Treatment often involves emergent surgical exploration and bowel resection. PMID:28144211

  5. Stricturoplasty-a bowel-sparing option for long segment small bowel Crohn's disease.

    Science.gov (United States)

    Limmer, Alexandra M; Koh, Hoey C; Gilmore, Andrew

    2017-08-01

    Stricturoplasty is a surgical option for management of severe stricturing Crohn's disease of the small bowel. It avoids the need for small bowel resection and the associated metabolic complications. This report contrasts the indications and technical aspects of two different stricturoplasty techniques. Case 1 describes an extensive Michelassi (side-to-side isoperistaltic) stricturoplasty performed for a 100 cm segment of diseased small bowel in a 45-year-old patient. Case 2 describes the performance of 12 Heineke-Mikulicz stricturoplasties in a 23-year-old patient with multiple short fibrotic strictures.

  6. Transient small-bowel intussusception in children on CT

    International Nuclear Information System (INIS)

    Strouse, Peter J.; DiPietro, Michael A.; Saez, Fermin

    2003-01-01

    To determine the frequency and significance of small-bowel intussusception identified in children on CT. All abdomen CT reports between July 1995 and April 2002 were reviewed to identify patients with small-bowel intussusception. Intussusceptions were identified as an intraluminal mass with a characteristic layered appearance and/or continuity with adjacent mesenteric fat. Ileocolic intussusceptions and intussusceptions related to feeding tubes were excluded. Imaging studies and medical records were reviewed. Twenty-five pediatric patients (16 boys, 9 girls; mean age 11.2 years) were identified with small-bowel intussusception on CT. No patient had a persistent intussusception requiring surgery. Fourteen had limited immediate repeat CT images as part of the same examination, ten of which demonstrated resolution of the CT abnormality. Follow-up CT [n=13 (6 within 24 h)], ultrasound (n=3), small-bowel follow-through (n=4) and surgery (n=3) showed no intussusception. In four patients with persistent symptoms, underlying pathology was identified requiring treatment (giardiasis, 2; small-bowel inflammation/strictures, 1; abscess and partial small-bowel obstruction after perforated appendicitis, 1). In 21 other patients, direct correlation of symptoms to CT abnormality was absent or questionable, no treatment was required, and there was no clinical or imaging evidence of persistence or recurrence. Most small-bowel intussusceptions identified in children by CT are transient and of no clinical significance. (orig.)

  7. Small bowel resection

    Science.gov (United States)

    ... Ileostomy and your diet Ileostomy - caring for your stoma Ileostomy - changing your pouch Ileostomy - discharge Ileostomy - what to ask your doctor Low-fiber diet Preventing falls Small bowel resection - discharge Surgical wound care - open Types of ileostomy Ulcerative colitis - discharge When ...

  8. Identifying decreased peristalsis of abnormal small bowel segments in Crohn's disease using cine MR enterography: the frozen bowel sign.

    Science.gov (United States)

    Guglielmo, Flavius F; Mitchell, Donald G; O'Kane, Patrick L; Deshmukh, Sandeep P; Roth, Christopher G; Burach, Ilene; Burns, Aaron; Dulka, Susan; Parker, Laurence

    2015-06-01

    The purpose of this study was to evaluate whether affected bowel in Crohn's disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images. 5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn's disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn's disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted. For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn's disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn's patients, but not in the overall small bowel between normal-MRE patients and Crohn's disease patients. Abnormal Crohn's small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.

  9. Non-perforating small bowel Crohn's disease assessed by MRI enterography: Derivation and histopathological validation of an MR-based activity index

    International Nuclear Information System (INIS)

    Steward, Michael J.; Punwani, Shonit; Proctor, Ian; Adjei-Gyamfi, Yvette; Chatterjee, Fiona; Bloom, Stuart; Novelli, Marco; Halligan, Steve; Rodriguez-Justo, Manuel

    2012-01-01

    Objectives: To develop and validate a qualitative scoring system for enteric Crohn's disease activity using MR enterography (MRE). Methods: MRE was performed in 16 patients (mean age 33, 8 male) undergoing small bowel resection. Mural thickness, T2 signal, contrast enhancement, and perimural oedema were scored qualitatively (0–3) at 44 locations. Transmural histopathological scoring of acute inflammation (AIS) was performed at all locations (score 0–13). MRI parameters best predicting AIS were derived using multivariate analysis. The MRI activity index was applied to 26 Crohn's patients (mean age 32, range 13–69 years, 15 male) and correlated to terminal ileal biopsy scores of acute inflammation (“eAIS” score 1–6). Receiver operator characteristic curves were calculated. Results: Mural thickness (coefficient 1.34 (95% CI 0.36, 2.32)], p = 0.007) and T2 signal (coefficient 0.90 (95% CI −0.24, 2.04) p = 0.06) best predicted AIS (AIS = 1.79 + 1.34*mural thickness + 0.94*mural T2 score [R-squared 0.52]). There was a significant correlation between the MRI index and eAIS (Kendall's tau = 0.40, 95% CI 0.11–0.64, p = 0.02). The model achieved a sensitivity of 0.81 (95% CI 0.54–0.96), specificity of 0.70 (0.35–0.93) and AUC 0.77 for predicting acute inflammation (eAIS ≥2). Conclusions: A simple qualitative MRI Crohn's disease activity score appears predictive against a histopathological standard of reference

  10. Pathophysiology of the nodular and micronodular small bowel fold

    International Nuclear Information System (INIS)

    Olmstead, W.W.; Ros, P.R.; Moser, R.P.; Shekitka, K.M.; Lichtenstein, J.E.; Buck, J.L.

    1987-01-01

    The normal small bowel fold is easily seen on conventional studies of the small intestine, but visualization of the small bowel villus is just at the resolution of current roentgenographic technique. When the villi are enlarged, they can be seen radiographically as an irregularity or micronodularity of the small bowel fold. The anatomy of the fold and the pathophysiology of diseases producing fold nodularity (tumor, inflammatory disease, NLH, mastocytosis) and micronodularity (lymphangiectasia, Waldenstrom macroglobulinemia, Whipple disease) are presented, with an emphasis on radiologic-pathologic correlation. The radiologist should suggest certain diseases or conditions based on the roentgenographic characteristics of the closely analyzed small bowel fold

  11. Small bowel bacterial overgrowth

    Science.gov (United States)

    ... Surgical procedures that create a loop of small intestine where excess bacteria can grow. An example is a Billroth II type of stomach removal ( gastrectomy ). Some cases of irritable bowel syndrome (IBS).

  12. Arteriovenous Malformation Detected by Small Bowel Endoscopy

    Directory of Open Access Journals (Sweden)

    Takaaki Fujii

    2014-10-01

    Full Text Available Gastrointestinal bleeding that originates in the small intestine is often difficult to diagnose. When successful diagnosis reveals a lesion that can be localized preoperatively, the laparoscopic approach is an appropriate and beneficial treatment modality for small bowel resection. A 69-year-old man presented with a 6-month history of gastrointestinal bleeding and symptomatic transfusion-dependent anemia. Upper and lower endoscopy were normal. Double-balloon endoscopy established the source of the bleeding as a 0.5-cm polypoid mass appearing as a submucosal tumor with redness and pulsation in the lower ileum, suggesting a vascular lesion. Laparoscopic small bowel resection was successful in removing the mass in the ileum. Histological evaluation of the mass revealed an arteriovenous malformation. Preoperative small bowel endoscopy can be useful for diagnosing the cause and localization of arteriovenous malformation in the small intestine.

  13. Mesenteric Air Embolism Following Enteroscopic Small Bowel Tattooing Procedure

    Directory of Open Access Journals (Sweden)

    Natalie Chen

    2012-01-01

    Full Text Available Double balloon enteroscopy (DBE is a revolutionary procedure in which the entire small bowel can be visualized endoscopically. DBE has the advantage of both diagnostic and therapeutic capabilities in the setting of small bowel neoplasms and vascular malformations. We present a unique case of a 76-year-old female who underwent small bowel DBE tattoo marking of a distal small bowel tumor complicated by development of severe abdominal pain postprocedure secondary to bowel air embolism into the mesenteric veins. Mesenteric air can be seen after other endoscopic procedures such as biopsy, mucosal clip placement and polypectomy, or following a colonoscopy. Mesenteric air embolism following small bowel tattooing procedure has not been previously reported in the literature. Mesenteric air when present may be attributed to mesenteric ischemia and can subject the patient to unnecessary surgical intervention if misdiagnosed. Thus, this report holds significance for the radiologist as computed tomography (CT findings of mesenteric air embolism must be evaluated in the context of appropriate clinical history before treatment decisions are made.

  14. Small bowel volvulus with jejunal diverticulum: Primary or secondary?

    Science.gov (United States)

    Shen, Xiao-Fei; Guan, Wen-Xian; Cao, Ke; Wang, Hao; Du, Jun-Feng

    2015-09-28

    Small bowel volvulus, which is torsion of the small bowel and its mesentery, is a medical emergency, and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical anomalies, while the secondary type is common clinically and could be caused by numerous factors including postoperative adhesions, intestinal diverticulum, and/or tumors. Here, we report a rare case of a 60-year-old man diagnosed with small bowel volvulus using multidetector computed tomography (MDCT) angiography. Further discovery by laparotomy showed one jejunal diverticulum, longer corresponding mesentery with a narrower insertion, and a lack of mesenteric fat. This case report includes several etiological factors of small bowel volvulus, and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease.

  15. Small Bowel Obstruction Caused by Aloe vera Bezoars: A Case Report.

    Science.gov (United States)

    Hong, In Taik; Cha, Jae Myung; Ki, Hye Jin; Kwak, Min Seob; Yoon, Jin Young; Shin, Hyun Phil; Jeoun, Jung Won; Choi, Sung Il

    2017-05-25

    Small bowel obstruction is a clinical condition commonly caused by postoperative adhesion, volvulus, intussusceptions, and hernia. Small bowel obstruction due to bezoars is clinically uncommon, accounting for approximately 2-4% of all obstructions. Computed tomography (CT) is a useful method in diagnosing the cause of small bowel obstruction. However, small bowel obstruction caused by bezoars may not be detected by an abdominal CT examination. Herein, we report a rare case of small bowel obstruction by Aloe vera bezoars, which were undetected by an abdominal CT. Phytobezoars should be included in the differential diagnosis of small bowel obstruction in patients with predisposing factors, such as excessive consumption of high-fiber food and diabetes.

  16. Small Bowel Follow-Through

    Science.gov (United States)

    ... Small bowel follow-through uses a form of real-time x-ray called fluoroscopy and a barium-based ... Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow ...

  17. Radiographer performed single contrast small bowel enteroclysis

    International Nuclear Information System (INIS)

    Law, Robert L.; Slack, Nicola; Harvey, Richard F.

    2005-01-01

    Aim: To analyse the technical success and reporting sensitivity of radiographer performed small bowel enteroclysis (SBE) undertaken by a specialist radiographer according to a standard technique [Nolan DJ, Cadman PJ. The small bowel enema made easy. Clinical Radiology 1987;38(3):295-301]. Methods: Patients (1413) had 1646 SBE in 10 years from May 1992 to April 2002. The original request card and the separate radiographer and consultant radiologist reports were reviewed. Where the radiology reports were discordant or inconclusive, the clinical notes were also reviewed. Results: Patients (1022) X-ray films were available. Nine hundred and forty-three (93.3%) SBEs had been successfully completed. Radiographer and consultant radiologist reporting had a 99.3% concordance. There was a 98.4% sensitivity for Crohn's disease (181 of 184 cases where Crohn's disease was the clinical final diagnosis). Overall reporting sensitivity was 93.7% although correct 'probably normal and abnormal' reporting bias suggests a sensitivity of 96.9%. Sixty of 943 (6.4%) reports were inconclusive. Of 1022 patients, 68 (6.6%) of small bowel intubations were not achieved, or else consent was withdrawn at the time of the procedure. Conclusion: Specialist radiographers can perform small bowel enteroclysis with a reporting sensitivity equal to that of a consultant radiologist. Radiographers accustomed to providing an SBE service become skilled at passing fine bore feeding tubes into the small bowel and can provide this service also

  18. CT findings of small bowel metastases from primary lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Wook; Ha, Hyun Kwon; Kim, Ah Young; Kim, Gab Choul; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2002-11-01

    To evaluate the CT findings of small bowel metastases from primary lung cancer. Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in patients. CT helps in defining the extent and

  19. CT findings of small bowel metastases from primary lung cancer

    International Nuclear Information System (INIS)

    Kim, Jae Wook; Ha, Hyun Kwon; Kim, Ah Young; Kim, Gab Choul; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu

    2002-01-01

    To evaluate the CT findings of small bowel metastases from primary lung cancer. Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in patients. CT helps in defining the extent and

  20. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.

    Science.gov (United States)

    Gerson, Lauren B; Fidler, Jeff L; Cave, David R; Leighton, Jonathan A

    2015-09-01

    Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended

  1. Dose-volume correlation in radiation-related late small-bowel complication

    International Nuclear Information System (INIS)

    Letschert, J.G.J.; Lebesque, J.V.; Boer, R.W. de; hart, A.A.M.; Barteling, H.

    1990-01-01

    The effects of the volume of irradiated small bowel on late small-bowel tolerance was studied, taking into account the equivalent total dose ant type of pre-irradiation surgical procedure. A method was developed to estimate small-bowel volumes in the high-bowel volumes were measured for three-field and AP-PA pelvic treatments (165 cm 3 and 400 cm 3 , respectively), extended AP-PA treatment of para-aortic and iliac nodes (1000 cm 3 ). In a retrospective study of 111 patientst irradiated after surgery for rectal or recto-sigmoid cancer to a dose of 45-50 Gy in 5 weeks, extended AP-PA pelvic treatment (n = 27) resulted in a high incidence of severe small-bowel complications (37%), whereas for limited (three-field) pelvic treatment (n = 84) the complication rate was 6%. These complication data together with data from the literature on postoperative radiation-related small-bowel complications were analysed using the maximum likelihood method to fit the data to the logistic form of the dose-response relation, taking the volume effect into account by a power law. The analysis indicated that the incidence of radiation-related small-bowel compllications was higher after rectal surgery than after other types of surgery, which might be explained by the development of more adhesions. For both types of surgery a volume exponent of the power-law of 0.26 ± 0.05 was established. This means that if the small-bowel volume is increased by a factor of 2, the total dose has to be reduced by 17% for the same incidence of small-bowel complications. (author). 45 refs.; 6 figs.; 4 tabs

  2. The pathophysiology of the nodular and micronodular small bowel fold

    International Nuclear Information System (INIS)

    Olmsted, W.W.; Ros, P.R.; Moser, R.P.; Shekita, K.M.; Lichtenstein, J.E.

    1986-01-01

    The normal small bowel fold is easily seen on conventional studies of the small intestine, but visualization of the small bowel villus is at the limit of resolution of current roentgenographic technique. When the villi are enlarged, they appear radiographically as an irregularity or micronodularity of the small bowel fold. The anatomy of the fold and the pathophysiology of diseases producing fold nodularity (tumor,inflammatory disease, NLH, mastocytosis) and micronodularity (lymphangiectasia, Waldenstrom macroglobulinemia, Whipple disease) are presented, with an emphasis on radiologic-pathologic correlation. The radiologist should suggest certain diseases or conditions based on the roentgenographic characteristics of the closely analyzed small bowel fold

  3. Pathophysiology of acute small bowel disease with CT correlation

    International Nuclear Information System (INIS)

    Sarwani, N.; Tappouni, R.; Tice, J.

    2011-01-01

    The objective of this article is to review the pathophysiology of acute small bowel diseases, and to correlate the mechanisms of disease with computed tomography (CT) findings. Disease entities will be classified into the following: immune mediated and infectious causes, vascular causes, mechanical causes, trauma, and others. Having an understanding of acute small bowel pathophysiology is a useful teaching tool, and can lead to imaging clues to the most likely diagnosis of acute small bowel disorders.

  4. The research progress of acute small bowel perforation

    Directory of Open Access Journals (Sweden)

    Rudolf Schiessel

    2015-08-01

    Full Text Available This article reviews the various aetiologies of small bowel perforations and their management. In addition to the well-known aetiologies such as trauma, inflammation and circulatory disorders, several new causes of small bowel perforation have been described in recent years. The spectrum reaches from iatrogenic perforations during laparoscopic surgery or enteroscopies to drug-induced perforations with new anticancer agents. The management of small bowel perforations requires a concept consisting of the safe revision of the leaking bowel and the treatment of the peritonitis. Depending on the local situation and the condition of the patient, several treatment options are available. The surgical management of the bowel leak can range from a simple primary closure to a delayed restoration of bowel continuity. When the condition of the bowel or patient is frail, the risk of a failure of a closure or anastomosis is too high, and the exteriorization of the bowel defect as a primary measure is a safe option. The treatment of the peritonitis is also dependent on the condition of the patient and the local situation. Early stages of peritonitis can be treated by a simple peritoneal lavage, either performed by laparoscopy or laparotomy. Severe forms of peritonitis with multi-organ failure and an abdominal compartment syndrome need repeated peritoneal revisions. In such cases, the abdomen can only be closed temporarily. Different technical options are available in order to overcome the difficult care of these patients.

  5. Radiologic examination of the small bowel: 1987

    International Nuclear Information System (INIS)

    Carlson, H.C.; Maglinte, D.D.T.

    1987-01-01

    Effective clinical imaging of the small intestine is accomplished only with methods capable of accurately demonstrating bowel morphology. The two major approaches to barium enema examination of this segment of gut - orally and enteroclysis - will be described and illustrated with short videotape presentations. Pursued vigorously and with interest, both methods can yield excellent results in an efficient manner. Careful execution of the examination rather than use of a particular methodology is probably the most important factor in realizing such results. However, each method has its advantages and disadvantages, and these will be presented and discussed. A cursory small bowel examination has no role in modern medicine. Radiologists assume primary responsibility for the diagnostic evaluation of the small bowel and should strive to refine and advance the accuracy of the examination

  6. Small bowel tissue engineering using small intestinal submucosa as a scaffold.

    Science.gov (United States)

    Chen, M K; Badylak, S F

    2001-08-01

    Small intestinal submucosa (SIS) is an extracellular matrix used in tissue engineering studies to create de novo abdominal wall, urinary bladder, tendons, blood vessels, and dura mater. The purpose of this study is to evaluate the feasibility of using SIS as a scaffold for small bowel regeneration in an in situ xenograft model. Twenty-three dogs had a partial defect created on the small bowel wall which was repaired with a SIS patch. Four dogs underwent small bowel resection with placement of an interposed tube of SIS. The animals were followed 2 weeks to 1 year. Three of the 23 dogs with SIS placed as a patch died shortly after surgery due to leakage from the site. The other 20 dogs survived up to time of elective necropsy with no evidence of intestinal dysfunction. At necropsy, the bowel circumference in the patched area had no stenosis. Histological evaluation showed the presence of a mucosal epithelial layer, varying amount of smooth muscle, sheets of collagen, and a serosal covering. Architecturally, the layers were not well organized in the submucosal region. An abundance of inflammatory cells was present in the early postoperative period but receded with time. All 4 dogs with a tubular segment of SIS interposed had significant problems. One had partial obstruction at 1 month, and 3 died in the early postoperative period due to leakage. This preliminary study suggests that SIS patches can be used for small bowel regeneration. Tubular segmental replacement is not feasible at this time. Copyright 2001 Academic Press.

  7. Small Bowel Transplantation: Current Clinical Status

    Directory of Open Access Journals (Sweden)

    David Sigalet

    1991-01-01

    Full Text Available With recent refinements in immunosuppression techniques, the first successful reports of small bowel transplantation in humans have now been made, increasing interest in bowel transplantation among clinicians and patients alike. This article reviews recent developments in understanding of the functional capabilities and requirements for effective immune suppression in bowel transplantation. Both experimental and clinical experience with transplantation are discussed, as are the areas which appear to offer the most promise for future developments. Finally guidelines for consideration of patient selection for this procedure are reviewed.

  8. Small bowel endoluminal imaging (capsule and enteroscopy).

    Science.gov (United States)

    Murino, Alberto; Despott, Edward J

    2017-04-01

    Over the last 16 years, the disruptive technologies of small bowel capsule endoscopy and device-assisted enteroscopy have revolutionised endoluminal imaging and minimally invasive therapy of the small bowel. Further technological developments continue to expand their indications and use. This brief review highlights the state-of-the-art in this arena and aims to summarise the current and potential future role of these technologies in clinical practice.

  9. Primary small bowel anastomosis in generalised peritonitis

    NARCIS (Netherlands)

    deGraaf, JS; van Goor, Harry; Bleichrodt, RP

    Objective: To find out if primary small bowel anastomosis of the bowel is safe in patients with generalised peritonitis who are treated by planned relaparotomies. Design: Retrospective study. Setting: University hospital, The Netherlands. Subjects. 10 Patients with generalised purulent peritonitis

  10. Small-bowel neoplasms in patients undergoing video capsule endoscopy

    DEFF Research Database (Denmark)

    Rondonotti, E; Pennazio, M; Toth, E

    2008-01-01

    BACKGROUND AND STUDY AIM: Small-bowel tumors account for 1% - 3% of all gastrointestinal neoplasms. Recent studies with video capsule endoscopy (VCE) suggest that the frequency of these tumors may be substantially higher than previously reported. The aim of the study was to evaluate the frequency......, clinical presentation, diagnostic/therapeutic work-up, and endoscopic appearance of small-bowel tumors in a large population of patients undergoing VCE. PATIENTS AND METHODS: Identification by a questionnaire of patients with VCE findings suggesting small-bowel tumors and histological confirmation...... of the neoplasm seen in 29 centers of 10 European Countries. RESULTS: Of 5129 patients undergoing VCE, 124 (2.4%) had small-bowel tumors (112 primary, 12 metastatic). Among these patients, indications for VCE were: obscure gastrointestinal bleeding (108 patients), abdominal pain (9), search for primary neoplasm...

  11. The effect of obesity levels on irradiated small bowel volume in belly board with small bowel displacement device for rectal cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Se Young; Kim, Joo Ho; Park, Hyo Kuk; Cho, Jeong Hee [Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul (Korea, Republic of)

    2013-03-15

    For radiotherapy in rectal cancer patients treated with small bowel displacement device (SBDD) and belly board, We will suggest new indication of using SBDD depending on obesity index by analyzing correlation between obesity and irradiated small bowel volume. In this study, We reviewed 29 rectal cancer patients who received pelvic radiation therapy with belly board and SBDD from January to April in 2012. We only analyzed those patients treated with three-field technique (PA and both LAT) on 45 Gy (1.8 Gy/fx). We measured patients' height, weight, body mass index (BMI), waist-hip ratio (WHR) and divided BMI into two groups.(≥23:BMI=group 1, <23:BMI=group 2) We performed a statistical analysis to evaluate correlation between total volume of bladder (TV{sub bldder}), obesity index and high dose volume of small bowel (small bowel volume irradiated at 90% of prescribed dose, HDV{sub sb}), low dose volume of small bowel (small bowel volume irradiated at 33% of prescribed dose, LDV{sub sb}). The result shows, gender, WHR and status of pre operative or post operative do not greatly affect HDV{sub sb} and LDV{sub sb}. Statistical result shows, there are significant correlation between HDV{sub sb} and BMI (p<0.04), HDV{sub sb} and TV{sub bladder} (p<0.01), LDV{sub sb} and TV{sub bladder} (p<0.01). BMI seems to correlate with HDV{sub sb} but does not with LDV{sub sb} (p>0.05). There are negative correlation between HDV{sub sb} and BMI, TV{sub bladder} and HDV{sub sb}, TV{sub bladder} and LDV{sub sb} . Especially, BMI group1 has more effective and negative correlation with HDV{sub sb} (p=0.027) than in BMI group 2. In the case of BMI group 1, TV{sub bladder} has significant negative correlation with HDV{sub sb} and LDV{sub sb} (p<0.04). In conclusions, we confirmed that Using SBDD with belly board in BMI group 1 could more effectively reduce irradiated small bowel volume in radiation therapy for rectal cancer. Therefore, We suggest using belly board with SBDD in order

  12. The effect of obesity levels on irradiated small bowel volume in belly board with small bowel displacement device for rectal cancer radiotherapy

    International Nuclear Information System (INIS)

    Kim, Se Young; Kim, Joo Ho; Park, Hyo Kuk; Cho, Jeong Hee

    2013-01-01

    For radiotherapy in rectal cancer patients treated with small bowel displacement device (SBDD) and belly board, We will suggest new indication of using SBDD depending on obesity index by analyzing correlation between obesity and irradiated small bowel volume. In this study, We reviewed 29 rectal cancer patients who received pelvic radiation therapy with belly board and SBDD from January to April in 2012. We only analyzed those patients treated with three-field technique (PA and both LAT) on 45 Gy (1.8 Gy/fx). We measured patients' height, weight, body mass index (BMI), waist-hip ratio (WHR) and divided BMI into two groups.(≥23:BMI=group 1, <23:BMI=group 2) We performed a statistical analysis to evaluate correlation between total volume of bladder (TV bldder ), obesity index and high dose volume of small bowel (small bowel volume irradiated at 90% of prescribed dose, HDV sb ), low dose volume of small bowel (small bowel volume irradiated at 33% of prescribed dose, LDV sb ). The result shows, gender, WHR and status of pre operative or post operative do not greatly affect HDV sb and LDV sb . Statistical result shows, there are significant correlation between HDV sb and BMI (p<0.04), HDV sb and TV bladder (p<0.01), LDV sb and TV bladder (p<0.01). BMI seems to correlate with HDV sb but does not with LDV sb (p>0.05). There are negative correlation between HDV sb and BMI, TV bladder and HDV sb , TV bladder and LDV sb . Especially, BMI group1 has more effective and negative correlation with HDV sb (p=0.027) than in BMI group 2. In the case of BMI group 1, TV bladder has significant negative correlation with HDV sb and LDV sb (p<0.04). In conclusions, we confirmed that Using SBDD with belly board in BMI group 1 could more effectively reduce irradiated small bowel volume in radiation therapy for rectal cancer. Therefore, We suggest using belly board with SBDD in order to reduce the small bowel toxicity in rectal radiotherapy, if patients' BMI is above 23

  13. US features of transient small bowel intussusception in pediatric patients

    International Nuclear Information System (INIS)

    Kim, Ji Hye

    2004-01-01

    To describe the sonographic (US) and clinical features of spontaneously reduced small bowel intussusception, and to discuss the management options for small bowel intussusception based on US findings with clinical correlation. During a five years of period, 34 small bowel intussusceptions were diagnosed on US in 32 infants and children. The clinical presentations and imaging findings of the patients were reviewed. The clinical presentations included abdominal pain or irritability (n = 25), vomiting (n 5), diarrhea (n = 3), bloody stool (n = 1), and abdominal distension (n = 1), in combination or alone. US showed multi-layered round masses of small (mean, 1.5 ± 0.3 cm) diameters and with thin (mean, 3.5 ± 1 mm) outer rims along the course of the small bowel. The mean length was 1.8 ± 0.5 cm and peristalsis was seen on the video records. There were no visible lead points. The vascular flow signal appeared on color Doppler images in all 21 patients examined. Spontaneous reduction was confirmed by combinations of US (n = 28), small bowel series (n = 6), CT scan (n = 3), and surgical exploration (n 2). All patients discharged with improved condition. Typical US findings of the transient small bowel intussusception included 1) small size without wall swelling, 2) short segment, 3) preserved wall motion, and 4) absence of the lead point. Conservative management with US monitoring rather than an immediate operation is recommended for those patient with typical transient small bowel intussusceptions. Atypical US findings or clinical deterioration of the patient with persistent intussusception warrant surgical exploration

  14. Surveillance of FAP: a prospective blinded comparison of capsule endoscopy and other GI imaging to detect small bowel polyps

    Directory of Open Access Journals (Sweden)

    Tescher Paul

    2010-04-01

    Full Text Available Abstract Background Familial adenomatous polyposis (FAP is a hereditary disorder characterized by polyposis along the gastrointestinal tract. Information on adenoma status below the duodenum has previously been restricted due to its inaccessibility in vivo. Capsule Endoscopy (CE may provide a useful adjunct in screening for polyposis in the small bowel in FAP patients. This study aims to evaluate the effectiveness of CE in the assessment of patients with FAP, compared to other imaging modalities for the detection of small bowel polyps. Method 20 consecutive patients with previously diagnosed FAP and duodenal polyps, presenting for routine surveillance of polyps at The Royal Melbourne Hospital were recruited. Each fasted patient initially underwent a magnetic resonance image (MRI of the abdomen, and a barium small bowel follow-through study. Capsule Endoscopy was performed four weeks later on the fasted patient. An upper gastrointestinal side-viewing endoscopy was done one (1 to two (2 weeks after this. Endoscopists and investigators were blinded to results of other investigations and patient history. Results Within the stomach, upper gastrointestinal endoscopy found more polyps than other forms of imaging. SBFT and MRI generally performed poorly, identifying fewer polyps than both upper gastrointestinal and capsule endoscopy. CE was the only form of imaging that identified polyps in all segments of the small bowel as well as the only form of imaging able to provide multiple findings outside the stomach/duodenum. Conclusion CE provides important information on possible polyp development distal to the duodenum, which may lead to surgical intervention. The place of CE as an adjunct in surveillance of FAP for a specific subset needs consideration and confirmation in replication studies. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12608000616370

  15. Large Intraluminal Ileal Hematoma Presenting as Small Bowel Obstruction in a Child

    International Nuclear Information System (INIS)

    Lim, Yun Jung; Nam, So Hyun; Kim, Seon Jeong

    2015-01-01

    Intraluminal small bowel hematoma has been rarely reported in children, as a rare cause of small bowel obstruction. We present a case of an intraluminal ileal hematoma presenting as small bowel obstruction in a child. Computed Tomography (CT) indicated a large intraluminal hyperdense lesion in the distal ileum as the cause of small bowel obstruction. Abdominal ultrasonography (US) showed an echogenic mass-like lesion with multiple septa in the distal ileum. Small bowel obstruction due to a complicated cystic mass was provisionally diagnosed. Histopathologic examination of the resected mass suggested a submucosal ileal hematoma. Although intraluminal small bowel hematoma is rare in children, it can present as an intraluminal cystic mass and should be considered as a rare cause of small bowel obstruction. The US and CT findings of submucosal ileal hematoma could be useful for the diagnosis of such cases in the future

  16. Non-perforating small bowel Crohn's disease assessed by MRI enterography: Derivation and histopathological validation of an MR-based activity index

    Energy Technology Data Exchange (ETDEWEB)

    Steward, Michael J., E-mail: mikejsteward@gmail.com [Department of Specialist Imaging, University College Hospital London, 235 Euston Road, London NW1 2BU (United Kingdom); Punwani, Shonit, E-mail: shonit.punwani@uclh.nhs.net [Department of Specialist Imaging, University College Hospital London, 235 Euston Road, London NW1 2BU (United Kingdom); Centre for Medical Imaging, Division of Medicine, University College London, 235 Euston Road, London NW1 2BU (United Kingdom); Proctor, Ian, E-mail: ian.proctor@nhs.net [Department of Histopathology, University College London Hospital, London, 235 Euston Road, London NW1 2BU (United Kingdom); Adjei-Gyamfi, Yvette, E-mail: yvette.adjei-gyamfi@uclh.nhs.net [Department of Specialist Imaging, University College Hospital London, 235 Euston Road, London NW1 2BU (United Kingdom); Chatterjee, Fiona, E-mail: fiona.chaterjee@uclh.nhs.net [Department of Specialist Imaging, University College Hospital London, 235 Euston Road, London NW1 2BU (United Kingdom); Bloom, Stuart, E-mail: stuart.bloom@uclh.nhs.net [Department of Gastroenterology, University College London Hospital, London, 235 Euston Road, London NW1 2BU (United Kingdom); Novelli, Marco, E-mail: marco.novealli@uclh.nhs.net [Department of Histopathology, University College London Hospital, London, 235 Euston Road, London NW1 2BU (United Kingdom); Halligan, Steve, E-mail: S.halligan@ucl.ac.uk [Department of Specialist Imaging, University College Hospital London, 235 Euston Road, London NW1 2BU (United Kingdom); Centre for Medical Imaging, Division of Medicine, University College London, 235 Euston Road, London NW1 2BU (United Kingdom); Rodriguez-Justo, Manuel, E-mail: manuel.rodriguez-justo@uclh.nhs.uk [Department of Histopathology, University College London Hospital, London, 235 Euston Road, London NW1 2BU (United Kingdom); and others

    2012-09-15

    Objectives: To develop and validate a qualitative scoring system for enteric Crohn's disease activity using MR enterography (MRE). Methods: MRE was performed in 16 patients (mean age 33, 8 male) undergoing small bowel resection. Mural thickness, T2 signal, contrast enhancement, and perimural oedema were scored qualitatively (0–3) at 44 locations. Transmural histopathological scoring of acute inflammation (AIS) was performed at all locations (score 0–13). MRI parameters best predicting AIS were derived using multivariate analysis. The MRI activity index was applied to 26 Crohn's patients (mean age 32, range 13–69 years, 15 male) and correlated to terminal ileal biopsy scores of acute inflammation (“eAIS” score 1–6). Receiver operator characteristic curves were calculated. Results: Mural thickness (coefficient 1.34 (95% CI 0.36, 2.32)], p = 0.007) and T2 signal (coefficient 0.90 (95% CI −0.24, 2.04) p = 0.06) best predicted AIS (AIS = 1.79 + 1.34*mural thickness + 0.94*mural T2 score [R-squared 0.52]). There was a significant correlation between the MRI index and eAIS (Kendall's tau = 0.40, 95% CI 0.11–0.64, p = 0.02). The model achieved a sensitivity of 0.81 (95% CI 0.54–0.96), specificity of 0.70 (0.35–0.93) and AUC 0.77 for predicting acute inflammation (eAIS ≥2). Conclusions: A simple qualitative MRI Crohn's disease activity score appears predictive against a histopathological standard of reference.

  17. Analysis of 178 penetrating stomach and small bowel injuries.

    Science.gov (United States)

    Salim, Ali; Teixeira, Pedro G R; Inaba, Kenji; Brown, Carlos; Browder, Timothy; Demetriades, Demetrios

    2008-03-01

    Surgical site infections (SSIs), such as wound infection, fascial dehiscence, and intraabdominal abscess, commonly occur following penetrating abdominal trauma. However, most of the literature involves penetrating colon injuries. There are few reports describing complications following penetrating stomach and small bowel injuries. Based on the hypothesis that SSIs are commonly found following penetrating stomach and small bowel trauma, a prospective observational study was performed at an academic Level I trauma center from March 1, 2004 until August 31, 2006. The subjects were patients who had sustained a penetrating injury to the stomach or small bowel. Patients were followed for the development of an SSI, defined as wound infection, fascial dehiscence, or intraabdominal abscess. A total of 178 patients were admitted with penetrating stomach or small bowel injuries over the 29-month period. There were 121 (68%) gunshot injuries and 57 (32%) stab wounds. Associated intraabdominal injuries occurred in 74% of patients. Overall, SSIs occurred in 20% of cases. Risk factors for SSI included associated duodenal or colon injury, whereas time to operating room, blood loss, and type and duration of antibiotic use were not. When associated colon injuries were excluded, SSIs occurred in 16% of patients with gastric injuries and 13% of those with small bowel injuries. SSIs commonly follow penetrating stomach and small bowel trauma. Risk factors for SSI include associated duodenal or colon injury. Delay to operating room, blood loss, and type and length of antibiotic prophylaxis were not associated with an increased risk of SSI.

  18. Small bowel ultrasound in patients with celiac disease

    Energy Technology Data Exchange (ETDEWEB)

    Bartusek, D. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: dbartusek@fnbrno.cz; Valek, V. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: v.valek@fnbrno.cz; Husty, J. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: jhusty@fnbrno.cz; Uteseny, J. [Department of Pediatric Internal Medicine, Masaryk University hospital Brno (Czech Republic)], E-mail: juteseny@fnbrno.cz

    2007-08-15

    Objective: Celiac disease (CD) is a common, lifelong disease with small bowel malabsorption based on genetically conditioned gluten intolerance. The clinical manifestation could be very heterogeneous. The proof of celiac disease is now based mainly on clinical and laboratory (antibodies and enterobiopsy) signs, which are in some cases problematic and inconvenient. Materials and methods: In our study we have examined 250 patients with suspection or with proven celiac disease and we evaluated specific ultrasound small bowel changes in this group. In the next step, we chose 59 patients with laboratory proved celiac disease and we statistically compared ultrasound, other laboratory and clinical findings in different forms and stages of the disease. Results: Specific small bowel pathologies in patients with celiac disease (like changes of intestinal villi in different parts of small bowel, abnormal peristalsis and mesenterial lymphadenopathy) can be well visualized by ultrasound and in combination with clinical and laboratory signs ultrasound examination could have an important role in screening, determination of diagnosis and monitoring of patients with different forms of celiac disease.

  19. Small bowel ultrasound in patients with celiac disease

    International Nuclear Information System (INIS)

    Bartusek, D.; Valek, V.; Husty, J.; Uteseny, J.

    2007-01-01

    Objective: Celiac disease (CD) is a common, lifelong disease with small bowel malabsorption based on genetically conditioned gluten intolerance. The clinical manifestation could be very heterogeneous. The proof of celiac disease is now based mainly on clinical and laboratory (antibodies and enterobiopsy) signs, which are in some cases problematic and inconvenient. Materials and methods: In our study we have examined 250 patients with suspection or with proven celiac disease and we evaluated specific ultrasound small bowel changes in this group. In the next step, we chose 59 patients with laboratory proved celiac disease and we statistically compared ultrasound, other laboratory and clinical findings in different forms and stages of the disease. Results: Specific small bowel pathologies in patients with celiac disease (like changes of intestinal villi in different parts of small bowel, abnormal peristalsis and mesenterial lymphadenopathy) can be well visualized by ultrasound and in combination with clinical and laboratory signs ultrasound examination could have an important role in screening, determination of diagnosis and monitoring of patients with different forms of celiac disease

  20. Small Bowel Obstruction due to Intestinal Xanthomatosis

    Directory of Open Access Journals (Sweden)

    L. E. Barrera-Herrera

    2015-01-01

    Full Text Available Vast majority of bowel obstruction is due to postoperative adhesions, malignancy, intestinal inflammatory disease, and hernias; however, knowledge of other uncommon causes is critical to establish a prompt treatment and decrease mortality. Xanthomatosis is produced by accumulation of cholesterol-rich foamy macrophages. Intestinal xanthomatosis is an uncommon nonneoplastic lesion that may cause small bowel obstruction and several cases have been reported in the English literature as obstruction in the jejunum. We report a case of small intestinal xanthomatosis occurring in a 51-year-old female who presented with one day of copious vomiting and intermittent abdominal pain. Radiologic images revealed jejunal loop thickening and inflammatory changes suggestive of foreign body obstruction, diagnostic laparoscopy found two strictures at the jejunum, and a pathologic examination confirmed a segmental small bowel xanthomatosis. This case illustrates that obstruction even without predisposing factors such as hyperlipidemia or lymphoproliferative disorders.

  1. Surgical management of irradiation-induced small bowel damage

    Energy Technology Data Exchange (ETDEWEB)

    Smith, S.T.; Seski, J.C.; Copeland, L.J.; Gershenson, D.M.; Edwards, C.L.; Herson, J.

    1985-04-01

    Seventy-seven patients, presenting with radiation small bowel injuries at the University of Texas M. D. Anderson Hospital and Tumor Institute at Houston between 1962 and 1978, were analyzed retrospectively. The patients were divided into two categories: bowel bypass without resection, and resection of irradiated bowel. Each group was then analyzed for its short- and long-term complications. Ileocolectomy with end-to-end anastomosis was the surgical procedure of choice in those people undergoing resection. There was no difference in short-term complications noted between the two groups. The long-term complications of fistula formation and continued small bowel necrosis could be prevented by resection, as a primary procedure. The surgical details of ileocolectomy with end-to-end anastomosis are presented, along with an analysis of the complications encountered in both groups.

  2. Surgical management of irradiation-induced small bowel damage

    International Nuclear Information System (INIS)

    Smith, S.T.; Seski, J.C.; Copeland, L.J.; Gershenson, D.M.; Edwards, C.L.; Herson, J.

    1985-01-01

    Seventy-seven patients, presenting with radiation small bowel injuries at the University of Texas M. D. Anderson Hospital and Tumor Institute at Houston between 1962 and 1978, were analyzed retrospectively. The patients were divided into two categories: bowel bypass without resection, and resection of irradiated bowel. Each group was then analyzed for its short- and long-term complications. Ileocolectomy with end-to-end anastomosis was the surgical procedure of choice in those people undergoing resection. There was no difference in short-term complications noted between the two groups. The long-term complications of fistula formation and continued small bowel necrosis could be prevented by resection, as a primary procedure. The surgical details of ileocolectomy with end-to-end anastomosis are presented, along with an analysis of the complications encountered in both groups

  3. Pediatric bowel MRI - accelerated parallel imaging in a single breathhold

    International Nuclear Information System (INIS)

    Hohl, C.; Honnef, D.; Krombach, G.; Muehlenbruch, G.; Guenther, R.W.; Niendorf, T.; Ocklenburg, C.; Wenzl, T.G.

    2008-01-01

    Purpose: to compare highly accelerated parallel MRI of the bowel with conventional balanced FFE sequences in children with inflammatory bowel disease (IBD). Materials and methods: 20 children with suspected or proven IBD underwent MRI using a 1.5 T scanner after oral administration of 700-1000 ml of a Mannitol solution and an additional enema. The examination started with a 4-channel receiver coil and a conventional balanced FFE sequence in axial (2.5 s/slice) and coronal (4.7 s/slice) planes. Afterwards highly accelerated (R = 5) balanced FFE sequences in axial (0.5 s/slice) and coronal (0.9 s/slice) were performed using a 32-channel receiver coil and parallel imaging (SENSE). Both receiver coils achieved a resolution of 0.88 x 0.88 mm with a slice thickness of 5 mm (coronal) and 6 mm (axial) respectively. Using the conventional imaging technique, 4 - 8 breathholds were needed to cover the whole abdomen, while parallel imaging shortened the acquisition time down to a single breathhold. Two blinded radiologists did a consensus reading of the images regarding pathological findings, image quality, susceptibility to artifacts and bowel distension. The results for both coil systems were compared using the kappa-(κ)-coefficient, differences in the susceptibility to artifacts were checked with the Wilcoxon signed rank test. Statistical significance was assumed for p = 0.05. Results: 13 of the 20 children had inflammatory bowel wall changes at the time of the examination, which could be correctly diagnosed with both coil systems in 12 of 13 cases (92%). The comparison of both coil systems showed a good agreement for pathological findings (κ = 0.74 - 1.0) and the image quality. Using parallel imaging significantly more artifacts could be observed (κ = 0.47)

  4. The first joint ESGAR/ ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging

    International Nuclear Information System (INIS)

    Taylor, S.A.; Torkzad, M.R.; Bhatnagar, G.; Avni, F.; Cronin, C.G.; Hoeffel, C.; Kim, S.H.; Laghi, A.; Napolitano, M.; Petit, P.; Rimola, J.; Tolan, D.J.; Zappa, M.; Puylaert, C.A.J.; Stoker, J.

    2017-01-01

    To develop guidelines describing a standardised approach to patient preparation and acquisition protocols for magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound (US) of the small bowel and colon, with an emphasis on imaging inflammatory bowel disease. An expert consensus committee of 13 members from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and European Society of Paediatric Radiology (ESPR) undertook a six-stage modified Delphi process, including a detailed literature review, to create a series of consensus statements concerning patient preparation, imaging hardware and image acquisition protocols. One hundred and fifty-seven statements were scored for agreement by the panel of which 129 statements (82 %) achieved immediate consensus with a further 19 (12 %) achieving consensus after appropriate modification. Nine (6 %) statements were rejected as consensus could not be reached. These expert consensus recommendations can be used to help guide cross-sectional radiological practice for imaging the small bowel and colon. (orig.)

  5. The first joint ESGAR/ ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, S.A.; Torkzad, M.R.; Bhatnagar, G. [University College London, Centre for Medical Imaging, London (United Kingdom); Avni, F. [Lille University Hospitals, Department of Paediatric Imaging, Jeanne de Flandre Hospital, Lille (France); Cronin, C.G. [Mater Misericordiae University Hospital, Department of Radiology, Dublin (Ireland); Hoeffel, C. [Hopital Robert Debre, Department of Radiology, Reims (France); Kim, S.H. [Inje University College of Medicine, Haeundae Paik Hospital, Department of Radiology, Busan (Korea, Republic of); Laghi, A. [Sapienza University of Rome, I.C.O.T. Hospital, Department of Radiological Sciences, Oncology and Pathology, Latina (Italy); Napolitano, M. [V. Buzzi Children' s Hospital, Department of Radiology and Neuroradiology, Milan (Italy); Petit, P. [Timone Enfant Hospital, Department of Paediatric Radiology, Marseille (France); Rimola, J. [University of Barcelona, Radiology Department, Hospital Clinic Barcelona, Catalonia (Spain); Tolan, D.J. [St James' s University Hospital, Leeds Teaching Hospitals NHS Trust (United Kingdom); Zappa, M. [Hopital Beaujon, AP-HP, Universite Paris 7, INSERM CRI U1149, Department of Radiology, Clichy (France); Puylaert, C.A.J.; Stoker, J. [University of Amsterdam, Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands)

    2017-06-15

    To develop guidelines describing a standardised approach to patient preparation and acquisition protocols for magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound (US) of the small bowel and colon, with an emphasis on imaging inflammatory bowel disease. An expert consensus committee of 13 members from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and European Society of Paediatric Radiology (ESPR) undertook a six-stage modified Delphi process, including a detailed literature review, to create a series of consensus statements concerning patient preparation, imaging hardware and image acquisition protocols. One hundred and fifty-seven statements were scored for agreement by the panel of which 129 statements (82 %) achieved immediate consensus with a further 19 (12 %) achieving consensus after appropriate modification. Nine (6 %) statements were rejected as consensus could not be reached. These expert consensus recommendations can be used to help guide cross-sectional radiological practice for imaging the small bowel and colon. (orig.)

  6. Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma

    Directory of Open Access Journals (Sweden)

    Hiroaki Shiba

    2009-11-01

    Full Text Available Adult intussusception is rare, accounting for only 5% of all intussusceptions, for which preoperative diagnosis is difficult. We herein report a preoperatively diagnosed case of adult intussusception caused by a small bowel lipoma. A 33-year-old man was admitted to our hospital with three weeks history of colicky epigastric pain. Computed tomography revealed thickening of the ileal wall suggestive of intussusception. Colonoscopy revealed an ileocolic intussusception. Barium enema for reduction of ileocolic intussusception demonstrated a small bowel tumor in the ileum 15 cm proximal to the ileocecal valve. The intussusception was reduced, and the patient underwent partial resection of the ileum encompassing the small bowel tumor. Histological findings confirmed the diagnosis of lipoma of the small bowel. The patient made a satisfactory recovery and remains well.

  7. Mucosa-associated Lymphoid Tissue Lymphoma Presenting with Bowel Obstruction of the Duodenum and Small Bowels: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Guen Ho; Hong, Seong Sook; Kim, Jung Hoon; Chang, Yun Woo; Choi, Duek Lin; Hwang, Jung Hwa; Kwon, Kui Hyang [Soonchunhyang University Hospital, Seoul (Korea, Republic of)

    2010-01-15

    The occurrence of primary duodenal mucosa associated lymphoid tissue (MALT) lymphoma is extremely rare, and more so is the obstruction of the duodenum for the MALT lymphoma. We describe the small bowel follow through and CT findings in an uncommon case of MALT lymphoma presenting with bowel obstruction of the 2nd portion of the duodenum and small bowels.

  8. Mucosa-associated Lymphoid Tissue Lymphoma Presenting with Bowel Obstruction of the Duodenum and Small Bowels: A Case Report

    International Nuclear Information System (INIS)

    Ryu, Guen Ho; Hong, Seong Sook; Kim, Jung Hoon; Chang, Yun Woo; Choi, Duek Lin; Hwang, Jung Hwa; Kwon, Kui Hyang

    2010-01-01

    The occurrence of primary duodenal mucosa associated lymphoid tissue (MALT) lymphoma is extremely rare, and more so is the obstruction of the duodenum for the MALT lymphoma. We describe the small bowel follow through and CT findings in an uncommon case of MALT lymphoma presenting with bowel obstruction of the 2nd portion of the duodenum and small bowels

  9. [Premalignant conditions of the small bowel].

    Science.gov (United States)

    Drastich, P

    2013-01-01

    Small intestinal dysplastic lesions are rare and difficult to detect before they progress to cancer. New investigative modalities, such as capsule endoscopy and doubleballoon enteroscopy, are very promising in search for premalignant lesions. Screening patients at high-risk for small bowel neoplasia is the only sensible approach. Duodenal adenoma represents the most easily accessible tumors with the possibility of curative endoscopic resection. Due to the strong association of the small bowel and colonic adenomas, it is always necessary to perform colonoscopy. In young patients, the exclusion of familial polyposis by genetic testing is always mandatory. Patients with celiac disease are especially at risk of developing nonHodgkins lymphomas and adenocarcinomas. There is a high-risk of ampuloma and other adenomas in patients with familial adenomatous polyposis. Patients with prolonged and complicated course of Crohns disease, Peutz Jeghers syndrome and patients with ileoanal pouch have higher risk of adenocarcinoma of the small intestine.

  10. Small Bowel Volvulus Induced by Mesenteric Lymphangioma in an Adult: a Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Jin Hee; Lee, Su Lim; Ku, Young Mi; An, Chang Hyeok; Chang, Eun Deok [Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu (Korea, Republic of)

    2009-06-15

    Mesenteric lymphangiomas are rare abdominal masses that are seldom associated with small bowel volvulus, and especially in adult patients. We report here on an unusual case of small bowel volvulus that was induced by a mesenteric lymphangioma in a 43-year-old man who suffered from repeated bouts of abdominal pain. At multidetector CT, we noticed whirling of the cystic mesenteric mass and the adjacent small bowel around the superior mesenteric artery. Small bowel volvulus induced by the rotation of the mesenteric lymphangioma was found on exploratory laparotomy. Lymphangioma should be considered as a rare cause of small bowel volvulus in adult patients.

  11. Extensive small bowel intramural haematoma secondary to warfarin

    OpenAIRE

    Limmer, Alexandra M.; Clement, Zackariah

    2017-01-01

    Abstract Intramural haematoma is a rare complication of oral anticoagulant therapy, occurring in? 1 in 2500 patients treated with warfarin. This report describes a 71-year-old gentleman who presented with tachycardia, vomiting and abdominal distension on a background of anticoagulation for a metallic aortic valve. He was found to have a supratherapeutic international normalized ratio (INR) of 9.9 with an extensive small bowel intramural haematoma and secondary small bowel obstruction. He was ...

  12. Small bowel obstruction in children: usefulness of CT for diagnosis and localization

    International Nuclear Information System (INIS)

    Lee, Young Cheol; Kim, Young Tong; Bae, Won Kyung; Kim, Il Young

    2007-01-01

    To evaluate the usefulness of CT for the diagnosis of the cause and localization of small bowel obstruction. Out of a group of children who underwent a CT examination for a suspected small bowel obstruction, 19 patients with confirmed underlying disorders were identified and included in the study. Neonates and patients with duodenal obstruction were excluded from the study. The CT findings were analyzed for the location of obstruction site, abnormalities of the mesentery and mesenteric vessels, bowel wall thickening, closed loop obstruction, and strangulation. The obstruction site was divided into five parts. The preoperative CT diagnosis was compared with the final diagnosis. Causes of small bowel obstruction were intussusception (n = 6), appendiceal perforation (n = 4), transmesenteric internal hernia (n = 2), postoperative bands (n = 1), idiopathic multiple bands (n = 1), a foreign body (n = 1), a small bowel adenocarcinoma (n = 1), Meckel's diverticulitis (n = 1), tuberculous peritonitis (n = 1) and Salmonella enteritis with bowel perforation (n = 1). The CT findings showed mesenteric vascular prominence (n = 13), omental or mesenteric infiltration (n = 10), localized bowel wall thickening (n = 7) closed loops obstruction (n = 3) and strangulation (n = 1). The obstruction site was identified in all cases. The causes of obstruction could be diagnosed preoperatively in 14 cases, but a preoperative diagnosis was difficult in 5 cases. The causes of small bowel obstruction in children are variable, and CT is useful for evaluating the cause and localization of small bowel obstruction

  13. Small bowel obstruction in children: usefulness of CT for diagnosis and localization

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Young Cheol; Kim, Young Tong; Bae, Won Kyung; Kim, Il Young [Cheonan Hospital, Soonchunhyang University, Cheonan (Korea, Republic of)

    2007-12-15

    To evaluate the usefulness of CT for the diagnosis of the cause and localization of small bowel obstruction. Out of a group of children who underwent a CT examination for a suspected small bowel obstruction, 19 patients with confirmed underlying disorders were identified and included in the study. Neonates and patients with duodenal obstruction were excluded from the study. The CT findings were analyzed for the location of obstruction site, abnormalities of the mesentery and mesenteric vessels, bowel wall thickening, closed loop obstruction, and strangulation. The obstruction site was divided into five parts. The preoperative CT diagnosis was compared with the final diagnosis. Causes of small bowel obstruction were intussusception (n = 6), appendiceal perforation (n = 4), transmesenteric internal hernia (n = 2), postoperative bands (n = 1), idiopathic multiple bands (n = 1), a foreign body (n = 1), a small bowel adenocarcinoma (n = 1), Meckel's diverticulitis (n = 1), tuberculous peritonitis (n = 1) and Salmonella enteritis with bowel perforation (n = 1). The CT findings showed mesenteric vascular prominence (n = 13), omental or mesenteric infiltration (n = 10), localized bowel wall thickening (n = 7) closed loops obstruction (n = 3) and strangulation (n = 1). The obstruction site was identified in all cases. The causes of obstruction could be diagnosed preoperatively in 14 cases, but a preoperative diagnosis was difficult in 5 cases. The causes of small bowel obstruction in children are variable, and CT is useful for evaluating the cause and localization of small bowel obstruction.

  14. Target tailoring and proton beam therapy to reduce small bowel dose in cervical cancer radiotherapy. A comparison of benefits

    Energy Technology Data Exchange (ETDEWEB)

    Boer, Peter de; Westerveld, Henrike; Smit, Mark; Bel, Arjan; Rasch, Coen R.N.; Stalpers, Lukas J.A. [Academic Medical Center, University of Amsterdam, Department of Radiation Oncology, Amsterdam (Netherlands); Schoot, Agustinus J.A.J. van de [The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Radiation Oncology, Amsterdam (Netherlands); Buist, Marrije R. [Academic Medical Center, University of Amsterdam, Department of Gynaecology and Obstetrics, Amsterdam (Netherlands)

    2018-03-15

    The aim of the study was to investigate the potential clinical benefit from both target tailoring by excluding the tumour-free proximal part of the uterus during image-guided adaptive radiotherapy (IGART) and improved dose conformity based on intensity-modulated proton therapy (IMPT). The study included planning CTs from 11 previously treated patients with cervical cancer with a >4-cm tumour-free part of the proximal uterus on diagnostic magnetic resonance imaging (MRI). IGART and robustly optimised IMPT plans were generated for both conventional target volumes and for MRI-based target tailoring (where the non-invaded proximal part of the uterus was excluded), yielding four treatment plans per patient. For each plan, the V{sub 15Gy}, V{sub 30Gy}, V{sub 45Gy} and D{sub mean} for bladder, sigmoid, rectum and bowel bag were compared, and the normal tissue complication probability (NTCP) for ≥grade 2 acute small bowel toxicity was calculated. Both IMPT and MRI-based target tailoring resulted in significant reductions in V{sub 15Gy}, V{sub 30Gy}, V{sub 45Gy} and D{sub mean} for bladder and small bowel. IMPT reduced the NTCP for small bowel toxicity from 25% to 18%; this was further reduced to 9% when combined with MRI-based target tailoring. In four of the 11 patients (36%), NTCP reductions of >10% were estimated by IMPT, and in six of the 11 patients (55%) when combined with MRI-based target tailoring. This >10% NTCP reduction was expected if the V{sub 45Gy} for bowel bag was >275 cm{sup 3} and >200 cm{sup 3}, respectively, during standard IGART alone. In patients with cervical cancer, both proton therapy and MRI-based target tailoring lead to a significant reduction in the dose to surrounding organs at risk and small bowel toxicity. (orig.) [German] In der vorliegenden Studie wurden die moeglichen klinischen Vorteile einer Zielvolumenpraezisierung durch Ausschluss des tumorfreien proximalen Gebaermutteranteils bei der ''image-guided adaptive radiotherapy

  15. Small bowel angiodysplasia and novel disease associations: a cohort study.

    LENUS (Irish Health Repository)

    Holleran, Grainne

    2013-04-01

    Gastrointestinal angiodysplasias recurrently bleed, accounting for 3-5% of obscure gastrointestinal bleeding. The advent of small bowel capsule endoscopy (SBCE) has led to an increased recognition of small bowel angiodysplasias (SBAs) but little is known about their etiology. Previous small cohorts and case reports suggest an equal gender incidence and associations with cardiovascular disease, renal impairment, and coagulopathies.

  16. Scintigraphic pattern of small bowel bleeding

    International Nuclear Information System (INIS)

    Anshu Rajnish Sharma; Charan, S.; Silva, I.

    2004-01-01

    Introduction: Small intestine is the longest part of gastrointestinal tract. Intra-luminal haemorrhage occurring anywhere in its long and tortuous course is difficult to trace. It is relatively inaccessible to endoscopic evaluation. Upper GI endoscopy can see only up to distal duodenum, whereas colonoscope can view maximum of 30 centimeters of terminal ileum after negotiating the scope through ileo-caecal valve. Hence, localization of bleeding source from small bowel remains a difficult clinical problem. This group of patients can be evaluated with scintigraphy for localizing the site of bleeding before undergoing either angiography or surgery. To our best of knowledge, there is no study, which has utilized scintigraphy for evaluation of small bowel bleed exclusively. The present study has been designed to know the efficacy of 99mTc-RBC scintigraphy in detecting small bowel bleed and to know whether it can differentiate between jejunal and ileal bleeding ? Materials and methods: Thirteen patients presenting with lower gastrointestinal bleeding (malena) were enrolled for the study. In all cases, upper GI endoscopy (UGIE) was unremarkable. Colonoscopic examination was either negative or suspected bleeding occurring proximal to ileo-caecal valve. Thus, in these patients, it is presumed clinically that bleeding is originating from small bowel. Barium meal follow through (BMFT) studies, however, could not delineate any etiological lesion in these patients. There were 8 men and 5 women (mean age 48 years). All patients were anemic (Hb- 6 gm%) and mean 3 units of blood were transfused.These patients were subjected to Tc-99m labeled red blood cells scintigraphy (15 mci, in-vivo method) for localization of source of bleeding. The scintiscan was acquired in two phases. A first pass phase acquired at a rate of 2 seconds per frame for 60 seconds followed by acquisition of static abdominal images (500 K, 256 x 256 matrix) at 5 minutes intervals up to 90 minutes on LFOV gamma

  17. Portal venous air in an adult patient with obstructive small bowel volvulus

    NARCIS (Netherlands)

    Tan, ECTH; Jager, GJ; Bleeker, WA; van Goor, Harry

    2002-01-01

    Background. Diagnosis of small bowel volvulus is frequently delayed often resulting in bowel ischaemia and infarction and impairing clinical outcome. Instant and correct diagnosis and subsequent adequate surgery may improve the outcome. Methods: We describe a 19-year-old female with small bowel

  18. Correlation between morphological expansion and impairment of intra- and prelesionary motility in inflammatory small bowel lesions in patients with Crohn's disease – Preliminary data

    International Nuclear Information System (INIS)

    Bickelhaupt, Sebastian; Wurnig, Moritz; Boss, Andreas; Patak, Michael A.

    2014-01-01

    Introduction: The aim of this study is to investigate if alterations of intra- and prelesionary motility in inflamed small-bowel segments correlate with length, wall-thickness and prelesionary dilatation of inflammatory small bowel lesions in patients suffering from Crohn's disease assessed with MRI. Methods and materials: This retrospective IRB approved study included 25 patients (12 males, 18–77y) with inflammatory lesions examined using (MRE) magnetic resonance imaging enterography. Cine MRE was performed using a coronal 2D steady-state free precession sequence (TR 2.9, TE 1.25) on a 1.5T MRI scanner. Small bowel motility was examined using a dedicated MR-motility assessment software (Motasso, Vers. 1.0, Sohard AG, Bern, Switzerland). Motility patterns (contraction frequency, relative occlusion rate and mean diameter) were assessed in correlation to wall thickness, length and prelesionary dilatation of the lesions. Statistical analysis was performed by calculation of the Pearson's-Correlation coefficient. Results: The length of the inflammatory segments, the wall thickening and prelesionary dilatation did not correlate with the frequency of the contractions (r = 0.17, p = 0.477; r = 0.316, p = 0.123; r = 0.161, p = 0.441) or the impairment of luminal occlusion (r = 0.274, p = 0.184; r = 0.199, p = .0339; r = 0.015, p = 0.945) and only the prelesionary dilatation (r = 0.410, p = 0.042) correlated to the mean luminal diameter of the segment. Conclusion: The degree of motility impairment within inflammatory small bowel lesions does not significantly correlate with the extent of the lesion but with the motility measured in prelesionary, non-affected segments, suggesting an interdependent functional aspect of inflammation even in morphologically non-affected small bowel segments

  19. Correlation between morphological expansion and impairment of intra- and prelesionary motility in inflammatory small bowel lesions in patients with Crohn's disease – Preliminary data

    Energy Technology Data Exchange (ETDEWEB)

    Bickelhaupt, Sebastian; Wurnig, Moritz; Boss, Andreas [University Hospital Zürich, Department of Radiology, Rämistrasse 100, 8091 Zürich (Switzerland); Patak, Michael A., E-mail: Michael.Patak@patak.ch [University Hospital Zürich, Department of Radiology, Rämistrasse 100, 8091 Zürich (Switzerland); Hirslanden Clinic, Radiology, Witellikerstrasse 40, 8032 Zürich (Switzerland)

    2014-07-15

    Introduction: The aim of this study is to investigate if alterations of intra- and prelesionary motility in inflamed small-bowel segments correlate with length, wall-thickness and prelesionary dilatation of inflammatory small bowel lesions in patients suffering from Crohn's disease assessed with MRI. Methods and materials: This retrospective IRB approved study included 25 patients (12 males, 18–77y) with inflammatory lesions examined using (MRE) magnetic resonance imaging enterography. Cine MRE was performed using a coronal 2D steady-state free precession sequence (TR 2.9, TE 1.25) on a 1.5T MRI scanner. Small bowel motility was examined using a dedicated MR-motility assessment software (Motasso, Vers. 1.0, Sohard AG, Bern, Switzerland). Motility patterns (contraction frequency, relative occlusion rate and mean diameter) were assessed in correlation to wall thickness, length and prelesionary dilatation of the lesions. Statistical analysis was performed by calculation of the Pearson's-Correlation coefficient. Results: The length of the inflammatory segments, the wall thickening and prelesionary dilatation did not correlate with the frequency of the contractions (r = 0.17, p = 0.477; r = 0.316, p = 0.123; r = 0.161, p = 0.441) or the impairment of luminal occlusion (r = 0.274, p = 0.184; r = 0.199, p = .0339; r = 0.015, p = 0.945) and only the prelesionary dilatation (r = 0.410, p = 0.042) correlated to the mean luminal diameter of the segment. Conclusion: The degree of motility impairment within inflammatory small bowel lesions does not significantly correlate with the extent of the lesion but with the motility measured in prelesionary, non-affected segments, suggesting an interdependent functional aspect of inflammation even in morphologically non-affected small bowel segments.

  20. Gastrointestinal Motility, Part 2: Small-Bowel and Colon Transit.

    Science.gov (United States)

    Maurer, Alan H

    2016-03-01

    Because of the difficulty often encountered in deciding whether a patient's symptoms originate in the upper or lower gastrointestinal tract, gastrointestinal transit scintigraphy is a uniquely suited noninvasive, quantitative, and physiologic method of determining whether there is a motility disorder affecting the stomach, small bowel, or colon. Small-bowel and colon transit studies can be performed alone or together with gastric emptying studies after oral administration of an appropriately radiolabeled meal. It is hoped that newly published standards for performing these studies and the anticipated arrival of new Current Procedural Terminology codes in the United States for small-bowel and colon transit studies will increase their availability and use. © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

  1. Extensive small bowel intramural haematoma secondary to warfarin.

    Science.gov (United States)

    Limmer, Alexandra M; Clement, Zackariah

    2017-03-01

    Intramural haematoma is a rare complication of oral anticoagulant therapy, occurring in  1 in 2500 patients treated with warfarin. This report describes a 71-year-old gentleman who presented with tachycardia, vomiting and abdominal distension on a background of anticoagulation for a metallic aortic valve. He was found to have a supratherapeutic international normalized ratio (INR) of 9.9 with an extensive small bowel intramural haematoma and secondary small bowel obstruction. He was successfully managed non-operatively with fluid resuscitation, INR reversal, bowel rest and nasogastric decompression. The patient's presentation was atypical with a lack of classic symptoms such as abdominal pain. This highlights the importance of considering intramural haematoma as a differential diagnosis for gastrointestinal symptoms in anticoagulated patients.

  2. Small bowel perforation due to fish bone: A case report

    Directory of Open Access Journals (Sweden)

    Huseyin Pulat

    2015-09-01

    Full Text Available Accidental ingestion of foreign bodies are a common condition in clinical practice. However, small bowel perforation which dues to ingestion foreign bodies has been rarely seen. In this article, we report a case of small bowel perforation which dues to ingestion foreign body. A 80-year-old female patient, presenting with complaints of acute abdomen, was admitted to the emergency department. She denied abdominal pain, nausea and vomiting. The patient had tenderness and defense on the right lower quadrant. Contrast enhanced abdominal computed tomography has been used on the patient's diagnosis. This revealed small bowel perforation due to the ingestion of foreign body. The patient was operated emergency. A microperforation due to fish bone was detected on the terminal ileum. The patient underwent debridement and primary repair. The patient was discharged postoperative 7th day without problem. Bowel perforation due to the ingestion of foreign bodies should be considered in the differential diagnosis of acute abdomen. Keywords: Foreign body, Small intestine, Perforation

  3. Small Bowel Dose Parameters Predicting Grade ≥3 Acute Toxicity in Rectal Cancer Patients Treated With Neoadjuvant Chemoradiation: An Independent Validation Study Comparing Peritoneal Space Versus Small Bowel Loop Contouring Techniques

    International Nuclear Information System (INIS)

    Banerjee, Robyn; Chakraborty, Santam; Nygren, Ian; Sinha, Richie

    2013-01-01

    Purpose: To determine whether volumes based on contours of the peritoneal space can be used instead of individual small bowel loops to predict for grade ≥3 acute small bowel toxicity in patients with rectal cancer treated with neoadjuvant chemoradiation therapy. Methods and Materials: A standardized contouring method was developed for the peritoneal space and retrospectively applied to the radiation treatment plans of 67 patients treated with neoadjuvant chemoradiation therapy for rectal cancer. Dose-volume histogram (DVH) data were extracted and analyzed against patient toxicity. Receiver operating characteristic analysis and logistic regression were carried out for both contouring methods. Results: Grade ≥3 small bowel toxicity occurred in 16% (11/67) of patients in the study. A highly significant dose-volume relationship between small bowel irradiation and acute small bowel toxicity was supported by the use of both small bowel loop and peritoneal space contouring techniques. Receiver operating characteristic analysis demonstrated that, for both contouring methods, the greatest sensitivity for predicting toxicity was associated with the volume receiving between 15 and 25 Gy. Conclusion: DVH analysis of peritoneal space volumes accurately predicts grade ≥3 small bowel toxicity in patients with rectal cancer receiving neoadjuvant chemoradiation therapy, suggesting that the contours of the peritoneal space provide a reasonable surrogate for the contours of individual small bowel loops. The study finds that a small bowel V15 less than 275 cc and a peritoneal space V15 less than 830 cc are associated with a less than 10% risk of grade ≥3 acute toxicity

  4. Diospyrobezoar as a Cause of Small Bowel Obstruction

    Directory of Open Access Journals (Sweden)

    Andréia Padilha de Toledo

    2012-09-01

    Full Text Available Phytobezoar, a concretion of indigestible fibers derived from ingested vegetables and fruits, is the most common type of bezoar. Diospyrobezoar is a subtype of phytobezoar formed after excessive intake of persimmons (Diospyros kaki. We report the case of a diabetic man with a 5-day history of abdominal pain after massive ingestion of persimmons who developed signs of complicated small bowel obstruction. The patient had a previous history of Billroth II hemigastrectomy associated with truncal vagotomy to treat a chronic duodenal ulcer 14 years earlier. Since intestinal obstruction was suspected, he underwent emergency laparotomy that revealed an ileal obstruction with small bowel perforation and local peritonitis due to a phytobezoar that was impacted 15 cm above the ileocecal valve. After segmental intestinal resection, the patient had a good recovery and was discharged on the 6th postoperative day. This report provides evidence that diospyrobezoar should be considered as a possible cause of small bowel obstruction in patients who have previously undergone gastric surgery.

  5. Rapunzel Syndrome: a rare cause of acute small bowel obstruction ...

    African Journals Online (AJOL)

    The Rapunzel syndrome is a very rare condition where trichobezoar has extended up to the small bowel. Here we are reporting a rare case of Rapunzel syndrome in an adolescent girl with history of trichophagia who presented with small bowel obstruction. Patient underwent exploratory laparotomy and bezoar was ...

  6. Enteroclysis and small bowel series: Comparison of radiation dose and examination time

    International Nuclear Information System (INIS)

    Thoeni, R.F.; Gould, R.G.

    1991-01-01

    Respective radiation doses and total examination and fluoroscopy times were compared for 50 patients; 25 underwent enteroclysis and 25 underwent small bowel series with (n = 17) and without (n = 8) an examination of the upper gastrointestinal (GI) tract. For enteroclysis, the mean skin entry radiation dose (12.3 rad [123 mGy]) and mean fluoroscopy time (18.4 minutes) were almost 1 1/2 times greater than those for the small bowel series with examination of the upper GI tract (8.4 rad [84 mGy]; 11.4 minutes) and almost three times greater than those for the small bowel series without upper GI examination (4.6 rad [46 mGy]; 6.3 minutes). However, the mean total examination completion time for enteroclysis (31.2 minutes) was almost half that of the small bowel series without upper GI examination (57.5 minutes) and almost four times shorter than that of the small bowel series with upper GI examination (114 minutes). The higher radiation dose of enteroclysis should be considered along with the short examination time, the age and clinical condition of the patient, and the reported higher accuracy when deciding on the appropriate radiographic examination of the small bowel

  7. Small-bowel carcinoid with no liver metastases.

    Science.gov (United States)

    Juniku-Shkololli, Argjira; Haziri, Adem

    2009-01-01

    Carcinoid is a slowly-growing tumor from the group of neuroendocrine or APUD tumors. Characteristic of these tumors is the production of biogene amins & polypeptide hormones. 90% of all carcinoids are located in the GI system. A female patient, 68 years old, comes for a visit with signs of diffuse abdominal pain, diarrhea, irregular bowel movements, weakness, dyspnea and pretibial edemas. The gastroenterologist gives her only symptomatic therapy at first, and starts the examinations after her hospitalization (initial dg: Enterocolitis). One month later she visits again with the same complains. CT scan result shows steatosis hepatica and lots of liquids in the small bowel and colon. She underwent operation--resection of 20 cm of the small bowel with tumor masses and part-time ileostoma. The biopsy of the resected segment of the bowel shows multiple carcinoids. Our patient had no flushing of the skin and therefore couldn't be suspected clinically for this diagnosis. The intestinal carcinoid does not usually produce the carcionid syndrome unless hepatic metastases have occurred. The infiltration of the mesentery provokes an intense fibrotic reaction resulting in kinking of the bowel segments, which causes intestinal obstruction as it happened in this patient. As long as in our clinic we don't have this technique, it is much harder to make an early diagnosis. Fortunately our patient was diagnosed before liver metastases occurred, and therefore her treatment was successful.

  8. Computed tomography features of small bowel volvulus

    International Nuclear Information System (INIS)

    Loh, Y.H.; Dunn, G.D.

    2000-01-01

    Small bowel volvulus is a cause of acute abdomen and commonly occurs in neonates and young infants. Although it is rare in adults in the Western world,' it is a relatively common surgical emergency in the Middle East, India and Central Africa. It is associated with a mortality rate of 10-67% and, hence, it is important to make an early diagnosis to expedite surgical intervention. Computed tomography has become an important imaging modality in diagnosis and a number of signs have been recognized in a handful of documented case reports. We describe a case of small bowel volvulus that illustrates these important CT signs. Copyright (1999) Blackwell Science Pty Ltd

  9. Small Bowel Review: Part II

    Directory of Open Access Journals (Sweden)

    ABR Thomson

    1999-01-01

    Full Text Available In the past year there have been many advances in the area of small bowel physiology and pathology. In preparation for this review, over 500 papers were assessed; some have been selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist.

  10. Small Bowel Review: Part I

    Directory of Open Access Journals (Sweden)

    ABR Thomson

    1998-01-01

    Full Text Available In the past year there have been many advances in the area of small bowel physiology and pathology. In preparation for this review, over 500 papers were assessed, and some have been selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist.

  11. Fetal bowel anomalies - US and MR assessment

    Energy Technology Data Exchange (ETDEWEB)

    Rubesova, Erika [Stanford University, Department of Radiology, Lucile Packard Children' s Hospital, Stanford, CA (United States)

    2012-01-15

    The technical quality of prenatal US and fetal MRI has significantly improved during the last decade and allows an accurate diagnosis of bowel pathology prenatally. Accurate diagnosis of bowel pathology in utero is important for parental counseling and postnatal management. It is essential to recognize the US presentation of bowel pathology in the fetus in order to refer the patient for further evaluation or follow-up. Fetal MRI has been shown to offer some advantages over US for specific bowel abnormalities. In this paper, we review the normal appearance of the fetal bowel on US and MRI as well as the typical presentations of bowel pathologies. We discuss more specifically the importance of recognizing on fetal MRI the abnormalities of size and T1-weighted signal of the meconium-filled distal bowel. (orig.)

  12. CT Findings of Small Bowel Anisakiasis: Analysis of Four Cases

    International Nuclear Information System (INIS)

    Kim, Wee Kyoung; Song, Soon Young; Cho, On Koo; Koh, Byung Hee; Kim, Yong Soo; Jung, Woo Kyoung; Kim, Min Yeong

    2011-01-01

    We wanted to describe the CT findings of small bowel anisakiasis with the pathologic correlation. Four patients with surgically and pathologically proven small bowel anisakiasis were included in this retrospective study. They were three men and one woman and their ages ranged from 28 to 43 years (mean age: 38 years). We evaluated their clinical, CT and histological findings. All the patients had a history of ingesting raw fish within 24 hours from the time of symptom onset. They complained of abdominal pain (n=4), nausea (n=4), vomiting (n=2) and diarrhea (n=1). Physical examination revealed tenderness (n=4), rebound tenderness (n=4) and increased bowel sounds (n=3). Leukocytosis was noted in all the patients on the laboratory examination. None of the patients showed eosinophilia. The CT findings were segmental small bowel wall thickening with preserved layering (n=4), focal segmental luminal narrowing with proximal dilatation (n=4), peritoneal thickening (n=3), mesenteric or omental infiltration (n=4) and varying degrees of ascites (n=4). On the histopathologic examination, they revealed an infiltration of eosinophils (n=4) in all layers of the bowel wall with severe edema. The larvae were found on surgico-pathologic examination in all the cases. The CT findings may be helpful to make the specific diagnosis of small bowel anisakiasis in a patient with the clinical findings of an acute abdomen and a history of eating raw fish

  13. CT Findings of Small Bowel Anisakiasis: Analysis of Four Cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Wee Kyoung; Song, Soon Young; Cho, On Koo; Koh, Byung Hee [Hanyang University College of Medicine, Seoul (Korea, Republic of); Kim, Yong Soo; Jung, Woo Kyoung; Kim, Min Yeong [Hanyang University Guri Hospital, College of Medicine, Guri (Korea, Republic of)

    2011-02-15

    We wanted to describe the CT findings of small bowel anisakiasis with the pathologic correlation. Four patients with surgically and pathologically proven small bowel anisakiasis were included in this retrospective study. They were three men and one woman and their ages ranged from 28 to 43 years (mean age: 38 years). We evaluated their clinical, CT and histological findings. All the patients had a history of ingesting raw fish within 24 hours from the time of symptom onset. They complained of abdominal pain (n=4), nausea (n=4), vomiting (n=2) and diarrhea (n=1). Physical examination revealed tenderness (n=4), rebound tenderness (n=4) and increased bowel sounds (n=3). Leukocytosis was noted in all the patients on the laboratory examination. None of the patients showed eosinophilia. The CT findings were segmental small bowel wall thickening with preserved layering (n=4), focal segmental luminal narrowing with proximal dilatation (n=4), peritoneal thickening (n=3), mesenteric or omental infiltration (n=4) and varying degrees of ascites (n=4). On the histopathologic examination, they revealed an infiltration of eosinophils (n=4) in all layers of the bowel wall with severe edema. The larvae were found on surgico-pathologic examination in all the cases. The CT findings may be helpful to make the specific diagnosis of small bowel anisakiasis in a patient with the clinical findings of an acute abdomen and a history of eating raw fish

  14. Graft-versus-host reaction in small-bowel transplantation and possibilities for its circumvention.

    Science.gov (United States)

    Watanabe, K; Yagi, T; Iwagaki, H; Kimura, Y; Mitsuoka, N; Inagaki, M; Tanaka, S; Tanaka, N

    2001-01-01

    To study graft-versus-host reaction (GVHR) in small-bowel transplantation and its underlying mechanisms and to find methods for circumventing GVHR, we used an unidirectional GVHR model in which F1 Lewis (LEW) x Wistar King A (WKA) hybrid rats received small-bowel transplants from either LEW or WKA parent rats. The survival time of F1 hybrid rats that received full-length small-bowel transplantation from LEW and WKA was 16.3+/-2.1 days and 18.2+/-3.4 days, respectively. When one-quarter of LEW small bowel was transplanted to an F1 hybrid recipient, the survival time was significantly longer at 44.0+/-23.4 days compared with rats that had received full-length LEW small-bowel transplantation. The survival time of F1 hybrid rats which received an injection of high-dose (5 x 10(8) cells) LEW or WKA spleen cells was 11.9+/-4.0 days and 13.1+/-3.6 days, respectively. However, when an injection containing a low dose (1 x 108 cells) of LEW spleen cells was used, survival was > 100 days, showing significance compared with the survival of rats receiving the higher dose LEW spleen-cell injection. Both small-bowel transplantation and spleen-cell injection were compared for the effective period of recipient resistance to donor cell or small-bowel transplantation as second challenge. When the F1 rats given a quarter LEW small-bowel transplant as first challenge were treated with a high-dose of spleen cells 30 days after transplantation, they survived for > 30 days without GVHR. F1 rats that were treated with a low-dose LEW spleen-cell injection, followed 30 days later by full LEW small-bowel transplantation, had a survival time of > 100 days. These results indicate that segmental small-bowel transplantation and spleen-cell injection as first challenge may facilitate the prevention of GVHR, resulting in resistance to subsequent immunological challenge.

  15. Fetal primary small bowel volvulus in a child without intestinal malrotation.

    Science.gov (United States)

    Chung, Jae Hee; Lim, Gye-Yeon; We, Ji Sun

    2013-07-01

    Fetal primary small bowel volvulus without atresia or malrotation is an extremely rare but life-threatening surgical emergency. We report a case of primary small bowel volvulus that presented as sudden fetal distress and was diagnosed on the basis of the 'whirl-pool sign' of fetal sonography. This diagnosis led to emergency operation after birth at the third trimester with a good outcome. Although the pathogenesis of fetal primary small bowel volvulus is unclear, ganglion cell immaturity may play a role in the etiology. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Surgical aspects of radiation enteritis of the small bowel

    Energy Technology Data Exchange (ETDEWEB)

    Wobbes, T.; Verschueren, R.C.; Lubbers, E.J.; Jansen, W.; Paping, R.H.

    1984-02-01

    Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.

  17. Surgical aspects of radiation enteritis of the small bowel

    International Nuclear Information System (INIS)

    Wobbes, T.; Verschueren, R.C.; Lubbers, E.J.; Jansen, W.; Paping, R.H.

    1984-01-01

    Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation

  18. Obstructive Small Bowel Metastasis from Uterine Leiomyosarcoma: A Case Report

    Directory of Open Access Journals (Sweden)

    Mutahir A. Tunio

    2014-01-01

    Full Text Available Background. Uterine leiomyosarcoma is a rare and aggressive gynecologic malignancy with an overall poor prognosis. Lungs, bones, and brain are common sites of metastases of uterine leiomyosarcoma. Metastases of uterine leiomyosarcoma to the small bowel are extremely rare, and only four case reports have been published to date. Case presentation. A 55-year-old Saudi woman diagnosed with a case of uterine leiomyosarcoma treated with total abdominal hysterectomy (TAH and bilateral salpingooophorectomy (BSO presented in emergency room after sixteen months with acute abdomen. Subsequent work-up showed a jejunal mass for which resection and end-to-end anastomosis were performed. Biopsy confirmed the diagnosis of small bowel metastasis from uterine leiomyosarcoma. Further staging work-up showed wide spread metastasis in lungs and brain. After palliative cranial irradiation, systemic chemotherapy based on single agent doxorubicin was started. Conclusion. Metastatic leiomyosarcoma of small bowel from uterine leiomyosarcoma is a rare entity and is sign of advanced disease. It should be differentiated from primary leiomyosarcoma of small bowel as both are treated with different systemic chemotherapeutic agents.

  19. Fecal impaction: a cause of isolated small bowel dilatation on abdominal radiographs

    International Nuclear Information System (INIS)

    Torigian, Drew A.; Levine, Marc S.; Rubesin, Stephen E.; Laufer, Igor

    2001-01-01

    Objective: The purpose of this study was to assess the frequency of isolated small bowel dilatation on abdominal radiographs in patients with colonic fecal impaction and also to elucidate the cause of this finding. Methods: A computerized search of radiology files revealed 515 patients with colonic fecal impaction on abdominal radiographs. The radiologic reports described isolated small bowel dilatation not related to other known causes of ileus or obstruction in 18 (3.5%) of the 515 patients. The films were reviewed to determine the distribution of fecal impaction and the degree and extent of small bowel dilatation. In 16 cases, medical records were reviewed to determine the clinical presentation, treatment, and course. Finally, follow-up radiographs were reviewed in four cases to determine the response to treatment of the impaction. Results: All 16 patients with available medical records had abdominal symptoms. The average diameter of the dilated small bowel on abdominal radiographs was 3.7 cm. Fourteen patients (78%) had a diffuse colonic fecal impaction (nine) or a predominantly right-sided fecal impaction (five) that involved the cecum, and the remaining four (22%) had a left-sided colonic fecal impaction. All 12 patients with clinical follow-up had resolution of symptoms and all four with follow-up radiographs had resolution of small bowel dilatation after treatment of the underlying impaction. Conclusion: Fecal impaction should be considered in the differential diagnosis of small bowel dilatation on abdominal radiographs, as treatment of the underlying impaction usually produces a dramatic clinical response with resolution of the small bowel dilatation on follow-up radiographs

  20. Diagnosis of pediatric gastric, small-bowel and colonic volvulus.

    Science.gov (United States)

    Garel, Charles; Blouet, Marie; Belloy, Frederique; Petit, Thierry; Pelage, Jean-Pierre

    2016-01-01

    Digestive volvulus affects the stomach, small bowel and mobile segments of the colon and often has a developmental cause. Reference radiologic examinations include upper gastrointestinal contrast series for gastric volvulus, possibly with ultrasonography for small-bowel volvulus, and contrast enema for colonic volvulus. Treatment is usually surgical. This pictorial essay describes the embryological development and discusses the clinical and radiologic presentation of volvulus, depending on location, and details the appropriate radiologic examinations.

  1. Phytobezoar in a jejunal diverticulum as a cause of small bowel obstruction: a case report

    Directory of Open Access Journals (Sweden)

    Rauf Fozia

    2011-09-01

    Full Text Available Abstract Introduction Phytobezoars are concretions of poorly digested fruit and vegetable fibers found in the alimentary tract. Previous gastric resection, gastrojejunostomy, or pyloroplasty predispose people to bezoar formation. Small-bowel bezoars normally come from the stomach, and primary small-bowel bezoars are very rare. They are seen only in patients with underlying small-bowel diseases such as diverticula, strictures, or tumors. Primary small-bowel bezoars almost always present as intestinal obstructions, although it is a very rare cause, being responsible for less than 3% of all small-bowel obstructions in one series. Jejunal diverticula are rare, with an incidence of less than 0.5%. They are usually asymptomatic pseudodiverticula of pulsion type, and complications are reported in 10% to 30% of patients. A phytobezoar in a jejunal diverticulum is an extremely rare presentation. Case presentation A 78-year-old Pakistani man presented to our clinic with small-bowel obstruction. Upon exploration, we found a primary small-bowel bezoar originating in a jejunal diverticulum and causing jejunal obstruction. Resection and anastomosis of the jejunal segment harboring the diverticulum was performed, and our patient had an uneventful recovery. Conclusion Primary small-bowel bezoars are very rare but must be kept in mind as a possible cause of small-bowel obstruction.

  2. Development of a new method for small bowel transit study

    International Nuclear Information System (INIS)

    Hung, Guang-Uei; Tsai, Chien-Chung; Lin, Wan-Yu

    2006-01-01

    Currently, most studies combine the small bowel transit examination with gastric emptying time examination. There are significant drawbacks to this method. The radiotracer does not enter the small intestine in a bolus and the starting time for transit in the duodenum is difficult to define. This makes the result unreliable. In this study, we used a commercial enteric capsule containing radioactive charcoal to solve these problems. Activated charcoal powder was mixed with Tc-99m pertechnetate and loaded to the enteric capsule which can resist gastric acid and dissolve only in the small intestine, in-vitro stability experiment was performed by immersing these capsules in a colorless phosphate buffer of variable pH which mimicked the condition in stomach and small intestine. In addition, ten healthy Chinese volunteers were included for in-vivo experiment. Anterior and posterior views of abdomen were obtained at regular 30-minute intervals until the eighth hour after administration of the radioactive enteric capsule. Small bowel transit time was calculated. The enteric capsule remained intact for at least 480 minutes in the solution mimicking gastric content (pH=3.0) and disrupted at a mean duration of 227.2 minutes at a pH of 6.8 and at a mean duration of 212.4 minutes at a pH of 7.4 in the solution mimicking pancreaticobiliary secretions. In nine of ten volunteers, the small bowel transit time was between 30 to 270 minutes with a mean transit time of 140 min. In one volunteer, we failed to detect the exact time of small bowel transit because the capsule remained in the stomach throughout the study for up to 8 hours. We consider activated charcoal labeled with Tc-99m pertechnetate using an enteric capsule as the carrier to be a potential radioactive marker for small bowel transit study. (author)

  3. Adult small bowel obstruction.

    Science.gov (United States)

    Taylor, Mark R; Lalani, Nadim

    2013-06-01

    Small bowel obstruction (SBO) is a clinical condition that is often initially diagnosed and managed in the emergency department (ED). The high rates of potential complications that are associated with an SBO make it essential for the emergency physician (EP) to make a timely and accurate diagnosis. The primary objective was to perform a systematic review and meta-analysis of the history, physical examination, and imaging modalities associated with the diagnosis of SBO. The secondary objectives were to identify the prevalence of SBO in prospective ED-based studies of adult abdominal pain and to apply Pauker and Kassirer's threshold approach to clinical decision-making to the diagnosis and management of SBO. MEDLINE, EMBASE, major emergency medicine (EM) textbooks, and the bibliographies of selected articles were scanned for studies that assessed one or more components of the history, physical examination, or diagnostic imaging modalities used for the diagnosis of SBO. The selected articles underwent a quality assessment by two of the authors using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Data used to compile sensitivities and specificities were obtained from these studies and a meta-analysis was performed on those that examined the same historical component, physical examination technique, or diagnostic test. Separate information on the prevalence and management of SBO was used in conjunction with the meta-analysis findings of computed tomography (CT) to determine the test and treatment threshold. The prevalence of SBO in the ED was determined to be approximately 2% of all patients who present with abdominal pain. Having a previous history of abdominal surgery, constipation, abnormal bowel sounds, and/or abdominal distention on examination were the best history and physical examination predictors of SBO. X-ray was determined to be the least useful imaging modality for the diagnosis of SBO, with a pooled positive likelihood ratio (+LR

  4. Small-bowel cancer in Lynch syndrome : is it time for surveillance?

    NARCIS (Netherlands)

    Koornstra, Jan J.; Kleibeuker, Jan H.; Vasen, Hans F. A.

    Small-bowel cancer is part of the tumour spectrum of Lynch syndrome. Lynch syndrome, or hereditary non-polyposis colorectal cancer, is caused by germline mutations in one of the mismatch repair genes. Mutation carriers have an estimated lifetime risk for the development of small-bowel cancer of

  5. Diseases of the small bowel in chronic diarrhea: diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    M. Simadibrata

    2002-09-01

    Full Text Available The incidence of chronic diarrhea in Asia is between 0.8-1.0%. The diseases and abnormalities according to the location, which can cause chronic diarrhea, are divided into three locations: the small bowel, the large bowel and extraintestinal. The small bowel diseases include infectious and non-infectious diseases. The infectious diseases are bacterial infections, parasitic infections etc. The non-infectious diseases include of Crohn’s disease, Celiac sprue, NSAID enteropathy, lactose intolerance, benign tumor, carcinoid tumor, carcinoma, post surgery complications, laxative etc. The approaches to diagnosis include good anamnesis, careful physical examination, supporting laboratory tests, more specialized supporting examinations including X-ray of the colon, esophagogastroduodenum follow-through, enteroclysis, ileo-colonoscopy and endoscopy on the upper portion of the digestive tract including the small intestine with biopsy for histopathology examinations. The treatment for chronic diarrhea is divided into supportive and causal therapy. (Med J Indones 2002; 11: 179-89 Keywords: small bowel, chronic diarrhea, approaches to diagnosis, treatment

  6. MR enterography in the evaluation of small bowel dilation

    Energy Technology Data Exchange (ETDEWEB)

    Cronin, C.G. [Department of Radiology, University College Hospital, Galway (Ireland)], E-mail: carmelcronin2000@hotmail.com; Lohan, D.G.; Browne, A.M.; Alhajeri, A.N.; Roche, C.; Murphy, J.M. [Department of Radiology, University College Hospital, Galway (Ireland)

    2009-10-15

    Magnetic reasonance (MR) enterography enables high contrast resolution depiction of the location and cause of bowel obstruction through a combination of predictable luminal distension and multiplanar imaging capabilities. Furthermore, because the patient is not exposed to ionizing radiation, sequential 'dynamic' MR imaging can be performed repeatedly over time further facilitating depiction of the site and/or the cause of obstruction. With increasing availability of MR imaging and standardization of the oral contrast medium regimens, it is likely that this technique will assume an ever-increasing role in the evaluation of small bowel dilation in the coming years. We illustrate the utility of MR enterography in the evaluation of small bowel dilation, whether it be mechanical, functional (e.g., ileus), or related to infiltrative mural disease.

  7. CT findings in acute small bowel diverticulitis; Computertomographie bei akuter Duenndarmdivertikulitis

    Energy Technology Data Exchange (ETDEWEB)

    Ferstl, F.J.; Obert, R. [Radiologisch-Nuklearmedizinisches Zentrum (RNZ) am St. Theresienkrankenhaus Nuernberg (Germany)

    2004-02-01

    Small bowel diverticulitis is a rare cause of an acute abdomen. Originating from acquired diverticula of the jejunum, less often of the ileum, or Meckel diverticulum, the symptoms are non-specific, simulating other acute inflammatory disorders, such as appendicitis, cholecystitis or colonic diverticulitis. The diagnosis of small bowel diverticulitis is solely based on radiologic findings, with computed tomography (CT) regarded as the method of choice. In recent years, a number of case reports have described the spectrum of the CT features in acute small bowel diverticulitis and its dependence on the severity of the inflammatory process. Typical findings are an inflamed diverticulum, inflammatory mesenteric infiltration, extraluminal gas collection and mural edema of adjacent small bowel loops with resultant separation of bowel loops. An enterolith is rarely found in an inflamed diverticulum. Complications include abscesses, fistulae, small bowel obstruction and free perforation with peritonitis. Small bowel diverticulitis can be a diagnostic problem if it involves the terminal ileum or Meckel's diverticulum. For preoperative confirmation of the presumed diagnosis of small bowel diverticulitis on CT, an enteroclysis for acquired diverticula or a technetium scan for Meckel's diverticulum should be performed. We present the CT findings in three patients of acute small bowel diverticulitis, two affecting the jejunum and one a Meckel's diverticulum. (orig.) [German] Die akute Duenndarmdivertikulitis ist eine seltene Ursache eines akuten Abdomens. Ausgehend von den erworbenen Divertikeln des Jejunums, seltener des Ileums, oder von einem Meckel-Divertikel, manifestiert sich die Divertikulitis klinisch durch eine unspezifische Symptomatik, die zuerst an die haeufigeren, akutentzuendlichen Erkrankungen des Abdomens wie z. B. Appendizitis, Cholezystitis oder Kolondivertikulitis denken laesst. Die Duenndarmdivertikulitis kann praeoperativ nur durch

  8. Anatomy and Physiology of the Small Bowel.

    Science.gov (United States)

    Volk, Neil; Lacy, Brian

    2017-01-01

    Comprehension of small intestine physiology and function provides a framework for the understanding of several important disease pathways of the gastrointestinal system. This article reviews the development, anatomy and histology of the small bowel in addition to physiology and digestion of key nutrients. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Small bowel volvulus in children. Its appearance on the barium enema examination

    Energy Technology Data Exchange (ETDEWEB)

    Siegel, M.J.; Shackelford, G.D.; McAlister, W.H.

    1980-01-01

    Two children with small bowel volvulus diagnosed on barium enema examination are reported. In one patient the volvulus was associated with malrotation and in the other patient there was a post-operative peritoneal adhesion. In both cases the diagnosis was based on beaking of the head of the barium column at the site of volvulus. Radiographic demonstration of a beak sign in the small bowel on barium enema examination should suggest a diagnosis of small bowel volvulus, and indicates the need for immediate surgery.

  10. Capsule endoscopy: Beyond small bowel

    Directory of Open Access Journals (Sweden)

    Samuel N Adler

    2012-01-01

    Full Text Available In this article the brief and dramatic history of capsule endoscopy of the digestive tract is reviewed. Capsule endoscopy offers a non invasive method to diagnose diseases that affect the esophagus, small bowel and colon. Technological improvements relating to optics, software, data recorders with two way communication have revolutionized this field. These advancements have produced better diagnostic performance.

  11. Merkel cell carcinoma metastatic to the small bowel mesentery

    Directory of Open Access Journals (Sweden)

    Guang-Yu Yang

    2011-03-01

    Full Text Available Merkel cell carcinoma (MCC is an uncommon cutaneous malignant tumor that presents as a rapidly growing skin nodule on sun-exposed areas of the body. MCC is aggressive with regional nodal and distant metastases to the skin, lung, and bones. There have been no reports of metastatic MCC to the mesentery and 6 reports describing metastasis to the small intestine. We present a case of metastatic MCC to the mesentery with infiltration to the small bowel, 8 years after original tumor resection. This is the 5th metastasis and it encased the small bowel resulting in a hair-pin loop contributing to the unusual clinical presentation. Although MCC metastatic to the bowel is uncommon, it is not rare. It is important to recognize the unusual manifestations of this disease as they are becoming more common in the future. Routine radiologic surveillance and thorough review of systems are important to patient follow-up.

  12. Plain magnetic resonance imaging as an alternative in evaluating inflammation and bowel damage in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Jesuratnam-Nielsen, Kayalvily; Løgager, Vibeke B; Rezanavaz-Gheshlagh, Bijan

    2015-01-01

    -52%, 83-94% and 76-92% for DWI, respectively. The κ values for bowel wall thickening, DWI, and mural hyperenhancement were detected with fair agreement (κ = 0.26-0.39) at both MRI examinations, whereas only bowel wall thickening in MRFT were detected with moderate agreement (κ = 0.47) Conclusion. Plain......OBJECTIVE: To compare prospectively the diagnostic accuracy of magnetic resonance imaging (MRI) without use of contrast medium orally or intravenously (plain MRI) with magnetic resonance follow-through (MRFT) in patients with inflammatory bowel disease (IBD). MATERIAL AND METHODS: Plain MRI...

  13. Survived case of tardive small bowel injury resulting from radiotherapy for ovarial tumor

    Energy Technology Data Exchange (ETDEWEB)

    Haruyama, H; Hattori, K; Okubo, H; Ishizaki, Y; Kanemoto, T [National Hospital of Sapporo (Japan)

    1981-07-01

    In a patient who underwent surgical excision of recurrent tumor of ovarian disgerminoma, small bowel injury following radiotherapy was treated by extensive excision of the small intestine followed by intravenous hyperalimentation (I.V.H.) and hyperbaric oxygen therapy. From its clinical course and treatment, we concluded that 1) In small bowel complication due to radiation injury, especially perforation of the small bowel, radical excision of the diseased segment is most promising, if the general and local conditions permit. 2) I.V.H. is effective for protecting and improving postoperative malnutrition after extensive excision of the small bowel. 3) Hyperbaric oxygen therapy is very effective for postoperative paralytic ileus in the case in which surgical operation cannot be performed. 4) Zinc deficiency as a complication of prolonged I.V.H. therapy must be protected. 5) It is necessary to study pathophysiology of short bowel syndrome following the extensive excision and to continue treatment and careful long-term follow-up.

  14. Leukocyte scintigraphy compared to intraoperative small bowel enteroscopy and laparotomy findings in Crohn's disease

    DEFF Research Database (Denmark)

    Almen, Sven; Granerus, Göran; Ström, Magnus

    2007-01-01

    Background: Leukocyte scintigraphy is a noninvasive investigation to assess inflammation. We evaluated the utility of labeled leukocytes to detect small bowel inflammation and disease complications in Crohn's disease and compared it to whole small bowel enteroscopy and laparotomy findings. Methods......: Scintigraphy with technetium-99m exametazime-labeled leukocytes was prospectively performed in 48 patients with Crohn's disease a few days before laparotomy; 41 also had an intraoperative small bowel enteroscopy. The same procedures were performed in 8 control patients. Independent grading of scans...... was compared with the results of enteroscopy and with surgical, histopathologic, and clinical data. Results: In the 8 control patients leukocyte scan, endoscopy, and histopathology were all negative for the small bowel. In patients with Crohn's disease and small bowel inflammation seen at enteroscopy and...

  15. Peristalsis gap sign at cine magnetic resonance imaging for diagnosing strangulated small bowel obstruction. Feasibility study

    International Nuclear Information System (INIS)

    Takahara, Taro; Kwee, T.C.; Haradome, Hiroki

    2011-01-01

    The aim of this study was to determine the feasibility of cine magnetic resonance imaging (MRI) for diagnosing strangulated small bowel obstruction (SBO). This study included 38 patients with clinically confirmed SBO who had undergone cine MRI. Cine MRI scans were evaluated regarding the presence of the 'peristalsis gap sign' (referring to an akinetic or severely hypokinetic closed loop), indicating strangulation. Computed tomography (CT) was performed in 34 of 38 patients with (n=25) or without (n=9) contrast enhancement. CT images were evaluated using a combination of criteria (presence of hyperattenuation, poor contrast enhancement, mesenteric edema, wall thickening, massive ascites) indicating strangulation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of cine MRI and CT for the diagnosis of strangulation were calculated and compared using surgical findings and the clinical course as the reference standard. Sensitivity, specificity, PPV, and NPV of cine MRI were 100%, 92.9%, 83.3%, and 100%, respectively; and those of CT (of which 26.5% was performed without contrast enhancement) were 66.7%, 92.0%, 75.0%, and 88.5%, respectively. There was no significant difference in diagnostic accuracy between the two methods (P=0.375). Cine MRI is a feasible and promising technique for diagnosing strangulation. (author)

  16. Coffee Enema for Preparation for Small Bowel Video Capsule Endoscopy: A Pilot Study

    Science.gov (United States)

    Kim, Eun Sun; Keum, Bora; Seo, Yeon Seok; Jeen, Yoon Tae; Lee, Hong Sik; Um, Soon Ho; Kim, Chang Duck; Ryu, Ho Sang

    2014-01-01

    Coffee enemas are believed to cause dilatation of bile ducts and excretion of bile through the colon wall. Proponents of coffee enemas claim that the cafestol palmitate in coffee enhances the activity of glutathione S-transferase, an enzyme that stimulates bile excretion. During video capsule endoscopy (VCE), excreted bile is one of the causes of poor preparation of the small bowel. This study aimed to evaluate the feasibility and effect of coffee enema for preparation of the small bowel during VCE. In this pilot study, 17 of 34 patients were assigned to the coffee enema plus polyethylene glycol (PEG) 2 L ingestion group, whereas the 17 remaining control patients received 2 L of PEG only. The quality of bowel preparation was evaluated in the two patient groups. Bowel preparations in the proximal segments of small bowel were not differ between two groups. In the mid and distal segments of the small intestine, bowel preparations tend to be better in patients who received coffee enemas plus PEG than in patients who received PEG only. The coffee enema group did not experience any complications or side effects. Coffee enemas may be a feasible option, and there were no clinically significant adverse events related to coffee enemas. More prospective randomized studies are warranted to improve small bowel preparation for VCE. PMID:25136541

  17. Transient small-bowel intussusceptions in adults: significance of ultrasonographic detection

    Energy Technology Data Exchange (ETDEWEB)

    Maconi, G. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy)]. E-mail: giovanni.maconi@unimi.it; Radice, E. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy); Greco, S. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy); Bezzio, C. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy); Bianchi Porro, G. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy)

    2007-08-15

    Aim: To investigate the frequency, clinical significance, and outcome of small-bowel intussusceptions in adults detected using ultrasound in an outpatient setting. Patients and methods: In two different retrospective (January 2001 to April 2003) and prospective (May 2003 to June 2005) periods, 33 small-bowel intussusceptions were found in 32 patients (13 females; mean age: 38.1 years) with known or suspected intestinal disease. Patients underwent diagnostic work-up to assess any organic disease. Patients with self-limiting intussusception were submitted to clinical and ultrasonographic follow-up. Results: Of the 32 patients with small-bowel intussusception, 25 were identified in the prospective series of 4487 examinations (0.53%) and seven in the retrospective series of 5342 examinations (0.15%; p = 0.002). Four patients had persistent and 28 self-limiting intussusceptions. Self-limiting intussusceptions were idiopathic in 11 patients (39%) or associated with organic diseases in 17 (Crohn's disease in 11 patients, celiac disease in three, ulcerative colitis in one patient, and previous surgery for cancer in two). Self-limiting intussusceptions were asymptomatic in 25% of patients. Conclusion: Small-bowel intussusceptions in adults are not rare and are frequently self-limiting, idiopathic, or related to organic diseases, mainly Crohn's disease and coeliac disease.

  18. Transient small-bowel intussusceptions in adults: significance of ultrasonographic detection

    International Nuclear Information System (INIS)

    Maconi, G.; Radice, E.; Greco, S.; Bezzio, C.; Bianchi Porro, G.

    2007-01-01

    Aim: To investigate the frequency, clinical significance, and outcome of small-bowel intussusceptions in adults detected using ultrasound in an outpatient setting. Patients and methods: In two different retrospective (January 2001 to April 2003) and prospective (May 2003 to June 2005) periods, 33 small-bowel intussusceptions were found in 32 patients (13 females; mean age: 38.1 years) with known or suspected intestinal disease. Patients underwent diagnostic work-up to assess any organic disease. Patients with self-limiting intussusception were submitted to clinical and ultrasonographic follow-up. Results: Of the 32 patients with small-bowel intussusception, 25 were identified in the prospective series of 4487 examinations (0.53%) and seven in the retrospective series of 5342 examinations (0.15%; p = 0.002). Four patients had persistent and 28 self-limiting intussusceptions. Self-limiting intussusceptions were idiopathic in 11 patients (39%) or associated with organic diseases in 17 (Crohn's disease in 11 patients, celiac disease in three, ulcerative colitis in one patient, and previous surgery for cancer in two). Self-limiting intussusceptions were asymptomatic in 25% of patients. Conclusion: Small-bowel intussusceptions in adults are not rare and are frequently self-limiting, idiopathic, or related to organic diseases, mainly Crohn's disease and coeliac disease

  19. Acute small bowel obstruction due to chicken bone bezoar

    Directory of Open Access Journals (Sweden)

    Vetpillai P

    2012-12-01

    Full Text Available Preadeepan Vetpillai,1 Ayo Oshowo21CT2 Surgery in General, Charing Cross Hospital, 2Colorectal and Laparoscopic Surgery, Whittington Hospital, London, UKAbstract: Acute intestinal obstruction due to foreign bodies, or bezoar, is a rare occurrence in an adult with a normal intestinal tract. We report an unusual case of a 43-year-old black man with no previous abdominal surgery and no significant medical history who presented with an acute episode of small bowel obstruction due to an impacted undigested chicken bone.Keywords: small bowel obstruction, chicken bone, bezoar

  20. Small bowel enteroscopy and intraoperative enteroscopy for obscure gastrointestinal bleeding.

    Science.gov (United States)

    Lewis, B S; Wenger, J S; Waye, J D

    1991-02-01

    Intraoperative endoscopy (IOE) is accepted as the ultimate diagnostic procedure for completely evaluating the small bowel in patients with obscure gastrointestinal (GI) bleeding. Small bowel enteroscopy (SBE) has been reported useful in the nonsurgical evaluation of the small intestine in these patients, but findings may be limited because of incomplete small bowel intubation and a lack of tip deflection. Twenty-three patients underwent 25 SBE exams and subsequently had 25 IOE exams during surgical exploration for continued bleeding. Patients' bleeding histories averaged 2 yr, with an average transfusion requirement of 27 units. Findings on IOE were the same as with SBE in 17/22 (77%) of examinations. We conclude that SBE and IOE are comparable in depth of insertion and ability to detect small vascular ectasias. Both procedures missed pathology due to limited visibility and the evanescent nature of ectasias. Long-term success in abolishing bleeding with these combined techniques can be expected in 55% of these patients. SBE should precede surgery, since the finding of diffuse ectasias precludes any benefit from operative intervention.

  1. Small bowel preparations for capsule endoscopy with mannitol and simethicone: a prospective, randomized, clinical trial.

    Science.gov (United States)

    Chen, Hong-bin; Huang, Yue; Chen, Su-yu; Song, Hui-wen; Li, Xiao-lin; Dai, Dong-lin; Xie, Jia-tia; He, Song; Zhao, Yuan-yuan; Huang, Chun; Zhang, Sheng-jun; Yang, Lin-na

    2011-04-01

    There is no consensus concerning small bowel preparation before capsule endoscopy (CE). This study evaluated the effects of 4 regimens on small bowel cleansing and diagnostic yield. Patients were randomly divided into 4 groups. Group A consumed a clear liquid diet after lunch on the day before CE, followed by overnight fasting. Group B took 250 mL 20% mannitol and 1 L 0.9% saline orally at 05:00 hours on the day of the procedure. In group C, the same regimen was taken at 20:00 hours on the day before and at 05:00 hours on the day of CE. In group D, in addition to the group C regimen, 20 mL oral simethicone was taken 30 minutes before CE. Two hundred patients were prospectively enrolled, and 7 were excluded from the final analysis because of incomplete small bowel transit. No significant difference was noted among the 4 groups for small bowel transit time. Bowel preparation in group D was significantly better than for the other regimens for overall cleansing of the proximal small bowel, and showed improved overall cleansing of the distal small bowel when compared with 10-hours overnight fasting. Pathological lesions of the proximal and distal small bowel were, respectively, achieved in 82 and 74 patients, mostly distributed in group D. Small bowel preparation that involves split-dose oral mannitol plus single-dose simethicone for CE can improve mucosal visualization and subsequent diagnostic yield when compared with 10-hours overnight fasting.

  2. Non-emergency small bowel obstruction: assessment of CT findings that predict need for surgery

    Energy Technology Data Exchange (ETDEWEB)

    Deshmukh, Swati D.; Shin, David S.; Willmann, Juergen K.; Rosenberg, Jarrett; Shin, Lewis; Jeffrey, R.B. [Stanford University, School of Medicine, Department of Radiology, Stanford, CA (United States)

    2011-05-15

    To identify CT findings predictive of surgical management in non-emergency small bowel obstruction (SBO). Contrast-enhanced abdominal CT of 129 patients with non-emergency SBO were evaluated for small bowel luminal diameter, wall thickness, presence of the small bowel faeces sign (intraluminal particulate matter in a dilated small bowel) and length, transition point, submucosal oedema, mesenteric stranding, ascites and degree of obstruction (low grade partial, high grade partial and complete obstruction). Medical records were reviewed for age, gender, management and history of abdominal surgery, abdominal malignancy, or SBO. Statistical analyses were performed with Stata Release 9.2. Degree of obstruction was the only predictor of need for surgery. Whereas 18.0% of patients with low-grade partial obstruction (n = 50) underwent surgery, 32.5% of patients with high-grade partial obstruction (n = 77) and 100% of patients with complete obstruction (n = 2) required surgery (P = 0.004). The small bowel faeces sign was inversely predictive of surgery (P = 0.018). In non-emergency SBO patients with contrast-enhanced CT imaging, grade of obstruction predicts surgery, while the small bowel faeces sign inversely predicts need for surgery. (orig.)

  3. The effect of barium infusion rate on the diagnostic value of small bowel enteroclysis

    International Nuclear Information System (INIS)

    Oudkerk, M.; Rijke, A.M.

    1988-01-01

    Although enteroclysis may have many advantages over the conventional methods of small bowel examination, the contrast material is not always infused at a rate appropriate to gain maximum diagnostic information. In this study, 190 patients were examined by small bowell enteroclysis at five contrast infusion rates ranging from 50 to 150 ml/min using a newly designed infusion pump system. The results show that at rates above 75 ml/min, motility disturbances are masked by small bowel dilatation and paralysis, transit times are extended and morphological detail is obscured. At rates below 75 ml/min, incomplete filling of the loops renders optimal diagnostic evaluation impossible. An infusion rate of 75 ml/min was found to be optimal for initiating small bowel studies. This rate can be adjusted for individual cases when pathology or drugs affect the motility of the small bowel. 13 refs.; 5 figs.; 1 table

  4. Progress ill Small-Bowel Physiology and Disease

    African Journals Online (AJOL)

    1971-10-23

    Oct 23, 1971 ... The epithelial cell of the small-bowel mucosa is second ... an important part in the entrapment of fat micelles before absorption at the .... died with a gastric carcinoma. ... termed 'Mediterranean' because of its frequency in.

  5. Small Bowel Review: Part I

    Directory of Open Access Journals (Sweden)

    ABR Thomson

    1996-01-01

    Full Text Available Major scientific advances have been made over the past few years in the areas of small bowel physiology, pathology, microbiology and clinical sciences. Over 1000 papers have been reviewed and a selective number are considered here. Wherever possible, the clinical relevance of these advances have been identified. There have been a number of important and/or interesting developments in the past year that have clinical significance.

  6. The radiolesions of the small bowel

    International Nuclear Information System (INIS)

    Bories-Azeau, A.; Dayan, L.

    1980-01-01

    The irradiation of the pelvic abdominal cancers extends beyond the centre of the tumour and may induce actinic digestive lesions. The bowel and more rarely the small bowel -which is the subject-matter of our study- are concerned by those radiolesions that are favoured by therapeutic overdose, post-operative adhesions fastening the bows, radio-surgical or chemicostatic associations, and lastly by vascular or nutritive deficiencies. One may distinguish between two kinds of lesions, depending on the lapse of time before their coming out and on the symptoms. The early or acute types are characterized by a radio-mucitis and give an exsudative enteropathy with anorexia, vomiting, diarrhoea and loss of weight, of which the diagnosis is easy because it occurs during the irradiation and lessens at the end of the treatment. The late radiolesions of the small bowel are characterized by sclerosis and chronic endarteritis and, after a longlasting period of latency, give varied symptoms: disordered intestinal transit which sometimes is irreversible, perforation, fistula, syndrome of malabsorption, giving often rise to be mistaken for a recurrence of the cancer. The treatment varies whether the lesion is segmental or diffuse. In the first case, the failure of the medical means accounts for the surgical cutting away or the internal derivation; in the second case, the digestive mutilation which would result from an enlargement of the lesion commands to be more cautious and to call for the methods of parenteral feeding and digestive setting to rest [fr

  7. Imaging the small bowel.

    LENUS (Irish Health Repository)

    Murphy, Kevin P

    2014-03-01

    Radiologic investigations continue to play a pivotal role in the diagnosis of pathologic conditions of the small intestine despite enhancement of capsule endoscopy and double-balloon endoscopy. Imaging techniques continue to evolve and new techniques in MRI in particular, are being developed.

  8. Retroperitoneal fibrosis: A rare cause of both ureteral and small bowel obstruction

    Institute of Scientific and Technical Information of China (English)

    Faisal Aziz; Srinivasulu Conjeevaram; Than Phan

    2006-01-01

    Retroperitoneal fibrosis (RPF) is a rare condition of unclear etiology. It can cause ureteral obstruction. We present the unique case of a 54 years old female, who initially presented with spontaneous perforation of the cecum. Upon exploring the abdomen, the classical glistening white, unyielding retroperitoneal fibrosis was encountered. A right hemicolectomy was performed.Subsequently, the patient presented with bilateral ureteral obstruction, and later on with small bowel obstruction. Ureteral obstruction was treated with stents,and small bowel obstruction was treated with bypass.To our knowledge no case of idiopathic RPF presenting with features of both bilateral ureteral and small bowel obstruction has been reported in the literature.

  9. A simple technique to reduce small bowel toxicity when irradiating the periaortic area

    International Nuclear Information System (INIS)

    Hernandez, J.C.; Fine, B.; Herman, T.S.; Rothenberg, M.; Nicol, N.

    1996-01-01

    Purpose/Objective: Patients receiving periaortic radiation are normally treated in the supine position. We decided to evaluate whether positioning the patient prone on a modified 'belly-board' can reduce the volume of small bowel within the lateral fields in patients receiving four field periaortic radiation. Materials and Methods: Sixteen consecutive women with gynecologic primaries underwent simulation of the periaortic area using a four-field set up (AP, PA, Lats). The fields extended from the top of the L1 vertebral body to the bottom of L5 and had a mean length of 16.2 cm. The AP and PA fields had a width of 8 cm (centered on the midline of the vertebral bodies) while the right and left lateral fields had a width of 4 cm (2 cm anterior and 2 cm posterior to the anterior margin of the vertebral bodies) and did not include the spinal cord. Following oral ingestion of small bowel contrast, simulation films were obtained in the supine position and in the prone position on a modified 'belly-board' (with the pelvic opening extended superiorly to the superior abdomen). It was hypothesized that the prone position on a modified 'belly-board' would allow the abdominal small bowel to fall by gravity away from the periaortic area. We measured the volume of small bowel irradiated through the lateral fields for both the supine and prone-in-belly-board positions using the method described by Gallagher et al. Results: The volume of small bowel included within the lateral fields in the supine position ranged from 164 to 359.5 cc 3 (mean 285 cc 3 ) while placement in the prone-in-bellyboard position reduced the volume of small bowel within the lateral fields to a range of 35-152 cc 3 (mean 86 cc 3 ), an overall reduction of approximately 70% in the volume of small bowel included within lateral fields. Conclusion: The use of lateral fields in the prone-in-bellyboard position allows for significant small bowel sparing through the lateral component of a four-field periaortic set

  10. Imaging findings of hepatoid adenocarcinoma of the small bowel: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jong Won; Kim, Kyoung Ah; Jung, Sang Geun [CHA Bundang Medical Center, CHA University College of Medicine, Seongnam (Korea, Republic of)

    2016-12-15

    Hepatoid adenocarcinoma is a rare extrahepatic tumor defined as having a morphologic and immunohistochemical similarity to hepatocellular carcinoma. In this case report, we describe a patient with hepatoid adenocarcinoma of the jejunum with multiple liver metastases that developed in the absence of risk factors. We describe the radiologic findings including those of dynamic computed tomography and small bowel follow-through. To the best of our knowledge, only two cases of hepatoid adenocarcinoma of the small bowel have been reported in patients with inflammatory bowel disease.

  11. Historical analysis of experience with small bowel capsule endoscopy in a spanish tertiary hospital.

    Science.gov (United States)

    Egea Valenzuela, Juan; Carrilero Zaragoza, Gabriel; Iglesias Jorquera, Elena; Tomás Pujante, Paula; Alberca de Las Parras, Fernando; Carballo Álvarez, Fernando

    2017-02-01

    Capsule endoscopy was approved by the FDA in 2001. Gastrointestinal bleeding and inflammatory bowel disease are the main indications. It has been available in our hospital since 2004. We retrospectively analysed data from patients who underwent small bowel capsule endoscopy in our hospital from October 2004 to April 2015. Indications were divided into: Obscure gastrointestinal bleeding (occult and overt), inflammatory bowel disease, and other indications. Findings were divided into: Vascular lesions, inflammatory lesions, other lesions, normal studies, and inconclusive studies. A total of 1027 out of 1291 small bowel studies were included. Mean patient age was 56.45 years; 471 were men and 556 women. The most common lesion observed was angiectasia, as an isolated finding or associated with other lesions. Findings were significant in up to 80% of studies when the indication was gastrointestinal bleeding, but in only 50% of studies in inflammatory bowel disease. Diagnostic yield was low in the group «other indications». No major complications were reported. Small bowel capsule endoscopy has high diagnostic yield in patients with gastrointestinal bleeding, but yield is lower in patients with inflammatory bowel disease. Our experience shows that capsule endoscopy is a safe and useful tool for the diagnosis of small bowel disease. The diagnostic yield of the technique in inflammatory bowel disease must be improved. Copyright © 2016 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

  12. Abnormalities of small bowel and colon in systemic sclerosis

    International Nuclear Information System (INIS)

    Scutellari, P.N.; Cinotti, A.; Cavallari, L.; Orzincolo, C.; Dovigo, L.; Trotta, F.; Menegale, G.

    1990-01-01

    A series of 21 subjects (2 males and 19 females) affected with systemic sclerosis, was examined by small bowel (oral and intubation methods) and colon enema. The underlying process responsible for abnormalities in the small bowel and colon in systemic sclerosis is a variable and pacthy destruction of the muscularis propria, that produces the structural and functional changes detected on X-ray: Pathologic condition is the same affecting the esophagus. The scout film of the abdomen often reveals colonic distension and fecal impaction, so that it may be quite difficult to prepare adequately the patients for a barium enema. Peristalsis may be virtually absent in short segments, and transit time may be several time longer than that in normal patients. For these reasons, intestinal pseudo-obstruction may appear in systemic sclerosis. The observed radiographic changes are: 1) in the small bowel: a) dilatation of the gut, especially in its proximal portions (duodenum and jejunum), in which the valvulae conniventes are straightened, normal or thinned; b) presence of diverticula, 2-4 cm in diameter, with hemispherical shape without the neck-like opening into the bowel lumen; 2) in the colon, the characteristic finding is an increase in size of individual haustra, forming sacculations or pseudo-diverticula, usually on the antemesenteric border of the transverse colon, better demonstrated on post-evacuation film. Moreover, loss of colonic haustration is also observed associated to colonic elongation and dilatation

  13. The effects of erythromycin in small-bowel follow-through

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Hyun Yong; Lee, Young Hwan; Jung, Kyung Jae; Chung, Duck Soo; Kim, Ok Dong; Hwang, Jin Bok [Catholic Univ. School of Medicine, Daegu (Korea, Republic of)

    2001-05-01

    To evaluate the efficacy of erythromycin(EM), known to accelerate gastric emptying, in modified small-bowel follow-through(SBFT). We evaluated 32 normal patients who underwent modified SBFT by oral administration of methylcellulose. In the EM injection group(n=20), 500 mg EM (3 mg/kg in pediatric patients) in 100 ml saline was infused intravenously over a 15-minute period prior to the administration of a barium meal, while in the control group(n=12), EM was not infused. Gastric emptying time(GET), small-bowel transit time(SBTT) for barium and methylcellulose, small-bowel transit(SBT) during the first 15 minutes, luminal diameter and quality of image were compared between the two groups. SBT was assigned 1, 2, 3, or 4 points, depending on the extent to which the barium head reached the proximal or distal jejunum, and the proximal or distal ileum during the initial 15-minute. Three radiologists reached a consensus as to image quality. Mean GET was significantly faster in the EM injection group (18.5 mins for 150 ml barium suspension and 25.8 mins for 600 ml methylcellulose). The SBT score during the initial 15 minutes was significantly higher in the EM injection group (3.3 points) than in the control group (2.4points), but mean SBTT was not significantly different between the two groups. Luminal diameter and image quality were also higher in the EM injection group. EM does not decrease SBTT but is highly effective for shortening gastric emptying time, helping to increase the range of fluoroscopic examination and improve image quality in modified small-bowel follow-through, especially in patients with delayed gastric emptying.

  14. Whirl sign as CT finding in small-bowel volvulus

    International Nuclear Information System (INIS)

    Fujimoto, K.; Nakamura, K.; Nishio, H.; Takashima, S.; Minakuchi, K.; Onoyama, Y.; Nomura, K.; Hayata, S.

    1995-01-01

    In three patients with ileus CT showed a whirl sign in which the bowel and mesenteric folds encircled the superior mesenteric vein in a whirl-like pattern. Two patients were confirmed surgically to have small-bowel volvulus arising from postoperative adhesions. The whirl sign is useful in decision-making about the need for surgery. A CT examination should be performed for patients with ileus of unknown cause. (orig.)

  15. Whirl sign as CT finding in small-bowel volvulus

    Energy Technology Data Exchange (ETDEWEB)

    Fujimoto, K. [Dept. of Radiology, Osaka City Univ. Medical School, Osaka (Japan); Nakamura, K. [Dept. of Radiology, Osaka City Univ. Medical School, Osaka (Japan); Nishio, H. [Dept. of Radiology, Osaka City Univ. Medical School, Osaka (Japan); Takashima, S. [Dept. of Radiology, Osaka City Univ. Medical School, Osaka (Japan); Minakuchi, K. [Dept. of Radiology, Osaka City Univ. Medical School, Osaka (Japan); Onoyama, Y. [Dept. of Radiology, Osaka City Univ. Medical School, Osaka (Japan); Nomura, K. [Dept. of Radiology, Higashi-Osaka Ikeda Hospital, Osaka (Japan); Hayata, S. [Dept. of Surgery, Higashi-Osaka Ikeda Hospital, Osaka (Japan)

    1995-12-31

    In three patients with ileus CT showed a whirl sign in which the bowel and mesenteric folds encircled the superior mesenteric vein in a whirl-like pattern. Two patients were confirmed surgically to have small-bowel volvulus arising from postoperative adhesions. The whirl sign is useful in decision-making about the need for surgery. A CT examination should be performed for patients with ileus of unknown cause. (orig.)

  16. Gastric emptying rate and small bowel transit time in patients with irritable bowel syndrome determined with 99mTc-labeled pellets and scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Nielsen, O.H.; Gjorup, T.; Christensen, F.N.

    1986-12-01

    A new method employing 99mTc-labeled pellets for determination of the gastric emptying rate and small bowel transit time is described. The participants were six normal subjects and 16 patients with irritable bowel syndrome (eight with diarrhea and eight with obstipation as the primary complaint). The gastric emptying rate was the same in the three groups. The patients in the obstipation group had a significantly longer small bowel transit time than the normals (P less than 0.02) and the patients in the diarrhea group (P less than 0.01). There was no demonstrable difference between the small bowel transit time in the normals and in the patients in the diarrhea group.

  17. Gastric emptying rate and small bowel transit time in patients with irritable bowel syndrome determined with 99mTc-labeled pellets and scintigraphy

    International Nuclear Information System (INIS)

    Nielsen, O.H.; Gjorup, T.; Christensen, F.N.

    1986-01-01

    A new method employing 99mTc-labeled pellets for determination of the gastric emptying rate and small bowel transit time is described. The participants were six normal subjects and 16 patients with irritable bowel syndrome (eight with diarrhea and eight with obstipation as the primary complaint). The gastric emptying rate was the same in the three groups. The patients in the obstipation group had a significantly longer small bowel transit time than the normals (P less than 0.02) and the patients in the diarrhea group (P less than 0.01). There was no demonstrable difference between the small bowel transit time in the normals and in the patients in the diarrhea group

  18. Detection of high-grade small bowel obstruction on conventional radiography with convolutional neural networks.

    Science.gov (United States)

    Cheng, Phillip M; Tejura, Tapas K; Tran, Khoa N; Whang, Gilbert

    2018-05-01

    The purpose of this pilot study is to determine whether a deep convolutional neural network can be trained with limited image data to detect high-grade small bowel obstruction patterns on supine abdominal radiographs. Grayscale images from 3663 clinical supine abdominal radiographs were categorized into obstructive and non-obstructive categories independently by three abdominal radiologists, and the majority classification was used as ground truth; 74 images were found to be consistent with small bowel obstruction. Images were rescaled and randomized, with 2210 images constituting the training set (39 with small bowel obstruction) and 1453 images constituting the test set (35 with small bowel obstruction). Weight parameters for the final classification layer of the Inception v3 convolutional neural network, previously trained on the 2014 Large Scale Visual Recognition Challenge dataset, were retrained on the training set. After training, the neural network achieved an AUC of 0.84 on the test set (95% CI 0.78-0.89). At the maximum Youden index (sensitivity + specificity-1), the sensitivity of the system for small bowel obstruction is 83.8%, with a specificity of 68.1%. The results demonstrate that transfer learning with convolutional neural networks, even with limited training data, may be used to train a detector for high-grade small bowel obstruction gas patterns on supine radiographs.

  19. Wireless capsule endoscopy of the small bowel: development, testing, and first human trials

    Science.gov (United States)

    Swain, Paul; Iddan, Gavriel J.; Meron, Gavriel; Glukhovsky, Arkady

    2001-01-01

    Small bowel endoscopy with existing endoscopes is limited by problems of discomfort and the technical difficulty of advancing far into the small-bowel. Our aim has been to develop and test wireless capsule endoscopy. Wireless endoscopes, in the form of capsules (11 x 33 mm), were constructed by Given Imaging. These were powered by silver oxide batteries and each contained a CMOS imaging chip and miniature processor, white light emitting diodes (LEDs), a short focal length lens, and a miniature transmitter and antenna. Two video frames per second were transmitted, using radio-frequency (approx. 410 MHz), to an array of aerials attached to the body. The array of aerials can also be used to calculate the position of the capsule in the body. The images were stored on a portable recorder carried on a belt and subsequently downloaded for analysis. The batteries allow more than 5 hours of recording, although the capsule generally passes through the whole small bowel in under two hours. Clear video images of the human bowel were recorded from the pylorus to the caecum. Wireless endoscopy, for the first time, allows painless optical imaging of the whole of the small bowel.

  20. Small bowel perforation without tumor recurrence after radiotherapy for cervical carcinoma: report of seven cases.

    Science.gov (United States)

    Yamashita, Hideomi; Nakagawa, Keiichi; Tago, Masao; Igaki, Hiroshi; Shiraishi, Kenshirou; Nakamura, Naoki; Sasano, Nakashi; Yamakawa, Sen; Ohtomo, Kuni

    2006-04-01

    We describe the clinical presentation, evaluation, management and outcome of patients experiencing small bowel perforation following radiation therapy for cervical cancer. A database consisting of 95 Japanese women with stage 0-4 A cervix cancer treated between 1991 and 2004 contained seven patients (7.4%) with small bowel perforation. The median age at the time of perforation was 72.5 years (range 62-78). The median time from completion of radiotherapy to perforation was 6 months (range 2-58). Surgery (one small bowel resection and anastomosis with diversion; six small bowel resection and anastomosis) was performed immediately in all seven patients. One of seven patients died of small bowel perforation (i.e. mortality rate was 14%). Bowel adhesion was detected during the operation in only three cases (43%). Signs of peritonitis were absent in six cases (86%). Severe abdominal pain was seen in all seven patients. The perforation site was ileum in all seven cases. In all patients, pathological changes were compatible with postirradiation injury of the gastrointestinal tract. The presenting complaints of patients with bowel perforation following radiotherapy vary, and signs of peritonitis may be absent. Emergency physicians must be alert for these complications in patients who have been treated with radiotherapy.

  1. X-ray findings of small bowel taeniasis: A clinical and experimental study

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hong Soo; Kang, Hee Woong; Bahk, Yong Whee [St Mary' s Hospital Catholic Medical College, Seoul (Korea, Republic of)

    1972-12-15

    Unlike ascariasis of the small bowel, taeniasis can be detected radiologically with much difficulty because of the basic difference between the morphological features of each helminth. However once the characteristics of tape worms are appreciated and kept in mind, radiological diagnosis is fairly accurately made. In the present study we have reported typical radiological features of the small bowel taeniasis as observed in 6 adults patients seen at the Department of Radiology of St. Mary's Hospital and Holy Family Hospital, Catholic Medical College. Tapering tape-like or ribbon -like radiolucent shadows in distal small bowel appear unique. Compression spot film study of the ileum is most important in revealing such findings. An animal experiment using the swine small intestine and parasitological specimen of evacuated worm of taenia saginata was designed to help understand radiological manifestation in vivo.

  2. X-ray findings of small bowel taeniasis: A clinical and experimental study

    International Nuclear Information System (INIS)

    Kim, Hong Soo; Kang, Hee Woong; Bahk, Yong Whee

    1972-01-01

    Unlike ascariasis of the small bowel, taeniasis can be detected radiologically with much difficulty because of the basic difference between the morphological features of each helminth. However once the characteristics of tape worms are appreciated and kept in mind, radiological diagnosis is fairly accurately made. In the present study we have reported typical radiological features of the small bowel taeniasis as observed in 6 adults patients seen at the Department of Radiology of St. Mary's Hospital and Holy Family Hospital, Catholic Medical College. Tapering tape-like or ribbon -like radiolucent shadows in distal small bowel appear unique. Compression spot film study of the ileum is most important in revealing such findings. An animal experiment using the swine small intestine and parasitological specimen of evacuated worm of taenia saginata was designed to help understand radiological manifestation in vivo

  3. Adhesive small bowel obstruction due to pelvic inflammatory disease: A case report

    Directory of Open Access Journals (Sweden)

    Razan A Al-Ghassab

    2018-01-01

    Full Text Available We report a rare case of a 32-year-old woman with adhesive small bowel obstruction due to pelvic inflammatory disease. She had no history of abdominal surgery, gynecological complaints or constitutional symptoms of chronic illness. The diagnosis was based on the laparoscopic findings of small bowel adhesions, free peritoneal fluid, “violin string” adhesions of Fitz-Hugh–Curtis syndrome and left hydrosalpinx. Laparoscopic adhesiolysis was performed successfully, and the patient had an uneventful postoperative course. The authors conclude that pelvic inflammatory disease should be included as a cause of adhesive small bowel obstruction in sexually active young women with no history of abdominal surgery or constitutional symptoms of chronic disease. When performed by experienced surgeons, laparoscopy in such patients is feasible and safe.

  4. Small animal MRI: clinical MRI as an interface to basic biomedical research

    International Nuclear Information System (INIS)

    Pinkernelle, J.G.; Stelter, L.; Hamm, B.; Teichgraeber, U.

    2008-01-01

    The demand for highly resolved small animal MRI for the purpose of biomedical research has increased constantly. Dedicated small animal MRI scanners working at ultra high field strengths from 4.7 to 7.0 T and even above are MRI at its best. However, using high resolution RF coils in clinical scanners up to 3.0 T, small animal MRI can achieve highly resolved images showing excellent tissue contrast. In fact, in abundant experimental studies, clinical MRI is used for small animal imaging. Mostly clinical RF coils in the single-loop design are applied. In addition, custom-built RF coils and even gradient inserts are used in a clinical scanner. For the reduction of moving artifacts, special MRI-compatible animal ECG und respiration devices are available. In conclusion, clinical devices offer broad availability, are less expense in combination with good imaging performance and provide a translational nature of imaging results. (orig.)

  5. Does MRI with oral contrast medium allow single-study depiction of inflammatory bowel disease enteritis and colitis?

    International Nuclear Information System (INIS)

    Cronin, Carmel G.; Lohan, Derek G.; Browne, Ann Michelle; Roche, Clare; Murphy, Joseph M.

    2010-01-01

    To assess the feasibility and utility of magnetic resonance (MR) imaging of the bowel in concurrent small- and large-bowel evaluation for the presence of inflammatory bowel disease (IBD). Over a 5-year period, 62 MR examinations performed on 53 patients demonstrated evidence of IBD. Sixteen of these 53 (30.1%) patients had imaging findings of colonic disease and underwent 19 formal MR small bowel examinations. These were further evaluated for bowel distention and image quality. The sensitivity and specificity of the technique compared with colonoscopy as the 'gold standard' was evaluated. Simultaneous imaging of the colon is feasible at MR small bowel follow-through with moderate-to-excellent colonic visibility and colon distention obtained when the contrast medium is present in the colon at the time of image acquisition. MR imaging had a sensitivity of 80% (0.56-0.93), specificity of 100% (0.77-1.00), positive predictive value (PPV) of 1 and a negative predictive value (NPV) of 0.8 for the identification of colitis (based on available concurrent correlation of 38/62 examinations with colonoscopy). Small and large bowel MR imaging with orally consumed contrast medium represents a promising, feasible, non-invasive, non-radiating single mode of assessment of the entire gastrointestinal tract, performed at a single sitting. (orig.)

  6. High-resolution array comparative genomic hybridization in sporadic and celiac disease-related small bowel adenocarcinomas.

    NARCIS (Netherlands)

    Diosdado, B.; Buffart, T.E.; Watkins, R.; Carvalho, B.; Ylstra, B.; Tijssen, M.; Bolijn, A.S.; Lewis, F.; Maude, K.; Verbeke, C.; Nagtegaal, I.D.; Grabsch, H.; Mulder, C.J.; Quirke, P.; Howdle, P.; Meijer, G.A.

    2010-01-01

    PURPOSE: The molecular pathogenesis of small intestinal adenocarcinomas is not well understood. Understanding the molecular characteristics of small bowel adenocarcinoma may lead to more effective patient treatment. EXPERIMENTAL DESIGN: Forty-eight small bowel adenocarcinomas (33 non-celiac disease

  7. Goblet Cell Carcinoid Tumor of the Appendix with Small Bowel Obstruction: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Su Yeon; Jang, Kyung Mi; Kim, Min Jeong; Koh, Sung Hye; Jeon, Eui Yong; Min, Kwang Seon; Seo, Jin Won; Park, Hyoung Chul [Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)

    2009-09-15

    Goblet cell carcinoid tumor of the appendix (GCTA) is a tumor with histological features of both adenocarcinoma and carcinoid tumors. The most common clinical presentation of GCTA is acute appendicitis, although small bowel obstruction has been reported as a rare clinical symptom of GCTA. However, to the best of our knowledge, the CT feature of small bowel obstructions in patients with GCTA has not been reported to date. Here, we present a case of small bowel obstruction in a patient with GCTA caused by extensive tumor infiltration at the terminal ileum and distal ileum.

  8. Small Bowel Review: Part I

    Directory of Open Access Journals (Sweden)

    ABR Thomson

    2000-01-01

    Full Text Available In the past year, there have been many advances in the area of small bowel physiology and pathology. More than 1500 papers were assessed in preparation for this review. Some were selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist. Relevant review articles have been highlighted, and important clinical learning points have been stressed. The topics are varied in scope, and wherever possible show a logical progression from basic physiology to pathophysiology to clinical disorders and management.

  9. Small Bowel Review: Part II

    Directory of Open Access Journals (Sweden)

    ABR Thomson

    2001-01-01

    Full Text Available In the past year, there have been many advances in the area of small bowel physiology and pathology. In preparation for this review, over 1500 papers were assessed. Some have been selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist. Relevant review articles have been highlighted, and important clinical learning points have been stressed. The topics are varied in scope and wherever possible show a logical progression from basic physiology to pathophysiology to clinical disorders and management.

  10. Quantification, validation, and follow-up of small bowel motility in Crohn's disease

    Science.gov (United States)

    Cerrolaza, Juan J.; Peng, Jennifer Q.; Safdar, Nabile M.; Conklin, Laurie; Sze, Raymond; Linguraru, Marius George

    2015-03-01

    The use of magnetic resonance enterography (MRE) has become a mainstay in the evaluation, assessment and follow up of inflammatory bowel diseases, such as Crohn's disease (CD), thanks to its high image quality and its non-ionizing nature. In particular, the advent of faster MRE sequences less sensitive to image-motion artifacts offers the possibility to obtain visual, structural and functional information of the patient's small bowel. However, the inherent subjectivity of the mere visual inspection of these images often hinders the accurate identification and monitoring of the pathological areas. In this paper, we present a framework that provides quantitative and objective motility information of the small bowel from free-breathing MRE dynamic sequences. After compensating for the breathing motion of the patient, we create personalized peristaltic activity maps via optical flow analysis. The result is the creation of a new set of images providing objective and precise functional information of the small bowel. The accuracy of the new method was also evaluated from two different perspectives: objective accuracy (1.1 ± 0.6 mm/s of error), i.e., the ability of the system to provide quantitative and accurate information about the motility of moving bowel landmarks, and subjective accuracy (avg. difference of 0.7 ± 0.7 in a range of 1 to 5), i.e., the degree of agreement with the subjective evaluation of an expert. Finally, the practical utility of the new method was successfully evaluated in a preliminary study with 32 studies of healthy and CD cases, showing its potential for the fast and accurate assessment and follow up of CD in the small bowel.

  11. Cine Magnetic Resonance Imaging of the Small Bowel: Comparison of Different Oral Contrast Media

    International Nuclear Information System (INIS)

    Asbach, P.; Breitwieser, C.; Diederichs, G.; Eisele, S.; Kivelitz, D.; Taupitz, M.; Zeitz, M.; Hamm, B.; Klessen, C.

    2006-01-01

    Purpose: To evaluate several substances regarding small bowel distension and contrast on balanced steady-state free precession (bSSFP) cine magnetic resonance (MR) images. Material and Methods: Luminal contrast was evaluated in 24 volunteers after oral application of two different contrast agent groups leading to either bright lumen (pineapple, blueberry juice) or dark lumen (tap water, orange juice) on T1-weighted images. Bowel distension was evaluated in 30 patients ingesting either methylcellulose or mannitol solution for limiting intestinal absorption. Fifteen patients with duodeno-jejunal intubation served as the control. Quantitative evaluation included measurement of luminal signal intensities and diameters of four bowel segments, qualitative evaluation assessed luminal contrast and distension on a five-point scale. Results: Quantitative and qualitative evaluation of the four contrast agents revealed no significant differences regarding luminal contrast on bSSFP images. Quantitative evaluation revealed significantly lower (P<0.05) small bowel distension for three out of four segments (qualitative evaluation: two out of four segments) for methylcellulose in comparison to the control. Mannitol was found to be equal to the control. Conclusion: Oral ingestion of tap water or orange juice in combination with mannitol is recommended for cine MR imaging of the small bowel regarding luminal contrast and small bowel distension on bSSFP sequences

  12. Cine Magnetic Resonance Imaging of the Small Bowel: Comparison of Different Oral Contrast Media

    Energy Technology Data Exchange (ETDEWEB)

    Asbach, P.; Breitwieser, C.; Diederichs, G.; Eisele, S.; Kivelitz, D.; Taupitz, M.; Zeitz, M.; Hamm, B.; Klessen, C. [Charite - Universitatsmedizin Berlin, Charite Campus Mitte, Berlin (Germany). Dept. of Radiology

    2006-11-15

    Purpose: To evaluate several substances regarding small bowel distension and contrast on balanced steady-state free precession (bSSFP) cine magnetic resonance (MR) images. Material and Methods: Luminal contrast was evaluated in 24 volunteers after oral application of two different contrast agent groups leading to either bright lumen (pineapple, blueberry juice) or dark lumen (tap water, orange juice) on T1-weighted images. Bowel distension was evaluated in 30 patients ingesting either methylcellulose or mannitol solution for limiting intestinal absorption. Fifteen patients with duodeno-jejunal intubation served as the control. Quantitative evaluation included measurement of luminal signal intensities and diameters of four bowel segments, qualitative evaluation assessed luminal contrast and distension on a five-point scale. Results: Quantitative and qualitative evaluation of the four contrast agents revealed no significant differences regarding luminal contrast on bSSFP images. Quantitative evaluation revealed significantly lower (P<0.05) small bowel distension for three out of four segments (qualitative evaluation: two out of four segments) for methylcellulose in comparison to the control. Mannitol was found to be equal to the control. Conclusion: Oral ingestion of tap water or orange juice in combination with mannitol is recommended for cine MR imaging of the small bowel regarding luminal contrast and small bowel distension on bSSFP sequences.

  13. Magnesium sulfate as an oral contrast medium in magnetic resonance imaging of the small intestine.

    Science.gov (United States)

    Shi, Hao; Liu, Cun; Ding, Hong Yu; Li, Chun Wei

    2012-03-01

    To explore the use of magnesium sulfate (MgSO4) as an oral contrast medium (CM) in MRI of the small intestine. By comparing MgSO4 SNRs at different concentrations, we determined that 2.5% MgSO4 is the ideal concentration for small bowel MRI. Twenty volunteers underwent MRI after drinking 2.5% MgSO4. Thirty-one patients with clinical suspicion of small intestinal pathology underwent both MRI and the air-barium contrast examination. The patient's tolerance, side effects and complications were noted. 2.5% MgSO4 can decrease the absorption of water and fully fill the enteric cavity, thereby increasing the contrast between the intestinal wall and lumen and facilitating radiographic examination of the small bowel. The mean diameter of the small intestine was 19.8±1.21 mm in the 20 volunteers consuming 2.5% MgSO4 and 12.7±0.84 mm in the 20 volunteers given water. There was a significant difference (P0.05) in side effects between MgSO4 and water groups. Small intestinal MRI was successfully performed in all 31 patients, who were also examined by the double contrast barium, which gave almost identical diagnoses to MRI in all cases except for 1 patient with small intestinal hemorrhage. MRI with 2.5% MgSO4 can demonstrate intestinal abnormalities. Therefore, 2.5% MgSO4 solution is an ideal oral CM for small bowel MRI. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  14. Diagnosis, treatment and prognosis of small bowel volvulus in adults: A monocentric summary of a rare small intestinal obstruction.

    Directory of Open Access Journals (Sweden)

    Xiaohang Li

    Full Text Available Small bowel volvulus is a rare disease, which is also challenging to diagnose. The aims of this study were to characterize the clinical and radiological features associated with small bowel volvulus and treatment and to identify risk factors for associated small bowel necrosis.Patients with small bowel volvulus who underwent operations from January 2001 to December 2015 at the First Affiliated Hospital of China Medical University (Shenyang, China were reviewed. Clinical, surgical and postsurgical data were registered and analyzed.Thirty-one patients were included for analysis. Fifteen patients were female (48.4%, with an average age of 47.7 years (18-79 years. The clinical signs and symptoms were unspecific and resembled intestinal obstruction. Clinical examination revealed abdominal distension and/or diffuse tenderness with or without signs of peritonitis. The use of CT scans, X-rays or ultrasound did not differ significantly between patients. In 9 of 20 patients that received abdominal CT scans, "whirlpool sign" on the CT scan was present. Secondary small bowel volvulus was present in 58.1% of patients, and causes included bands (3, adhesion (7, congenital anomalies (7 and stromal tumor (1. Out of the 31 patients, 15 with gangrenous small bowel had to undergo intestinal resection. Intestinal gangrene was present with higher neutrophils count (p<0.0001 and the presence of bloody ascites (p = 0.004. Three patients died of septic shock (9.68%, and the recurrence rate was 3.23%.To complete an early and accurate diagnosis, a CT scan plus physical exam seems to be the best plan. After diagnosis, an urgent laparotomy must be performed to avoid intestinal necrosis and perforation. After surgery, more than 90% of the patients can expect to have a favorable prognosis.

  15. Diagnosis, treatment and prognosis of small bowel volvulus in adults: A monocentric summary of a rare small intestinal obstruction.

    Science.gov (United States)

    Li, Xiaohang; Zhang, Jialin; Li, Baifeng; Yi, Dehui; Zhang, Chengshuo; Sun, Ning; Lv, Wu; Jiao, Ao

    2017-01-01

    Small bowel volvulus is a rare disease, which is also challenging to diagnose. The aims of this study were to characterize the clinical and radiological features associated with small bowel volvulus and treatment and to identify risk factors for associated small bowel necrosis. Patients with small bowel volvulus who underwent operations from January 2001 to December 2015 at the First Affiliated Hospital of China Medical University (Shenyang, China) were reviewed. Clinical, surgical and postsurgical data were registered and analyzed. Thirty-one patients were included for analysis. Fifteen patients were female (48.4%), with an average age of 47.7 years (18-79 years). The clinical signs and symptoms were unspecific and resembled intestinal obstruction. Clinical examination revealed abdominal distension and/or diffuse tenderness with or without signs of peritonitis. The use of CT scans, X-rays or ultrasound did not differ significantly between patients. In 9 of 20 patients that received abdominal CT scans, "whirlpool sign" on the CT scan was present. Secondary small bowel volvulus was present in 58.1% of patients, and causes included bands (3), adhesion (7), congenital anomalies (7) and stromal tumor (1). Out of the 31 patients, 15 with gangrenous small bowel had to undergo intestinal resection. Intestinal gangrene was present with higher neutrophils count (p<0.0001) and the presence of bloody ascites (p = 0.004). Three patients died of septic shock (9.68%), and the recurrence rate was 3.23%. To complete an early and accurate diagnosis, a CT scan plus physical exam seems to be the best plan. After diagnosis, an urgent laparotomy must be performed to avoid intestinal necrosis and perforation. After surgery, more than 90% of the patients can expect to have a favorable prognosis.

  16. Axial torsion of meckel's diverticulum causing small bowel obstruction in adult: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Youn, In Kyung; Lee, Su Lim; Ku, Young Mi [Dept. of Radiology, Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu (Korea, Republic of)

    2016-02-15

    Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract that is prevalent in 2–3% of the population. The lifetime risk of complications is estimated at 4%. Small bowel obstruction is the second most common complication of MD. Among the causes of bowel obstruction, axial torsion of MD is the rarest complication. Urgent surgical treatment is needed in cases of small bowel obstruction associated with torsion of MD. Pre-operative diagnosis of MD as a cause of small bowel obstruction is difficult, because the diagnosis can be made only if the diverticulum is delineated at the site of obstruction. We reported a case of axial torsion of MD with necrosis that caused proximal small bowel perforation in a 21 year old male.

  17. Urachal Cyst Causing Small Bowel Obstruction in an Adult with a Virgin Abdomen

    Directory of Open Access Journals (Sweden)

    Michael P. O’Leary

    2016-01-01

    Full Text Available Introduction. A patent urachus is a rare congenital or acquired pathology, which can lead to complications later in life. We describe a case of urachal cystitis as the etiology of small bowel obstruction in an adult without prior intra-abdominal surgery. Case Report. A 64-year-old male presented to the acute care surgery team with a 5-day history of right lower quadrant abdominal pain, distention, nausea, and vomiting. He had a two-month history of urinary retention and his past medical history was significant for benign prostate hyperplasia. On exam, he had evidence of small bowel obstruction. Computed tomography revealed high-grade small bowel obstruction secondary to presumed ruptured appendicitis. In the operating room, an infected urachal cyst was identified with adhesions to the proximal ileum. After lysis of adhesions and resection of the cyst, the patient was subsequently discharged without further issues. Conclusion. Although rare, urachal pathology should be considered in the differential diagnosis when evaluating a patient with small bowel obstruction without prior intraabdominal surgery, hernia, or malignancy.

  18. Auxiliary en-bloc liver-small bowel transplantation with partial pancreas preservation in pigs

    Institute of Scientific and Technical Information of China (English)

    Zhen-Yu Yin; Xiao-Dong Ni; Feng Jiang; Ning Li; You-Sheng Li; Xiao-Ming Wang; Jie-Shou Li

    2004-01-01

    AIM: The aim of this study was to describe an auxiliary combined liver-small bowel transplantation model with the preservation of duodenum, head of pancreas and hepatic biliary system in pigs. The technique, feasibility, security and immunosuppression were commented.METHODS: Forty outbred long-white pigs were randomized into two groups, and the auxiliary composite liver/small bowel allotransplantations were undertaken in 10 long-white pigs in each group with the recipient liver preserved.Group A was not treated with immunosuppressive drugs while group B was treated with cyclosporine A and methylprednisolone after operation. The hemodynamic changes and amylase of body fluid (including blood, urine and abdominal drain) were analyzed.RESULTS: The average survival time of the animals was 10±1.929 d (6 to 25 d) in group A while more than 30 d in group B. The pigs could tolerate the hemodynamic fluctuation during operation and the hemodynamic parameters recovered to normal 2 h after blood reperfusion. The transient high amylase level was decreased to normal one week after operation and autopsy showed no pancreatitis.CONCLUSION: Auxiliary en-bloc liver-small bowel transplantation with partial pancreas preservation is a feasible and safe model with simplified surgical techniques for composite liver/small bowel transplantation. This model may be used as a preclinical training model for clinical transplantation method, clinical liver-small bowel transplantation related complication research, basic research including immunosuppressive treatment, organ preservation, acute rejection, chronic rejection, immuno-tolerance and xenotransplantation.

  19. Alterations in myoelectric activity of the small bowel in rabbits after transarterial embolization

    International Nuclear Information System (INIS)

    Ai Songtao; Wang Xiaolin; Gong Gaoquan; Chen Yi; Lin Genlai; Zhang Feng; Li Guoping; Liu Lingxiao

    2005-01-01

    Objective: To explore alterations in myoelectric activity of the small bowel in rabbits after transarterial embolization and provide academic basis for assessing bowel viability and management. Methods: Twenty normal rabbits were selected and divided into three groups (2 mg group, n=10; 6 mg group, n=5; control group, n=5). Members of 2 mg group were embolized with PVA 2 mg, those of 6 mg group with PVA 6 mg, and the control group with normal saline 2 ml. After microcatherization embolization, myoelectric activity of the small bowel was recorded for 24 hr using chronically implanted electrodes in conscious rabbits. Results: In 2 mg group, the frequency and the amplitude of slow wave of proximal jejunum were significantly lower in post-embolization period than pre-embolization period [(17.83±0.55) cpm vs (11.59±0.23) cpm(P 0.05) and (0.1632±0.002) mV vs (0.1606±0.003) mV (P>0.05), respectively]. Conclusions: Embolization with PVA evokes significant and passive effect on basal electrical rhythm of small bowel. It could provide academic basis for assessing bowel viability to interventional embolization. (authors)

  20. Prenatal Diagnosis of a Segmental Small Bowel Volvulus with Threatened Premature Labor

    Directory of Open Access Journals (Sweden)

    Barbara Monard

    2017-01-01

    Full Text Available Fetal primary small bowel volvulus is extremely rare but represents a serious life-threatening condition needing emergency neonatal surgical management to avoid severe digestive consequences. We report a case of primary small bowel volvulus with meconium peritonitis prenatally diagnosed at 27 weeks and 4 days of gestation during threatened premature labor with reduced fetal movements. Ultrasound showed a small bowel mildly dilated with thickened and hyperechogenic intestinal wall, with a typical whirlpool configuration. Normal fetal development allowed continuation of pregnancy with ultrasound follow-up. Induction of labor was decided at 37 weeks and 2 days of gestation because of a significant aggravation of intestinal dilatation appearing more extensive with peritoneal calcifications leading to the suspicion of meconium peritonitis, associated with reduced fetal movements and reduced fetal heart rate variability, for neonatal surgical management with a good outcome.

  1. Prenatal Diagnosis of a Segmental Small Bowel Volvulus with Threatened Premature Labor

    Science.gov (United States)

    Mottet, Nicolas; Ramanah, Rajeev; Riethmuller, Didier

    2017-01-01

    Fetal primary small bowel volvulus is extremely rare but represents a serious life-threatening condition needing emergency neonatal surgical management to avoid severe digestive consequences. We report a case of primary small bowel volvulus with meconium peritonitis prenatally diagnosed at 27 weeks and 4 days of gestation during threatened premature labor with reduced fetal movements. Ultrasound showed a small bowel mildly dilated with thickened and hyperechogenic intestinal wall, with a typical whirlpool configuration. Normal fetal development allowed continuation of pregnancy with ultrasound follow-up. Induction of labor was decided at 37 weeks and 2 days of gestation because of a significant aggravation of intestinal dilatation appearing more extensive with peritoneal calcifications leading to the suspicion of meconium peritonitis, associated with reduced fetal movements and reduced fetal heart rate variability, for neonatal surgical management with a good outcome. PMID:29230337

  2. [Volvulus of the small bowel due to ascaris lumbricoides package: about a case].

    Science.gov (United States)

    Diouf, Cheikh; Kane, Ahmed; Ndoye, Ndeye Aby; Ndour, Oumar; Faye-Fall, Aimé Lakh; Fall, Mbaye; Alumeti, Désiré Munyali; Ngom, Gabriel

    2016-01-01

    We report an exceptional case of a 7 year-old patient with necrotic small bowel volvulus due to adult ascaris lumbricoides. At the admission, the child had intestinal obstruction evolving since two days with alteration of general state. Abdominal radiography without preparation showed small bowel air-fluid levels and tiger-stripe appearance evoking the diagnosis of acute intestinal obstruction associated with abdominal mass. After resuscitation, the surgical treatment consisted of laparotomy which showed necrotic volvulus of the terminal ileum containing adult ascaris lumbricoides. The patient underwent small bowel resection, approximately one meter of affected section was removed and then an ileostomy was performed. The evolution was favorable. The patient underwent ileorectal anastomosis four weeks later. After a 2 year follow-up period the child had no symptoms.

  3. [Microflora of the upper part of the small bowel in healthy Peruvian subjects].

    Science.gov (United States)

    Vidal-Neira, L; Yi-Chu, A; León Barúa, R

    1983-01-01

    In 20 healthy Peruvians aerobic cultures were done of upper small bowel contents, obtained following the method of the string capsule or Enterotest, and of faringeal material, obtained doing gargles with sterilized water. In 15 (75%) of the 20 subjects cultures of small bowel contents either were sterile (in 5 subjects, or 25% of the total) or revealed only diverse aerobic germs (in 10 subjects, or 50% of the total), the germs more frequently found being: negative coagulase staphylococcus albus (in 7 subjects, or 35% of the total), alpha hemolytic streptococcus (in 4 subjects, or 20% of the total) and Neisseria catarrhalis (in 4 subjects, or 20% of the total). In 5 (25%) of the 20 subjects, coliform bacteria were found in the upper small bowel (Klebsiella pneumonia in 2, and Escherichia coli in the remaining 3). Of those 5 subjects, only 2 (10% or the total of 20) had the microorganisms exclusively in the bowel, and in both the concentration of germs was 10(4)/ml. On the contrary, the 3 remaining subjects (15% of the total) had coliforms also in the pharynx; in 2 of the 3 subjects the concentration of germs found in the bowel was 10(3)/ml, and, in the remaining one, 10/ml; only one of the 3 subjects presented germs in the pharynx in a greater concentration than in the bowel, while another presented germs in the same concentration in both localizations, and the remaining one presented germs in the bowel in a concentration lower than in the pharynx.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Supra-transumbilical laparotomy (STL) approach for small bowel ...

    African Journals Online (AJOL)

    Background: Supra-Transumbilical Laparotomy (STL) has been used in paediatric surgery for a broad spectrum of abdominal procedures. We report our experience with STL approach for small bowel atresia repair in newborns and review previous published series on the topic. Patients and Methods: Fourteen patients with ...

  5. High sensitivity of quick view capsule endoscopy for detection of small bowel Crohn's disease

    DEFF Research Database (Denmark)

    Halling, Morten Lee; Nathan, Torben; Kjeldsen, Jens

    2014-01-01

    Capsule endoscopy (CE) has a high sensitivity for diagnosing small bowel Crohn's disease, but video analysis is time consuming. The quick view (qv) function is an effective tool to reduce time consumption. The aim of this study was to determine the rate of missed small bowel ulcerations with qv-C...

  6. Unusual causes of mechanical small bowel obstruction

    International Nuclear Information System (INIS)

    Shatnawi, Nawaf J.; Bani-Hani, Kamal E.

    2005-01-01

    We herein report our experience regarding unusual causes of bowel obstruction to increase the awareness of surgeons regarding this disease. From 1991 to 2003, we had experience at the University affiliated hospitals, northern Jordan with 24 patients with small bowel obstruction resulting from unusual causes. We retrospectively reviewed the medical records of these patients with regards to the mode of presentation, cause of obstruction, radiological and operative findings, management and outcome. We recorded 15 patients who underwent previous abdominal surgery. Preoperative diagnosis was correct in only one patient with an internal hernia, but the abdominal CT scan suggested the diagnosis in 5 of the 9 patients who had the scan. The final diagnosis was internal hernias in 11 patients, foreign bodies in 5, ischemic strictures in 3, carcinoid tumors in 2, endometriosis in 2, and metastatic deposit from interstitial bladder carcinoma in one patient. Nine of the 12 patients with recurrent obstruction had either short course or recurrence obstruction during the same hospital admission. W carried out bowel resections in 15 patients (5 resections were due to bowel strangulation). Post operative death occurred in 4 patients. Awareness of these rare causes of intestinal obstruction even in patients with previous abdominal operation might improve the outcome. The tentative diagnosis of adhesion obstruction in patients with unusual obstructive etiology might lead to a higher rate of gangrenous complications. Rigorous preoperative evaluation including careful history and early abdominal CT may show the obstructive cause. (author)

  7. Small bowel endoscopy in familial adenomatous polyposis and Lynch syndrome

    NARCIS (Netherlands)

    Koornstra, Jan Jacob

    Patients with familial adenomatous polyposis (FAP) and patients with Lynch syndrome have an increased risk of developing small intestinal neoplasia. In both conditions, the lifetime risk to develop small bowel cancer is estimated to be around 5%. In FAP, this risk is associated with the degree of

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

    Energy Technology Data Exchange (ETDEWEB)

    Akman, C. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Korman, U. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey)]. E-mail: ugurk9@istanbul.edu.tr; Oguet, G. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Kurugoglu, S. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Urger, E. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Ulus, S. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Esen, G. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Tasci, I. [Department of Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey)

    2005-07-01

    AIM: The aim of this prospective study was to evaluate the overall findings of conventional enteroclysis (CE) with complementary magnetic resonance enteroclysis (MRE) in small bowel disease. METHODS: The study included 32 patients referred from various clinical departments, with known or suspected small bowel disease and abnormalities on CE. Immediately after CE, true fast imaging with steady-state precession (true FISP), and unenhanced and gadolinium-enhanced T1-weighted fast low-angle shot (FLASH) sequences with fat saturation were obtained. Mucosal, mural and luminal changes of the small bowel were evaluated by each technique. In addition, bowel wall thickening, bowel wall enhancement and perienteric changes were assessed by MRE. The radiological findings obtained were evaluated together as a combination, and the role of MRE in the determination of the activity and complications of the small bowel disease was assessed. Radiological findings were correlated with clinical evaluation and follow-up in all cases, including endoscopy in 14 cases and surgery in 5 cases. RESULTS: MRE provided important supplementary mural and extramural information, including degree of pathological wall thickness, mural enhancement pattern associated with disease activity, perivisceral collection, abscess formation, mesenteric fibrofatty proliferation, lymphadenopathy and increase in perienteric vascularity. Short strictures were not revealed on MRE; however, for patients with a history of abdominal malignancy, MRE helped characterize the level of any obstruction and the extent of the disease. CONCLUSION: We recommend MRE for patients who have findings of advanced inflammatory bowel disease or neoplasm on CE examination. The combination of these two techniques can provide important information on the degree and extent of the disorder.

  9. Small bowel volvulus due to torsion of pedunculated uterine leiomyoma: CT findings.

    Science.gov (United States)

    Guglielmo, Nicola; Malgras, Brice; Place, Vinciane; Guerrache, Youcef; Pautrat, Karine; Pocard, Marc; Soyer, Philippe

    Torsion of a uterine leiomyoma is a rare complication that can be life threatening because of ischemia or necrosis. This condition may also lead to gastrointestinal complications such as obstruction or, more rarely, small bowel volvulus. Its diagnosis is difficult and can be facilitated with the use of computed tomography or magnetic resonance imaging. Treatment is based on emergency surgical resection of the twisted uterine leiomyoma and detorsion of the small bowel volvulus. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Medical malpractice in the management of small bowel obstruction: A 33-year review of case law.

    Science.gov (United States)

    Choudhry, Asad J; Haddad, Nadeem N; Rivera, Mariela; Morris, David S; Zietlow, Scott P; Schiller, Henry J; Jenkins, Donald H; Chowdhury, Naadia M; Zielinski, Martin D

    2016-10-01

    Annually, 15% of practicing general surgeons face a malpractice claim. Small bowel obstruction accounts for 12-16% of all surgical admissions. Our objective was to analyze malpractice related to small bowel obstruction. Using the search terms "medical malpractice" and "small bowel obstruction," we searched through all jury verdicts and settlements for Westlaw. Information was collected on case demographics, alleged reasons for malpractice, and case outcomes. The search criteria yielded 359 initial case briefs; 156 met inclusion criteria. The most common reason for litigation was failure to diagnose and timely manage the small bowel obstruction (69%, n = 107). Overall, 54% (n = 84) of cases were decided in favor of the defendant (physician). Mortality was noted in 61% (n = 96) of cases. Eighty-six percent (42/49) of cases litigated as a result of failing to diagnose and manage the small bowel obstruction in a timely manner, resulting in patient mortality, had a verdict with an award payout for the plaintiff (patient). The median award payout was $1,136,220 (range, $29,575-$12,535,000). A majority of malpractice cases were decided in favor of the defendants; however, cases with an award payout were costly. Timely intervention may prevent a substantial number of medical malpractice lawsuits in small bowel obstruction, arguing in favor of small bowel obstruction management protocols. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Small bowel obstruction secondary to migration of a fragment of lithobezoar: a case report.

    LENUS (Irish Health Repository)

    Medani, Mekki

    2009-01-01

    INTRODUCTION: Small bowel obstruction is a common world-wide condition that has a range of etiological factors. The management is largely dependent on the cause of the obstruction. Small bowel obstruction caused by foreign body ingestion is rare; many items have been reported as responsible, but there are no reports implicating polyurethane foam. CASE PRESENTATION: We report the case of a 44-year-old Irish male who presented following ingestion of polyurethane foam. He was asymptomatic on presentation but developed a small bowel obstruction shortly thereafter. CONCLUSION: Patients presenting following ingestion of polyurethane foam should be scheduled for elective laparotomy, gastrotomy, and retrieval of the cast on the next available theatre list - given that they are suitable for surgery.

  12. Application of small intestine decompression combined with oral feeding in middle and late period of malignant small bowel obstruction.

    Science.gov (United States)

    Li, Dechun; Du, Hongtao; Shao, Guoqing; Guo, Yongtuan; Lu, Wan; Li, Ruihong

    2017-07-01

    The application value of small intestine decompression combined with oral feeding in the middle and late period of malignant small bowel obstruction was examined. A total of 22 patients with advanced malignant small bowel obstruction were included in the present study. An ileus tube was inserted via the nose under fluoroscopy into the obstructed small intestine of each patient. At the same time, the insertion depth the of the catheter was adjusted. When the catheter was blocked, small bowel selective angiography was performed to determine the location and cause of the obstruction and the extent of the obstruction, and to determine the length of the small intestine in the site of obstruction, and to select the variety and tolerance of enteral nutrition. We observed the decompression tube flow and ease of intestinal obstruction. In total, 20 patients were treated with oral enteral nutrition after abdominal distension, and 22 cases were treated by the nose to observe the drainage and the relief of intestinal obstruction. The distal end of the catheter was placed in a predetermined position. The symptoms of intestinal obstruction were relieved 1-4 days after decompression. The 22 patients with selective angiography of the small intestine showed positive X-ray signs: 18 patients with oral enteral nutrition therapy had improved the nutritional situation 2 weeks later. In 12 cases, where there was anal defecation exhaust, 2 had transient removal of intestinal obstruction catheter. In conclusion, this comprehensive treatment based on small intestine decompression combined with enteral nutrition is expected to become a new therapeutic approach and method for the treatment of patients with advanced tumor small bowel obstruction.

  13. Treating Small Bowel Obstruction with a Manual Physical Therapy: A Prospective Efficacy Study

    Directory of Open Access Journals (Sweden)

    Amanda D. Rice

    2016-01-01

    Full Text Available Small bowel obstructions (SBOs caused by adhesions are a common, often life-threatening postsurgical complication with few treatment options available for patients. This study examines the efficacy of a manual physical therapy treatment regimen on the pain and quality of life of subjects with a history of bowel obstructions due to adhesions in a prospective, controlled survey based study. Changes in six domains of quality of life were measured via ratings reported before and after treatment using the validated Small Bowel Obstruction Questionnaire (SBO-Q. Improvements in the domains for pain (p=0.0087, overall quality of life (p=0.0016, and pain severity (p=0.0006 were significant when average scores before treatment were compared with scores after treatment. The gastrointestinal symptoms (p=0.0258 domain was marginally significant. There was no statistically significant improvement identified in the diet or medication domains in the SBO-Q for this population. Significant improvements in range of motion in the trunk (p≤0.001, often limited by adhesions, were also observed for all measures. This study demonstrates in a small number of subjects that this manual physical therapy protocol is an effective treatment option for patients with adhesive small bowel obstructions as measured by subject reported symptoms and quality of life.

  14. The role of multidetector computed tomography in evaluation of small bowel obstructions

    Directory of Open Access Journals (Sweden)

    Mehmet Fatih İnci

    2013-03-01

    Full Text Available Objective: The purpose of the study was to evaluate therole and additional diagnostic contribution of multi-detectorcomputed tomography (MDCT in patients with acuteabdominal pain caused by small bowel obstruction.Materials and methods: A total of 48 patients who admittedto our hospital with acute abdominal pain and underwentMDCT on suspicion of intestinal obstruction and hadabdominal surgery between January 2012 and October2012 were included to our study. MDCT images were interpretedby two experienced radiologist retrospectively.All clinical data and surgery notes also were evaluated.Patients had surgery due to penetrating or blunt abdominalinjury were excluded.Results: Of these 48 patients, 26 (54.1% were male and22 (45.9% were female. Patients’ ages ranged 25 to 71and mean age was 52±5.4 years. The causes of intestinalobstruction of patients were adhesions for 12 (46.1% patients,tumors for 7 (26.9% patients, external hernias for5 (19.2% patients, internal hernia for 1 (3.9% patient andintussusception for 1 (3.9% patient. A total concordancebetween the MDCT findings and definitive diagnosis wasfound in 26 of 23 cases and the sensitivity and specifityof MDCT in the diagnosis of small bowel obstruction werefound to be 88.5% and 90%, respectively.Conclusion: MDCT is a fast, effective and reliable imagingmethod for preoperative diagnosing small bowel obstructioncauses acute abdominal pain with the advantagesof MDCT such as multi-planar and three-dimensionalreformatted imaging.Key words: Acute abdominal pain, multi-detector computed tomography, small bowel obstruction

  15. Small bowel obstruction and perforation after Essure sterilization: a case report.

    Science.gov (United States)

    Mantel, Hendrik T J; Wijma, Jacobus; Stael, Adrianus P M

    2013-01-01

    We present a rare but serious complication of Essure microinsert sterilization. Case report. A 42-year-old woman presented with nausea, vomiting, abdominal pain and abdominal distension 1 month after uncomplicated Essure sterilization. Abdominal X-ray showed small bowel obstruction. At subsequent laparotomy, a stretched Essure device was found ensnaring the terminal ileum. It had caused strangulation and local perforation of the bowel wall. The device was removed and an ileocecal resection with side-to-side ileocolostomy was performed. In retrospect, the aberrant location of the right Essure device near the ileocecal junction was noticed on the abdominal X-ray. This case illustrates that perforation of an Essure device can result in a serious complication leading to ileocecal resection. An abdominal X-ray with specific attention to the correct location of the Essure coils is advisable for patients presenting with small bowel obstruction after Essure sterilization. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Small bowel volvulus in the adult populace of the United States: results from a population-based study.

    Science.gov (United States)

    Coe, Taylor M; Chang, David C; Sicklick, Jason K

    2015-08-01

    Small bowel volvulus is a rare entity in Western adults. Greater insight into epidemiology and outcomes may be gained from a national database inquiry. The Nationwide Inpatient Sample (1998 to 2010), a 20% stratified sample of United States hospitals, was retrospectively reviewed for small bowel volvulus cases (International Classification of Diseases, 9th Edition [ICD-9] code 560.2 excluding gastric/colonic procedures) in patients greater than or equal to 18 years old. There were 2,065,599 hospitalizations for bowel obstruction (ICD-9 560.x). Of those, there were 20,680 (1.00%) small bowel volvulus cases; 169 were attributable to intestinal malrotation. Most cases presented emergently (89.24%) and operative management was employed more frequently than nonoperative (65.21% vs 34.79%, P volvulus, our findings provide a robust representation of this rare cause of small bowel obstruction in American adults. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Strangulated small bowel gangrene due to torsioned gangrenous appendix in an old man: a case report

    Directory of Open Access Journals (Sweden)

    Ardavan Shahbazi

    2016-11-01

    Full Text Available Background: Torsion of the appendix is a rare entity and divided into two categories: primary and secondary. The primary mode is due to an abnormality in either appendix anatomy or its meso or both and is more common in children. The secondary forms happen in adults which can be associated with appendiceal tumor, appendiceal mucocele, fecal impaction, volvulus of ovarian cyctadenoma. Adynamic small bowel obstruction or ileus is seen frequently with all forms of peritoneal inflammation. However, Anatomical small intestinal obstruction or gangrene due to torsioned appendix is a rare condition and few cases reported in the literature. Method: Here we have a 83-year-old man patient with small bowel obstruction and localized right lower quadrant peritonitis who undergo emergency laparotomy to eliminate small bowel obstruction and peritonitis. Preoperative abdominal radiography showed multiple dilated small bowel loops with empty colon. Results: During exploration necrosis of the terminal 40cm of the ileum due to a twisted and gangrenous appendix was discovered. Other parts were normal. Conclusion: it may be useful to recommend early midline exploratory laparotomy for patients with small bowel obstruction even in the presence symptoms of local appendicitis. This operation can be both diagnostic and therapeutic.

  18. The dose-volume relationship of acute small bowel toxicity from concurrent 5-FU-based chemotherapy and radiation therapy for rectal cancer

    International Nuclear Information System (INIS)

    Baglan, Kathy L.; Frazier, Robert C.; Yan Di; Huang, Raywin R.; Martinez, Alvaro A.; Robertson, John M.

    2002-01-01

    Purpose: A direct relationship between the volume of small bowel irradiated and the degree of acute small bowel toxicity experienced during concurrent 5-fluorouracil (5-FU)-based chemoradiotherapy for rectal carcinoma is well recognized but poorly quantified. This study uses three-dimensional treatment-planning tools to more precisely quantify this dose-volume relationship. Methods and Materials: Forty patients receiving concurrent 5-FU-based chemotherapy and pelvic irradiation for rectal carcinoma had treatment-planning CT scans with small bowel contrast. A median isocentric dose of 50.4 Gy was delivered using a posterior-anterior and opposed lateral field arrangement. Bowel exclusion techniques were routinely used, including prone treatment position on a vacuum bag cradle to allow anterior displacement of the abdominal contents and bladder distension. Individual loops of small bowel were contoured on each slice of the planning CT scan, and a small bowel dose-volume histogram was generated for the initial pelvis field receiving 45 Gy. The volume of small bowel receiving each dose between 5 and 40 Gy was recorded at 5-Gy intervals. Results: Ten patients (25%) experienced Common Toxicity Criteria Grade 3+ acute small bowel toxicity. A highly statistically significant association between the development of Grade 3+ acute small bowel toxicity and the volume of small bowel irradiated was found at each dose level. Specific dose-volume threshold levels were found, below which no Grade 3+ toxicity occurred and above which 50-60% of patients developed Grade 3+ toxicity. The volume of small bowel receiving at least 15 Gy (V 15 ) was strongly associated with the degree of toxicity. Univariate analysis of patient and treatment-related factors revealed no other significant predictors of severe toxicity. Conclusions: A strong dose-volume relationship exists for the development of Grade 3+ acute small bowel toxicity in patients receiving concurrent 5-FU-based chemoradiotherapy

  19. Imaging findings of midgut volvuIus associated with a large small-bowel diverticulum in an aduIt patient: case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jee Young; Rha, Sung Eun; Oh, Soon Nam; Bo, Seal Hwang; Byun, Jae Young [College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2004-05-01

    Although most patients with jejunoileal diverticulum are asymptomatic, a large, small-bowel diverticulum can be associated with midgut volvulus in an adult. We present a rare case of midgut volvulus that was associated with a large, small-bowel diverticulum in a 77-year-old woman presenting with chronic recurrent abdominal pain. The CT showed the characteristic whirl sign of twisted mesentery, the small bowel loops along the superior mesenteric artery and a large sac-like small-bowel diverticulum. A small bowel series also demonstrated a corkscrew appearance of proximal jejunum, a finding suggestive of midgut volvulus, and a large jejunal diverticulum. During the laparotomy, the small bowel was seen twisted counterclockwise 270 .deg.. The mesenteric root was very shortened. A 4 cm sized diverticulum was seen on the mesenteric border of jejunum, on the portion about 40 cm distal from the Treitz ligament.

  20. Imaging findings of midgut volvuIus associated with a large small-bowel diverticulum in an aduIt patient: case report

    International Nuclear Information System (INIS)

    Kim, Jee Young; Rha, Sung Eun; Oh, Soon Nam; Bo, Seal Hwang; Byun, Jae Young

    2004-01-01

    Although most patients with jejunoileal diverticulum are asymptomatic, a large, small-bowel diverticulum can be associated with midgut volvulus in an adult. We present a rare case of midgut volvulus that was associated with a large, small-bowel diverticulum in a 77-year-old woman presenting with chronic recurrent abdominal pain. The CT showed the characteristic whirl sign of twisted mesentery, the small bowel loops along the superior mesenteric artery and a large sac-like small-bowel diverticulum. A small bowel series also demonstrated a corkscrew appearance of proximal jejunum, a finding suggestive of midgut volvulus, and a large jejunal diverticulum. During the laparotomy, the small bowel was seen twisted counterclockwise 270 .deg.. The mesenteric root was very shortened. A 4 cm sized diverticulum was seen on the mesenteric border of jejunum, on the portion about 40 cm distal from the Treitz ligament

  1. Reduction of acute rejection by bone marrow mesenchymal stem cells during rat small bowel transplantation.

    Directory of Open Access Journals (Sweden)

    Yang Yang

    Full Text Available Bone marrow mesenchymal stem cells (BMMSCs have shown immunosuppressive activity in transplantation. This study was designed to determine whether BMMSCs could improve outcomes of small bowel transplantation in rats.Heterotopic small bowel transplantation was performed from Brown Norway to Lewis rats, followed by infusion of BMMSCs through the superficial dorsal veins of the penis. Controls included rats infused with normal saline (allogeneic control, isogeneically transplanted rats (BN-BN and nontransplanted animals. The animals were sacrificed after 1, 5, 7 or 10 days. Small bowel histology and apoptosis, cytokine concentrations in serum and intestinal grafts, and numbers of T regulatory (Treg cells were assessed at each time point.Acute cellular rejection occurred soon after transplantation and became aggravated over time in the allogeneic control rats, with increase in apoptosis, inflammatory response, and T helper (Th1/Th2 and Th17/Treg-related cytokines. BMMSCs significantly attenuated acute cellular rejection, reduced apoptosis and suppressed the concentrations of interleukin (IL-2, IL-6, IL-17, IL-23, tumor necrosis factor (TNF-α, and interferon (IFN-γ while upregulating IL-10 and transforming growth factor (TGF-β expression and increasing Treg levels.BMMSCs improve the outcomes of allogeneic small bowel transplantation by attenuating the inflammatory response and acute cellular rejection. Treatment with BMMSCs may overcome acute cellular rejection in small bowel transplantation.

  2. Evaluation of gastric and small bowel transit times in coeliac disease with the small bowel PillCam®: a single centre study in a non gluten-free diet adult Italian population with coeliac disease.

    Science.gov (United States)

    Urgesi, R; Cianci, R; Bizzotto, A; Costamagna, G; Riccioni, M E

    2013-05-01

    The mechanisms underlying bowel disturbances in coeliac disease are still relatively unclear. Past reports suggested that small bowel motor abnormalities may be involved in this pathological condition; there are no studies addressing small bowel transit in coeliac disease before and after a gluten-free diet. The objective of this study was to determine whether capsule endoscopy (CE) could serve as a test for measurement of gastric and small bowel transit times in a group of symptomatic or asymptomatic coeliac patients at the time of diagnosis with respect to a control group. Thirty coeliac untreated patients and 30 age-, sex- and BMI-matched healthy controls underwent CE assessment of whole gut transit times. All subjects completed the study per protocol and experienced natural passage of the pill. No statistical significant differences between gastric emptying and small bowel transit times both in coeliac and control group were found (p = 0.1842 and p = 0.7134; C.I. 95%, respectively). No correlation was found in coeliac patients and control group between transit times and age, sex and BMI. By using the Pearson's correlation test, significant correlation emerged between gastric emptying time and small bowel transit times in coeliac disease (r = 0.1706). CE reveals unrecognized gender differences and may be a novel outpatient technique for gut transit times' assessment without exposure to radiation and for the evaluation of upper gut dysfunction in healthy patients suffering from constipation without evidence of intestinal malabsorption. Nevertheless, CE does not seem to be the most suitable method for studying gut transit times in untreated coeliac patients; this might be ascribed to the fact that CE consists of inert (non-digestible, non-absorbable) substances.

  3. Sequential stenotic strictures of the small bowel leading to obstruction

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Small bowel obstructions (SBOs) are primarily caused by adhesions, hernias, neoplasms, or inflammatory strictures. Intraluminal strictures are an uncommon cause of SBO. This report describes our findings in a unique case of sequential, stenotic intraluminal strictures of the small intestine, discusses the differential diagnosis of intraluminal intestinal strictures, and reviews the literature regarding intraluminal pathology.

  4. Small bowel carcinomas in celiac or Crohn's disease: distinctive histophenotypic, molecular and histogenetic patterns.

    Science.gov (United States)

    Vanoli, Alessandro; Di Sabatino, Antonio; Martino, Michele; Klersy, Catherine; Grillo, Federica; Mescoli, Claudia; Nesi, Gabriella; Volta, Umberto; Fornino, Daniele; Luinetti, Ombretta; Fociani, Paolo; Villanacci, Vincenzo; D'Armiento, Francesco P; Cannizzaro, Renato; Latella, Giovanni; Ciacci, Carolina; Biancone, Livia; Paulli, Marco; Sessa, Fausto; Rugge, Massimo; Fiocca, Roberto; Corazza, Gino R; Solcia, Enrico

    2017-10-01

    Non-familial small bowel carcinomas are relatively rare and have a poor prognosis. Two small bowel carcinoma subsets may arise in distinct immune-inflammatory diseases (celiac disease and Crohn's disease) and have been recently suggested to differ in prognosis, celiac disease-associated carcinoma cases showing a better outcome, possibly due to their higher DNA microsatellite instability and tumor-infiltrating T lymphocytes. In this study, we investigated the histological structure (glandular vs diffuse/poorly cohesive, mixed or solid), cell phenotype (intestinal vs gastric/pancreatobiliary duct type) and Wnt signaling activation (β-catenin and/or SOX-9 nuclear expression) in a series of 26 celiac disease-associated small bowel carcinoma, 25 Crohn's disease-associated small bowel carcinoma and 25 sporadic small bowel carcinoma cases, searching for new prognostic parameters. In addition, non-tumor mucosa of celiac and Crohn's disease patients was investigated for epithelial precursor changes (hyperplastic, metaplastic or dysplastic) to help clarify carcinoma histogenesis. When compared with non-glandular structure and non-intestinal phenotype, both glandular structure and intestinal phenotype were associated with a more favorable outcome at univariable or stage- and microsatellite instability/tumor-infiltrating lymphocyte-inclusive multivariable analysis. The prognostic power of histological structure was independent of the clinical groups while the non-intestinal phenotype, associated with poor outcome, was dominant among Crohn's disease-associated carcinoma. Both nuclear β-catenin and SOX-9 were preferably expressed among celiac disease-associated carcinomas; however, they were devoid, per se, of prognostic value. We obtained findings supporting an origin of celiac disease-associated carcinoma in SOX-9-positive immature hyperplastic crypts, partly through flat β-catenin-positive dysplasia, and of Crohn's disease-associated carcinoma in a metaplastic (gastric and

  5. Small and large bowel volvulus: Clues to early recognition and complications

    International Nuclear Information System (INIS)

    Lepage-Saucier, Marianne; Tang, An; Billiard, Jean-Sebastien; Murphy-Lavallee, Jessica; Lepanto, Luigi

    2010-01-01

    Small and large bowel volvulus are uncommon causes of bowel obstruction with nonspecific clinical manifestations which may delay the diagnosis and increase morbidity. Therefore, radiologists play an important role in promptly establishing the diagnosis, recognizing underlying congenital or acquired risk factors and detecting potentially life-threatening complications. Multidetector CT performed with intravenous contrast is currently the preferred modality for the evaluation of volvulus, which is best appreciated when imaging is perpendicular to the axis of bowel rotation, hence the benefit of multiplanar reformations. In this pictorial essay we review the pathophysiology of the different types of intestinal volvulus, discuss diagnostic criteria for prompt diagnosis of volvulus and emphasize early recognition of the complications.

  6. Small and large bowel volvulus: Clues to early recognition and complications

    Energy Technology Data Exchange (ETDEWEB)

    Lepage-Saucier, Marianne [Departement de radiologie, Hopital Saint-Luc, Centre Hospitalier Universitaire de Montreal (CHUM), 1058 rue Saint-Denis, Montreal, Quebec, H2X 3J4 (Canada); Tang, An [Departement de radiologie, Hopital Saint-Luc, Centre Hospitalier Universitaire de Montreal (CHUM), 1058 rue Saint-Denis, Montreal, Quebec, H2X 3J4 (Canada)], E-mail: duotango@gmail.com; Billiard, Jean-Sebastien; Murphy-Lavallee, Jessica; Lepanto, Luigi [Departement de radiologie, Hopital Saint-Luc, Centre Hospitalier Universitaire de Montreal (CHUM), 1058 rue Saint-Denis, Montreal, Quebec, H2X 3J4 (Canada)

    2010-04-15

    Small and large bowel volvulus are uncommon causes of bowel obstruction with nonspecific clinical manifestations which may delay the diagnosis and increase morbidity. Therefore, radiologists play an important role in promptly establishing the diagnosis, recognizing underlying congenital or acquired risk factors and detecting potentially life-threatening complications. Multidetector CT performed with intravenous contrast is currently the preferred modality for the evaluation of volvulus, which is best appreciated when imaging is perpendicular to the axis of bowel rotation, hence the benefit of multiplanar reformations. In this pictorial essay we review the pathophysiology of the different types of intestinal volvulus, discuss diagnostic criteria for prompt diagnosis of volvulus and emphasize early recognition of the complications.

  7. Functional brain imaging in irritable bowel syndrome with rectal balloon-distention by using fMRI

    OpenAIRE

    Yuan, Yao-Zong; Tao, Ran-Jun; Xu, Bin; Sun, Jing; Chen, Ke-Min; Miao, Fei; Zhang, Zhong-Wei; Xu, Jia-Yu

    2003-01-01

    AIM: Irritable bowel syndrome (IBS) is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity is a key factor in the pathophysiology of IBS. The aim of this study was to examine the effect of rectal balloon-distention stimulus by blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) in visceral pain center and to compare the distribution, extent, and intensity of activated areas between IBS patients and normal controls.

  8. Small bowel obstruction following perforation of the uterus at ...

    African Journals Online (AJOL)

    BACKGROUND: Unsafe abortion is an important contributor to maternal morbidity and mortality. OBJECTIVE: To present a case of small bowel obstruction following perforation of the uterus at induced abortion. METHODS: A 36-year-old woman, presented at a private hospital, with abdominal pain and weight loss. She had ...

  9. A radiologist's guide to small bowel and multivisceral transplantation

    International Nuclear Information System (INIS)

    Godfrey, E.M.; Upponi, S.S.; See, T.C.; Cheow, H.K.; Sivaprakasam, R.; Butler, A.J.; Whitley, S.

    2013-01-01

    This review will describe the indications for the various small bowel containing transplants. The importance of early referral will be highlighted. Radiologists play a central role in assessing these complex patients prior to transplantation. Furthermore, in the postoperative period, radiologists play an important part in diagnosing and treating complications

  10. Gallstone Ileus: An Unlikely Cause of Mechanical Small Bowel Obstruction

    Directory of Open Access Journals (Sweden)

    Estela Abich

    2017-06-01

    Full Text Available Gallstone ileus is a rare disease that accounts for 1–4% of intestinal obstructions. Almost exclusively a condition in the older female population, it is a difficult diagnosis to make. We report the case of gallstone ileus in a 94-year-old Caucasian female, who presented to the emergency department with acute-onset nausea, coffee-ground emesis, lack of bowel movement, and abdominal distension. On CT scan, the diagnosis of gallstone ileus was made by the presence of a cholecystoduodenal fistula, pneumobilia, and small bowel obstruction. Emergent laparotomy with a one-stage procedure of enterolithotomy and stone removal by milking the bowel distal to the stone were performed. The postoperative course was uneventful until postoperative day 4 when the patient was found tachycardic, lethargic, and unresponsive. We reviewed the literature on the diagnosis and treatment of gallstone ileus.

  11. A study of diagnosis and manegement of mechanical small-bowel obstruction

    International Nuclear Information System (INIS)

    Kawasaki, Masayasu; Kurumi, Yoshimasa; Naitoh, Hiroyuki

    2007-01-01

    We tried to clarify the most appropriate management for simple bowel obstruction and effective methods for diagnosis of strangulated bowel obstruction. Consecutive 252 cases of mechanical small-bowel obstruction treated in the hospital from 2000 to 2005 were assessed retrospectively. There were 219 cases of simple obstructions and 33 cases of strangulated obstruction. Seventy-eight percent of simple obstruction cases were treated conservatively (fasting in 82, decompression tube treatment in 88 and operation in 49). The average duration for indwelling the decompression tube was 5.2 days and the amount of discharge from the tube decreased day by day. In the cases of operation, the operation was performed on the 4.5th day after admission on the average, and the average amount of tube discharge before the operation was more than 450 ml/day. On the other hand, strangulation was most frequently diagnosed by enhanced abdominal CT scan, followed by physical examination, and the properties of decompression tube discharge in this order, and the blood data were only used for reference. Simple small-bowel obstruction should be treated by surgical therapy if symptomatic remission could not be gained by five days after beginning of the treatment. Enhanced abdominal CT scan is the most useful method for diagnosis of strangulation in an early stage of ischemia. (author)

  12. The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults

    International Nuclear Information System (INIS)

    Grassi, Roberto; Romano, Stefania; D'Amario, Fenesia; Giorgio Rossi, Antonio; Romano, Luigia; Pinto, Fabio; Di Mizio, Roberto

    2004-01-01

    Introduction: The main role of the radiologist in the management of patients with suspicion of small bowel obstruction is to help triage patients into those that need immediate surgical intervention from those that require medical therapy or delayed surgery. Ultrasound examination is usually considered not helpful in bowel obstruction because of air in the intestinal lumen that interferes the evaluation of the intestinal loops, however recently some Authors attested the increasing important role of sonography in the acute abdominal disease. Aim of our report is to demonstrate the value of free fluid detected by US in differentiating between low and high-grade small bowel obstruction. Materials and methods: The study is based on 742 consecutive patients who presented symptoms of the acute abdomen; all patients had undergone initial serial abdominal plain film and US examinations prior to any medical intervention. We reviewed the imaging findings of 150 cases in whom small bowel obstruction was clinically suspected and confirmed at surgery. We consider the following radiographic and US findings: dilatation of small bowel loops; bowel wall thickness; presence of air-fluid levels; thickness of valvulae conniventes; evidence of peristalsis; presence and echogenicity of extraluminal fluid. We looked at the value of extraluminal peritoneal fluid at US examination in differentiating low and high-grade small bowel obstruction based on the surgical outcome. Results: In 46 patients altered peristaltic activity, thin bowel walls, fluid filled loops with hyperechoic spots in the bowel segment proximal to obstruction were noted at US, whereas radiographic features were: moderate dilatation of small bowel loops, with thin bowel wall and evidence of numerous and subtle valvulae conniventes; presence of air-fluid levels was also noted. In 70 other patients, US examination revealed all the findings described in the precedent cases and also the presence of free extraluminal fluid

  13. The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults

    Energy Technology Data Exchange (ETDEWEB)

    Grassi, Roberto; Romano, Stefania E-mail: stefromano@libero.it; D' Amario, Fenesia; Giorgio Rossi, Antonio; Romano, Luigia; Pinto, Fabio; Di Mizio, Roberto

    2004-04-01

    Introduction: The main role of the radiologist in the management of patients with suspicion of small bowel obstruction is to help triage patients into those that need immediate surgical intervention from those that require medical therapy or delayed surgery. Ultrasound examination is usually considered not helpful in bowel obstruction because of air in the intestinal lumen that interferes the evaluation of the intestinal loops, however recently some Authors attested the increasing important role of sonography in the acute abdominal disease. Aim of our report is to demonstrate the value of free fluid detected by US in differentiating between low and high-grade small bowel obstruction. Materials and methods: The study is based on 742 consecutive patients who presented symptoms of the acute abdomen; all patients had undergone initial serial abdominal plain film and US examinations prior to any medical intervention. We reviewed the imaging findings of 150 cases in whom small bowel obstruction was clinically suspected and confirmed at surgery. We consider the following radiographic and US findings: dilatation of small bowel loops; bowel wall thickness; presence of air-fluid levels; thickness of valvulae conniventes; evidence of peristalsis; presence and echogenicity of extraluminal fluid. We looked at the value of extraluminal peritoneal fluid at US examination in differentiating low and high-grade small bowel obstruction based on the surgical outcome. Results: In 46 patients altered peristaltic activity, thin bowel walls, fluid filled loops with hyperechoic spots in the bowel segment proximal to obstruction were noted at US, whereas radiographic features were: moderate dilatation of small bowel loops, with thin bowel wall and evidence of numerous and subtle valvulae conniventes; presence of air-fluid levels was also noted. In 70 other patients, US examination revealed all the findings described in the precedent cases and also the presence of free extraluminal fluid

  14. Imaging of small bowel-related complications following major abdominal surgery

    International Nuclear Information System (INIS)

    Sandrasegaran, Kumaresan; Maglinte, Dean D.T.

    2005-01-01

    To recognize and document the small bowel reactions following major abdominal surgery is an important key for a correct diagnosis. Usually, plain abdominal radiography is the initial imaging examination requested in the immediate postoperative period, whereas gastrointestinal contrast studies are used to look for specific complications. In some countries, especially in Europe, sonography is widely employed to evaluate any acute affection of the abdomen. CT is commonly used to assess postoperative abdominal complications; in our institution also CT enteroclysis is often performed, to provide additional important informations. Radiologist should be able to diagnose less common types of obstruction, such as afferent loop, closed loop, strangulating obstruction as well as internal hernia. This knowledge may assume a critical importance for surgeons to decide on therapy. In this article, we focus our attention on the imaging (particularly CT) in small bowel complications following abdominal surgery

  15. Epidemiology of small-bowel obstruction beyond the neonatal period

    African Journals Online (AJOL)

    Background The aim of this study was to evaluate the etiologies causing intestinal obstruction beyond the neonatal period. Patients and methods An observational study was conducted on children between 1 month and 17 years of age who underwent surgery for small-bowel obstruction. (SBO) at this tertiary referral center ...

  16. Late small bowel toxicity after aggressive abdominopelvic intensity modulated radiation therapy

    Directory of Open Access Journals (Sweden)

    Andrew Ling, BA

    2017-10-01

    Conclusion: It may be possible with IMRT to deliver high doses to small volumes of small bowel with low rates of significant long-term complications. Further studies should explore tolerable dose-volume relationships in cases in which aggressive abdominal or pelvic treatment may be warranted to treat the underlying malignancy.

  17. Fetal small bowel volvulus without malrotation: the whirlpool & coffee bean signs.

    Science.gov (United States)

    Jakhere, S G; Saifi, S A; Ranwaka, A A

    2014-01-01

    Intestinal volvulus is a common condition seen in infancy and adulthood, but small bowel volvulus is a rare condition affecting the fetus in utero. Very few cases have been reported describing the ultrasound findings of the same. We present a case report of a case of intestinal volvulus which was diagnosed prenatally based on the ultrasound features of whirlpool sign and coffee bean sign. An emergency caesarian section was performed, small bowel volvulus was confirmed on post-natal ultrasound, and the neonate was subsequently operated. Although these signs have been separately described previously in the literature, in our case both these signs were seen in the same patient. Our case is a rare presentation with the occurrence of volvulus without malrotation, the contrary being more common.

  18. Increased Expression of Toll-Like Receptors 4, 5, and 9 in Small Bowel Mucosa from Patients with Irritable Bowel Syndrome

    Directory of Open Access Journals (Sweden)

    Aldona Dlugosz

    2017-01-01

    Full Text Available The aim of our study was to compare patients with irritable bowel syndrome (IBS and healthy controls regarding the expression of toll-like receptors 2, 4, 5, and 9 (TLR2, TLR4, TLR5, and TLR9, the primary mucosal receptors of bacterial components, in small and large bowel mucosa. Methods. We analysed biopsies from jejunum and sigmoid colon of 22 patients (17 females with IBS aged 18–66 (median: 39 years and 14 healthy volunteers (12 females aged 22–61 (median: 42 years. Eight patients had constipation-predominant IBS (C-IBS, 7 had diarrhoea-predominant IBS (D-IBS, and 7 had IBS without predominance of constipation or diarrhoea. We analysed mRNA levels for TLRs using quantitative PCR and distribution of TLRs in mucosa using immunohistochemistry. Results. We found increased mRNA expression of TLR4 (mean fold change 1.85±0.31 versus 1.0±0.20; p<0.05, TLR5 (1.96±0.36 versus 1.0±0.20; p<0.05 and TLR9 (2.00±0.24 versus 1.0±0.25; p<0.01 but not of TLR2 in the small bowel mucosa from patients with IBS compared to the controls. There was no significant difference in mRNA levels for TLRs in colon mucosa between patients and controls. Conclusion. Upregulation of TLR4, TLR5, and TLR9 suggests the involvement of bacteria or dysregulation of the immune response to commensal flora in small bowel mucosa in IBS patients.

  19. A novel diagnostic tool for detecting functional patency of the small bowel: the Given patency capsule.

    Science.gov (United States)

    Spada, C; Spera, G; Riccioni, M; Biancone, L; Petruzziello, L; Tringali, A; Familiari, P; Marchese, M; Onder, G; Mutignani, M; Perri, V; Petruzziello, C; Pallone, F; Costamagna, G

    2005-09-01

    The current visualization of small-bowel strictures using traditional radiological methods is associated with high radiation doses and false-negative results. These methods do not always reveal small-bowel patency for solids. The aim is to assess the safety of the Given patency system and its ability to detect intestinal strictures in patients with strictures that are known or suspected radiologically. The Given patency capsule is composed of lactose, remains intact in the gastrointestinal tract for 40-100 hours post ingestion, and disintegrates thereafter. A total of 34 patients with small-bowel stricture were prospectively enrolled; 30 had a previous diagnosis of Crohn's disease, three had adhesion syndrome and in one ischemic enteritis was suspected. Of the patients, 15 (44.1 %) had previously undergone surgery. Following ingestion, the capsule was monitored for integrity and transit time, using a specially designed Given scanner and also radiologically. Seventeen patients had been enrolled with the intent of using the patency capsule as a preliminary test in patients with small-bowel strictures before undergoing video capsule endoscopy. 30 patients (88.2 %) retrieved the capsule in the stool; it was intact in 20 (median transit time 22 hours), and disintegrated in 10 patients (median transit time 53 hours). Six patients complained of abdominal pain which disappeared within 24 hours. The scanner successfully indicated the presence of the capsule in 94 % of cases. Ten patients underwent video capsule endoscopy following the patency capsule examination; in all of these the video capsule passed through the small-bowel stricture. This feasibility study has shown that the Given patency capsule is a safe, effective, and convenient tool for assessment of functional patency of the small bowel. It can indicate functional patency even in cases where traditional radiology indicates stricture.

  20. Capsule enteroscopy and radiology of the small intestine

    Energy Technology Data Exchange (ETDEWEB)

    Fork, Frans-Thomas [Malmoe University Hospital, Department of Diagnostic Radiology, Malmoe (Sweden); Aabakken, Lars [Rikshospitalet University Hospital, Department of Gastroenterology, Oslo (Norway)

    2007-12-15

    In a very few years, the video capsule for small bowel enteroscopy has gained widespread clinical acceptance. It is readily ingested, disposable, and allows for a complete, low-invasive endoscopic examination of the entire mucosa of the small bowel. It is a patient-friendly method and a first-line procedure in the difficult evaluation of obscure gastrointestinal bleeding. It has the highest proven figure of diagnostic sensitivity for detecting lesions of the mucosa, irrespective of aetiology. The limitations of capsule endoscopy include difficulty in localising mucosal lesions anatomically and its restricted use in patients with dysphagia, strictures or motor dysfunction. Strictures, transmural and extra-mural lesions in patients with small bowel Crohn's disease are evaluated by MRI- enterography and CT-enterography. (orig.)

  1. Capsule enteroscopy and radiology of the small intestine

    International Nuclear Information System (INIS)

    Fork, Frans-Thomas; Aabakken, Lars

    2007-01-01

    In a very few years, the video capsule for small bowel enteroscopy has gained widespread clinical acceptance. It is readily ingested, disposable, and allows for a complete, low-invasive endoscopic examination of the entire mucosa of the small bowel. It is a patient-friendly method and a first-line procedure in the difficult evaluation of obscure gastrointestinal bleeding. It has the highest proven figure of diagnostic sensitivity for detecting lesions of the mucosa, irrespective of aetiology. The limitations of capsule endoscopy include difficulty in localising mucosal lesions anatomically and its restricted use in patients with dysphagia, strictures or motor dysfunction. Strictures, transmural and extra-mural lesions in patients with small bowel Crohn's disease are evaluated by MRI- enterography and CT-enterography. (orig.)

  2. Graft-versus-host reaction in small bowel transplantation and possibilities for its circumvention

    International Nuclear Information System (INIS)

    Deltz, E.; Ulrichs, K.; Schack, T.; Friedrichs, B.; Mueller-Ruchholtz, W.M.; Mueller-Hermelink, H.K.T.; Thiede, A.

    1986-01-01

    To describe GVHR in small bowel transplantation and its underlying mechanisms and to find methods for circumventing that response, accessory small bowel transplantation was carried out in the rat model. Animals not treated with cyclosporine, irradiation, or removal of the mesenteric lymph nodes of the graft died within 22 days postoperatively due to graft versus host disease. Mesenteric lymph nodes of the graft and recipient spleen and peripheral lymph nodes showed strong immunologic stimulation histologically and high antihost T-cell-mediated cytotoxic antihost reactivity. Seventy-one percent of the animals that had received 15 mg of cyclosporine per kilogram body weight orally survived 150 days after transplantation. After donor irradiation with 50 rads, 77 percent of the recipients survived 120 days. After microsurgical removal of the mesenteric lymph nodes of the graft, 89 percent survived 120 days. We conclude that GVHR plays an important role in small bowel transplantation and that the experimental regimens of donor, graft, and recipient treatment described herein have proved their efficacy for circumventing GVHR

  3. Spontaneous sublingual and intramural small-bowel hematoma in a patient on oral anticoagulation

    Directory of Open Access Journals (Sweden)

    Mohamed Moftah

    2012-08-01

    Full Text Available Spontaneous sublingual hematoma and intramural small bowel hematoma are rare and serious complications of anticoagulant therapy. Though previously reported individually, there has been no previous report of the same two complications occurring in a single patient. A 71-year-old Caucasian man, who was on warfarin for atrial fibrillation, presented with difficulty in swallowing due to a sublingual hematoma. He was observed in our intensive care unit, his warfarin was held and he recovered with conservative management. He represented two months later with a two day history of abdominal pain and distension. An abdominopelvic computed tomography (CT scan now showed small bowel obstruction due to intramural small bowel hematoma and haemorrhagic ascites. Again, this was treated expectantly with a good outcome. In conclusion, life threatening haemorrhagic complications of oral anticoagulant therapy can recur. Conservative treatment is successful in most cases, but an accurate diagnosis is mandatory to avoid unnecessary surgery. CT scan is the investigation of choice for the diagnosis of suspected haemorrhagic complications of over coagulation.

  4. Endoscopic management of intraoperative small bowel laceration during natural orifice translumenal endoscopic surgery: a blinded porcine study.

    Science.gov (United States)

    Fyock, Christopher J; Forsmark, Chris E; Wagh, Mihir S

    2011-01-01

    Natural orifice translumenal endoscopic surgery (NOTES) has recently gained great enthusiasm, but there is concern regarding the ability to endoscopically manage complications purely via natural orifices. To assess the feasibility of endoscopically managing enteral perforation during NOTES using currently available endoscopic accessories. Twelve pigs underwent transgastric or transcolonic endoscopic exploration. Full-thickness enterotomies were intentionally created to mimic accidental small bowel lacerations during NOTES. These lacerations were then closed with endoclips. In the blinded arm of the study, small bowel repair was performed by a second blinded endoscopist. Adequate closure of the laceration was confirmed with a leak test. Primary access sites were closed with endoclips or T-anchors. At necropsy, the peritoneal cavity was inspected for abscesses, bleeding, or damage to surrounding structures. The enterotomy site was examined for adequacy of closure, adhesions, or evidence of infection. Fifteen small bowel lacerations were performed in 12 animals. Successful closure was achieved in all 10 cases in the nonblinded arm. Survival animals had an uncomplicated postoperative course and all enterotomy sites were well healed without evidence of necrosis, adhesions, abscess, or bleeding at necropsy. Leak test was negative in all animals. In the blinded arm, both small intestinal lacerations could not be identified by the blinded endoscopist. Necropsy revealed open small bowel lacerations. Small intestinal injuries are difficult to localize with currently available flexible endoscopes and accessories. Endoscopic clips, however, may be adequate for closure of small bowel lacerations if the site of injury is known.

  5. Blind bedside insertion of small bowel feeding tubes.

    LENUS (Irish Health Repository)

    Duggan, SN

    2009-12-01

    The use of Naso-Jejunal (NJ) feeding is limited by difficulty in feeding tube placement. Patients have traditionally required transfer to Endoscopy or Radiology for insertion of small bowel feeding tubes, with clear resource implications. We hypothesised that the adoption of a simple bedside procedure would be effective and reduce cost. Clinical nutrition and nurse specialist personnel were trained in the 10\\/10\\/10 method of blind bedside NJ insertion.

  6. Multiphasic MDCT in small bowel volvulus

    International Nuclear Information System (INIS)

    Feng Shiting; Chan Tao; Sun Canhui; Li Ziping; Guo Huanyi; Yang Guangqi; Peng Zhenpeng; Meng Quanfei

    2010-01-01

    Objective: Evaluate the use of MDCT with 3D CT angiography (CTA) and CT portal venography (CTPV) reconstruction for the diagnosis of small bowel volvulus (SBV). Methods: Multiphasic MDCT findings in nine patients (seven males and two females, age range 2-70) with surgically proven SBV were retrospectively reviewed. Non-contrast and double phase contrast enhanced MDCT including 3D CTA and CTPV reconstruction were performed in all the patients. Two experienced abdominal radiologists evaluated the images and defined the location, direction and degree of SBV. Results: On axial MDCT images, all cases show segmental or global dilatation of small intestine. Other findings include circumferential bowel wall thickening in eight cases, halo appearance and hyperemia in seven cases, whirl sign in six cases, beak-like appearance in six cases, closed loops in six cases and ascites in one case. CTA/CTPV showed abnormal courses involving main trunks of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in seven cases, with or without distortion of their tributaries. Normal course of SMA but abnormal course of SMV was seen in the other two cases. Of all the nine cases, whirl sign was seen in six cases and barber's pole sign in five cases. Dilated SMV was observed in eight cases and abrupt termination of SMA was found in one case. Compared with surgical findings, the location, direction and degree of SBV were correctly estimated in all cases based on CTA/CTPV. Conclusion: Multiphasic MDCT with CTA/CTPV reconstruction can play an important role in the diagnosis of SBV. The location, direction and degree of SBV can all be defined preoperatively using this method.

  7. Multiphasic MDCT in small bowel volvulus

    Energy Technology Data Exchange (ETDEWEB)

    Feng Shiting, E-mail: fst1977@163.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Chan Tao, E-mail: taochan@hku.hk [Department of Diagnostic Radiology, University of Hong Kong, Room 406, Block K, Queen Mary Hospital (Hong Kong); Sun Canhui, E-mail: canhuisun@sina.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Li Ziping, E-mail: liziping163@tom.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Guo Huanyi, E-mail: guohuanyi@163.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Yang Guangqi, E-mail: shwy03@126.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Peng Zhenpeng, E-mail: ppzhen@21cn.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Meng Quanfei, E-mail: mzycoco@gmail.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China)

    2010-11-15

    Objective: Evaluate the use of MDCT with 3D CT angiography (CTA) and CT portal venography (CTPV) reconstruction for the diagnosis of small bowel volvulus (SBV). Methods: Multiphasic MDCT findings in nine patients (seven males and two females, age range 2-70) with surgically proven SBV were retrospectively reviewed. Non-contrast and double phase contrast enhanced MDCT including 3D CTA and CTPV reconstruction were performed in all the patients. Two experienced abdominal radiologists evaluated the images and defined the location, direction and degree of SBV. Results: On axial MDCT images, all cases show segmental or global dilatation of small intestine. Other findings include circumferential bowel wall thickening in eight cases, halo appearance and hyperemia in seven cases, whirl sign in six cases, beak-like appearance in six cases, closed loops in six cases and ascites in one case. CTA/CTPV showed abnormal courses involving main trunks of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in seven cases, with or without distortion of their tributaries. Normal course of SMA but abnormal course of SMV was seen in the other two cases. Of all the nine cases, whirl sign was seen in six cases and barber's pole sign in five cases. Dilated SMV was observed in eight cases and abrupt termination of SMA was found in one case. Compared with surgical findings, the location, direction and degree of SBV were correctly estimated in all cases based on CTA/CTPV. Conclusion: Multiphasic MDCT with CTA/CTPV reconstruction can play an important role in the diagnosis of SBV. The location, direction and degree of SBV can all be defined preoperatively using this method.

  8. Transient angioedema of small bowel secondary to intravenous iodinated contrast medium

    Directory of Open Access Journals (Sweden)

    Kirankumar N Kulkarni

    2014-01-01

    Full Text Available We report the clinical details and imaging findings of a case of transient angioedema of the small bowel following intravenous administration of non-ionic iodinated contrast material in a 17 year old female with no predisposing risk factors. Findings included long segment, symmetric, circumferential, low-density, bowel wall thickening involving the duodenum, jejunum, and most of the ileum on computed tomography scan obtained at 7 min following intravenous contrast material injection. This entity is self-limiting with a favourable clinical outcome and requires no specific treatment but only aggressive clinical monitoring.

  9. Diagnostic and therapeutic value of laparoscopy for small bowel blunt injuries: A case report.

    Science.gov (United States)

    Addeo, Pietro; Calabrese, Daniela Paola

    2011-01-01

    Small bowel injuries after blunt abdominal trauma represent both a diagnostic and a therapeutic challenge. Early diagnosis and prompt treatment are necessary in order to avoid a dangerous diagnostic delay. Laparoscopy can represent a diagnostic and therapeutic tool in patients with uncertain clinical symptoms. We report the case of a 25-year-old man, haemodynamically stable, admitted for acute abdominal pain a few hours after a physical assault. Giving the persistence of the abdominal pain and the presence of free fluids at the computed tomography examination, an exploratory laparoscopy was performed. At the laparoscopic exploration, an isolated small bowel perforation was found, 60 cm distal from the ligament of Treitz. The injury was repaired by laparoscopic suturing and the patient was discharged home at postoperative day 3 after an uneventful postoperative course. Laparoscopy represents a valuable tool for patients with small bowel blunt injuries allowing a timely diagnosis and a prompt treatment.

  10. High-output stoma after small-bowel resections for Crohn's disease.

    Science.gov (United States)

    Tsao, Stephen K K; Baker, Melanie; Nightingale, Jeremy M D

    2005-12-01

    A 56-year-old Caucasian woman with a history of Crohn's disease and multiple bowel resections resulting in a loop jejunostomy was referred to our Nutritional Unit from a neighboring district general hospital for further management. She was first seen in October 2001, and initial assessment indicated that she was malnourished with fluid depletion, evidenced by the high volume of stomal fluid produced. There had been no sudden change in her medication, her Crohn's disease was quiescent and there was no evidence of any intra-abdominal sepsis. Despite a high calorific intake through her diet, she continued to lose weight. Serum urea and electrolytes; magnesium; C-reactive protein; full blood count; urinary spot sodium; anthropometric measurements. High-output stoma with malabsorption as a consequence of repeated small-bowel surgery. The patient was treated with oral hypotonic fluid restriction (0.5 l/day), 2 l of oral glucose-saline solution per day, high-dose oral antimotility agents (loperamide and codeine phosphate), a proton-pump inhibitor (omeprazole) and oral magnesium replacement. A year later, the patient's loop jejunostomy was closed and an end ileostomy fashioned, bringing an additional 35 cm of small bowel into continuity; macronutrient absorption improved but her problem of dehydration was only slightly reduced. She was stabilized on a twice-weekly subcutaneous magnesium and saline infusion and daily oral 1alpha-hydroxycholecalciferol.

  11. Disturbances in small bowel motility.

    LENUS (Irish Health Repository)

    Quigley, E M

    2012-02-03

    Recently, the small intestine has become the focus of investigation as a potential site of dysmotility in the irritable bowel syndrome (IBS). A number of motor abnormalities have been defined in some studies, and include \\'clustered\\' contractions, exaggerated post-prandial motor response and disturbances in intestinal transit. The significance of these findings remains unclear. The interpretation of available studies is complicated by differences in subject selection, the direct influence of certain symptoms, such as diarrhoea and constipation, and the interference of compounding factors, such as stress and psychopathology. Dysmotility could also reflect autonomic dysfunction, disturbed CNS control and the response to heightened visceral sensation or central perception. While motor abnormalities may not explain all symptoms in IBS, sensorimotor interactions may be important in symptom pathogenesis and deserve further study.

  12. Prediction of radiation-related small-bowel damage

    International Nuclear Information System (INIS)

    Potish, R.A.

    1980-01-01

    In order to predict which patients have a high risk for radiation-related small-bowel damage, the concept of the dose-response curve was applied to the predisposing factors (number of previous laparotomies, extent of surgery, thin physique, hypertension, age, cancer stage, number of treatment days, fractionation, and weight change during radiotherapy) present in 92 patients receiving identical radiation doses and volumes This analysis allows an estimate of the probability of complication to be assigned to individual patients. The utility and limitations of the dose-response concept are discussed

  13. Small bowel involvement documented by capsule endoscopy in Churg-Strauss syndrome.

    Science.gov (United States)

    Beye, Birane; Lesur, Gilles; Claude, Pierre; Martzolf, Lionel; Kieffer, Pierre; Sondag, Daniel

    2015-01-01

    Churg-Strauss syndrome is a small and medium vessel vasculitis and is also known as allergic granulomatous angiitis. Gastrointestinal involvement is common in patients with Churg-Strauss syndrome (20-50%). The most common symptoms are abdominal pain, diarrhoea and occasionally gastrointestinal bleeding and perforation. We present a case of Churg-Strauss syndrome with small bowel lesions documented by video capsule endoscopy.

  14. Manual Physical Therapy for Non-Surgical Treatment of Adhesion-Related Small Bowel Obstructions: Two Case Reports

    Directory of Open Access Journals (Sweden)

    Amanda D. Rice

    2013-02-01

    Full Text Available Background: Adhesion formation is a widely acknowledged risk following abdominal or pelvic surgery. Adhesions in the abdomen or pelvis can cause or contribute to partial or total small bowel obstruction (SBO. These adhesions deter or prevent the passage of nutrients through the digestive tract, and may bind the bowel to the peritoneum, or other organs. Small bowel obstructions can quickly become life-threatening, requiring immediate surgery to resect the bowel, or lyse any adhesions the surgeon can safely access. Bowel repair is an invasive surgery, with risks including bowel rupture, infection, and peritonitis. An additional risk includes the formation of new adhesions during the healing process, creating the potential for subsequent adhesiolysis or SBO surgeries. Objective: Report the use of manual soft tissue physical therapy for the reversal of adhesion-related partial SBOs, and create an initial inquiry into the possibility of nonsurgical lysis of adhesions. Case Reports: Two patients presenting with SBO symptoms due to abdominal adhesions secondary to abdominal and pelvic surgery were treated with manual soft tissue physical therapy focused on decreasing adhesions. Conclusions: Successful treatment with resolution of symptom presentation of partial SBO and sustained results were observed in both patients treated.

  15. CT findings of primary undifferentiated pleomorphic sarcoma in the small bowel: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Youe Ree; Lee, Young Hwan; Yoon, Kwon Ha; Yun, Ki Jung [Wonkwang University School of Medicine and Hospital, Institute of Wonkwang Medical Science, Iksan (Korea, Republic of)

    2015-11-15

    Undifferentiated pleomorphic sarcoma (UPS), previously known as malignant fibrous histiocytoma, is a soft tissue sarcoma arising from mesenchymal tissue of the body. UPS of the gastrointestinal tract is known to be rare and only a few cases have been reported in the literature. Based on our case and review of the other relevant literature, the CT findings of primary UPS of the small bowel included nodular bowel wall thickening with homogeneous enhancement. It presents as a rapidly growing tumor without bowel obstruction, and it may be accompanied by distant metastasis.

  16. Hydro-MRI for abdominal diagnostics in children

    International Nuclear Information System (INIS)

    Kern, A.; Schunk, K.; Oberholzer, K.; Thelen, M.; Kessler, M.

    2001-01-01

    A clinical evaluation of hydro-MRI as an alternative method to barium studies in children with abdominal pain of unknown origin is presented. Patients and Methods: 20 children with abdominal pain of unknown origin aged from 9 - 16 years were examined after oral bowel opacification using 1000 ml of 2.5% mannitol solution with a 1.0T MRI system. The investigation was done in 2 planes (coronal and axial) under breath-hold conditions. Imaging procedures included various sequences (T2W HASTE + FS, contrast-enhanced T1W FLASH FS). Suspicious findings in bowel segments and extra-intestinal changes were assessed. Results: In 21/24 examinations the small bowel was completely visualized, in 15/24 cases colon segments were identified. An accurate assessment of the terminal ileum was not possible in 3/24 procedures. Breathing artefacts occurred in 3/24 examinations. Signs of Crohn's disease were found in 4 examinations, inflammatory changes of the ileum were detected in 3 cases. Inflammation of the colon was demonstrated in 2 children. Furthermore, pathological findings included constipation in one child and inflammation of the ileo-colic and mesenterial lymph nodes were found in another child. Extra-intestinal changes in 3 children were caused by ovarian cysts, and in one case by pleural effusion. In 4 examinations we detected ascites in the absence of other pathological findings. In 5 children there was no pathological correlation in the bowel or extra-intestinal region for the complaints. The children tolerated the hydro-MRI very well. There were no side effects using oral mannitol. (orig.) [de

  17. Understanding about diagnosis of acute small bowel retrograde intussusception in adults by means of 64-slice-spinal CT

    International Nuclear Information System (INIS)

    Jiang Ruizhou; Chen Jincheng

    2009-01-01

    Objective: To have a further study of the value of MSCT in diagnosing acute small bowel retrograde intussusception in adults by means of 64-slice-spinal CT. Methods: A 46-year-old female patient with the history of abdominal operation was found having acute mechanical small bowel obstruction through plain X-ray radiograph. 64-slice MSCT was performed afterwards (plain scan + 3 stage contrast scans). Hence, evidence is provided for operation. Results: Using the technique of MSCT for the patient can promptly approach the diagnosis of jejuno-jejunal intussusception with severe bowel obstruction; no small bowel tumor or other organic lesion found in this case. With the patient who has the history of abdominal operations, MSCT can predict the reason of adhesion causing bowel intussusception, and provide the evidence for operation; whereas MSCT with contrast media offers a further investigation of the blood supply to the bowels through SMA, and observation of blood circulation through the intussuscepting site, which represents venous congestion of intussusception. This case is a retrograde small bowel intussusception and confirmed with operation evidence. A greater amount of gas and fluid is accumulated between the dilated space of middle-distal portion of intussusceptum and intussuscipiens. Nevertheless, less gas at the proximal portion and that can be an important sign for retrograde intussusception. Conclusion: MSCT is a good choice of examination for diagnosis of adult's intussusception. As the literature mentioned the advantages of MSCT for observing the circulation of intussusceptum and whether the diagnosis is antegrade or retrograde intussusception is also essential. (authors)

  18. Non-traumatic perforation of the small bowel | Eid | African Health ...

    African Journals Online (AJOL)

    ... medical records of four patients who have presented with non-traumatic perforation of the small bowel and were treated at Al-Ain Hospital during the last 5 years were studied retrospectively. Results: The presenting symptoms of all patients were similar. Erect chest X-ray has shown free air under diaphragm in 3 patients.

  19. Uterine Perforation With Subtotal Small Bowel Prolapse – A Rare Complication of Dilatation and Curettage

    Directory of Open Access Journals (Sweden)

    Jagannath Mala Sherigar

    2005-05-01

    Full Text Available Uterine perforation is the well known complication of induced abortion. We report a rare case of uterine perforation with subtotal prolapse of small bowel following first trimester abortion by an unqualified physician. Early surgical exploration with resection and anastomosis of bowel performed. Patient discharged uneventfully after postoperative recovery.

  20. Short bowel syndrome

    International Nuclear Information System (INIS)

    Engels, L.G.J.B.

    1983-01-01

    This thesis describes some aspects of short bowel syndrome. When approximately 1 m or less small bowel is retained after extensive resection, a condition called short bowel syndrome is present. Since the advent of parenteral nutrition, the prognosis of patients with a very short bowel has dramatically improved. Patients with 40 to 100 cm remaining jejunum and/or ileum can generally be maintained with oral nutrition due to increased absorption of the small bowel remnant as result of intestinal adaptation. This study reports clinical, biochemical and nutritional aspects of short bowel patients on oral or parenteral nutrition, emphasizing data on absorption of various nutrients and on bone metabolism. Furthermore, some technical apsects concerning long-term parenteral nutrition are discussed. (Auth.)

  1. The incidence of inclusion of the sigmoid colon and small bowel in the planning target volume in radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Meerleer, G.O. de; Vakaet, L.; Neve, W.J. de; Villeirs, G.M.; Delrue, L.J.

    2004-01-01

    Background and purpose: in radiotherapy for prostate cancer, the rectum is considered the dose-limiting organ. The incidence of overlap between the sigmoid colon and/or small bowel and the planning target volume (PTV) as well as the dose to sigmoid colon and small bowel were investigated. Patients and methods: the CT data of 75 prostate cancer patients were analyzed. The clinical target volume (CTV) consisted of prostate and seminal vesicles. The PTV was defined as a three-dimensional expansion of the CTV with a 10-mm margin in craniocaudal and a 7-mm margin in the other directions. All patients were planned to a mean CTV dose of at least 76 Gy. Minimum CTV dose was set at 70 Gy. Dose inhomogeneity within the CTV was kept between 12% and 17%. Sigmoid colon was defined upward from the level where the rectum turned in a transverse plane. Contrast-filled small bowel was contoured on all slices where it was visible. The presence of sigmoid colon and/or small bowel in close vicinity to or overlapping with the PTV was recorded. For each case, the dose to the sigmoid colon and small bowel was calculated. Results: the PTV was found to overlap with the sigmoid colon in 60% and with the small bowel in 19% of the cases. In these patients, mean maximum dose to the sigmoid colon was 76.2 Gy (5th-95th percentile: 70.0-80.7 Gy). Mean maximum dose to the small bowel was 74.9 Gy (5th-95th percentile: 68.0-80.0 Gy). Conclusion: when systematically investigating the anatomic position of sigmoid colon and small bowel in patients accepted for prostate irradiation, parts of both organs were often observed in close vicinity to the PTV. Apart from the rectum, these organs may be dose-limiting in prostate radiotherapy. (orig.)

  2. The incidence of inclusion of the sigmoid colon and small bowel in the planning target volume in radiotherapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Meerleer, G.O. de; Vakaet, L.; Neve, W.J. de [Dept. of Radiation Oncology, Gent Univ. Hospital, Gent (Belgium); Villeirs, G.M.; Delrue, L.J. [Dept. of Radiology, Gent Univ. Hospital, Gent (Belgium)

    2004-09-01

    Background and purpose: in radiotherapy for prostate cancer, the rectum is considered the dose-limiting organ. The incidence of overlap between the sigmoid colon and/or small bowel and the planning target volume (PTV) as well as the dose to sigmoid colon and small bowel were investigated. Patients and methods: the CT data of 75 prostate cancer patients were analyzed. The clinical target volume (CTV) consisted of prostate and seminal vesicles. The PTV was defined as a three-dimensional expansion of the CTV with a 10-mm margin in craniocaudal and a 7-mm margin in the other directions. All patients were planned to a mean CTV dose of at least 76 Gy. Minimum CTV dose was set at 70 Gy. Dose inhomogeneity within the CTV was kept between 12% and 17%. Sigmoid colon was defined upward from the level where the rectum turned in a transverse plane. Contrast-filled small bowel was contoured on all slices where it was visible. The presence of sigmoid colon and/or small bowel in close vicinity to or overlapping with the PTV was recorded. For each case, the dose to the sigmoid colon and small bowel was calculated. Results: the PTV was found to overlap with the sigmoid colon in 60% and with the small bowel in 19% of the cases. In these patients, mean maximum dose to the sigmoid colon was 76.2 Gy (5th-95th percentile: 70.0-80.7 Gy). Mean maximum dose to the small bowel was 74.9 Gy (5th-95th percentile: 68.0-80.0 Gy). Conclusion: when systematically investigating the anatomic position of sigmoid colon and small bowel in patients accepted for prostate irradiation, parts of both organs were often observed in close vicinity to the PTV. Apart from the rectum, these organs may be dose-limiting in prostate radiotherapy. (orig.)

  3. Role of luminal nutrients and endogenous GLP-2 in intestinal adaptation to mid-small bowel resection

    DEFF Research Database (Denmark)

    Dahly, Elizabeth M; Gillingham, Melanie B; Guo, Ziwen

    2003-01-01

    To elucidate the role of luminal nutrients and glucagon-like peptide-2 (GLP-2) in intestinal adaptation, rats were subjected to 70% midjejunoileal resection or ileal transection and were maintained with total parenteral nutrition (TPN) or oral feeding. TPN rats showed small bowel mucosal hyperpla......To elucidate the role of luminal nutrients and glucagon-like peptide-2 (GLP-2) in intestinal adaptation, rats were subjected to 70% midjejunoileal resection or ileal transection and were maintained with total parenteral nutrition (TPN) or oral feeding. TPN rats showed small bowel mucosal...... rats was associated with a significant positive correlation between increases in plasma bioactive GLP-2 and proglucagon mRNA expression in the colon of TPN rats and ileum of orally fed rats. These data support a significant role for endogenous GLP-2 in the adaptive response to mid-small bowel resection...

  4. Extramedullary plasmacytoma of small bowel mesentery in associated with cecal cancer: a case report

    International Nuclear Information System (INIS)

    Kim, Sung Kyu; Kim, Yong Soo; Kim, Young Sun; Cho, On Koo; Koh, Byung Hee; Rhim, Hyun Chul; Park, Choog Ki; Park, Dong Woo; Park, Yong Wook; Oh, Young Ha

    2005-01-01

    Extramedullary plasmacytoma is a rare disease that is histopathologically defined as a solitary tumor composed of a monoclonal proliferation of cells with plasmacytic differentiation in an extramedullary site. Most of these tumors occur in the submucosa of the upper aerodigestive tract, and they rarely occur in the small bowel mesentery. We report here on a case of extramedullary plasmacytoma of the small bowel mesentery that was in association with a cecal cancer. Abdominal ultrasound and CT revealed a lobulated soft tissue mass with a cystic portion and peripheral calcification. In this case, the preoperative radiological diagnosis was difficult due to accompanying cecal cancer

  5. Extramedullary plasmacytoma of small bowel mesentery in associated with cecal cancer: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Kyu; Kim, Yong Soo; Kim, Young Sun; Cho, On Koo; Koh, Byung Hee; Rhim, Hyun Chul; Park, Choog Ki; Park, Dong Woo [Hanyang University College of Medicine, Seoul (Korea, Republic of); Park, Yong Wook; Oh, Young Ha [Hanyang University Guri Hospital, Guri (Korea, Republic of)

    2005-07-15

    Extramedullary plasmacytoma is a rare disease that is histopathologically defined as a solitary tumor composed of a monoclonal proliferation of cells with plasmacytic differentiation in an extramedullary site. Most of these tumors occur in the submucosa of the upper aerodigestive tract, and they rarely occur in the small bowel mesentery. We report here on a case of extramedullary plasmacytoma of the small bowel mesentery that was in association with a cecal cancer. Abdominal ultrasound and CT revealed a lobulated soft tissue mass with a cystic portion and peripheral calcification. In this case, the preoperative radiological diagnosis was difficult due to accompanying cecal cancer.

  6. Spectrum of small-bowel mucosal abnormalities identified by capsule endoscopy in patients with portal hypertension of varied etiology.

    Science.gov (United States)

    Chandrasekar, T S; Janakan, Gokul Bollu; Chandrasekar, Viveksandeep Thoguluva; Kalamegam, Raja Yogesh; Suriyanarayanan, Sathiamoorthy; Sanjeevaraya, Prasad Menta

    2017-01-01

    Bleeding from small intestinal ectopic varices and persistent anemia caused by portal hypertensive enteropathy (PHE) can be very challenging. Capsule endoscopy (CE) is one of the best noninvasive modalities in identifying such lesions. The aims of this study are to study the prevalence of small-bowel changes related to portal hypertension (PHT) and to correlate them with the observations related to the effects of portal hypertension in the esophagus, stomach, and colon. Thirty-two patients with various etiologies of PHT with either anemia or gastrointestinal bleed were included along with age- and sex-matched controls without PHT. All patients underwent blood tests, gastroscopy, colonoscopy, and CE. The small-bowel findings by CE were categorized as inflammatory-like and vascular lesions. The small-bowel changes were analyzed to find out any association with various demographic, clinical, and endoscopic variables. Thirty-one out of 32 patients with PHT (96.8%) had PHE identified by CE. Of them, 31 (96.8%) had inflammatory-like appearance, 11 (34.4%) had vascular lesions, and 2 (6.2%) had small-bowel varices. Inflammatory-like appearance was noted in eight (25%) and angiodysplastic lesions in two (6.2%) controls. Findings compatible with PHE were detected in 96.8% of the patients and 25% of the controls (X 2 =34.72, p=0.000).The presence of PHE was not associated with any of the above-mentioned variables. Small-bowel mucosal changes were seen in significantly higher number of patients with PHT with anemia.

  7. The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome.

    Science.gov (United States)

    Pyleris, Emmannouil; Giamarellos-Bourboulis, Evangelos J; Tzivras, Dimitrios; Koussoulas, Vassilios; Barbatzas, Charalambos; Pimentel, Mark

    2012-05-01

    Many studies have linked irritable bowel syndrome (IBS) with small intestinal bacterial overgrowth (SIBO), although they have done so on a qualitative basis using breath tests even though quantitative cultures are the hallmark of diagnosis. The purpose of this study was to underscore the frequency of SIBO in a large number of Greeks necessitating upper gastrointestinal (GI) tract endoscopy by using quantitative microbiological assessment of the duodenal aspirate. Consecutive subjects presenting for upper GI endoscopy were eligible to participate. Quantitative culture of aspirates sampled from the third part of the duodenum during upper GI tract endoscopy was conducted under aerobic conditions. IBS was defined by Rome II criteria. Among 320 subjects enrolled, SIBO was diagnosed in 62 (19.4%); 42 of 62 had IBS (67.7%). SIBO was found in 37.5% of IBS sufferers. SIBO was found in 60% of IBS patients with predominant diarrhea compared with 27.3% without diarrhea (P = 0.004). Escherichia coli, Enterococcus spp and Klebsiella pneumoniae were the most common isolates within patients with SIBO. A step-wise logistic regression analysis revealed that IBS, history of type 2 diabetes mellitus and intake of proton pump inhibitors were independently and positively linked with SIBO; gastritis was protective against SIBO. Using culture of the small bowel, SIBO by aerobe bacteria is independently linked with IBS. These results reinforce results of clinical trials evidencing a therapeutic role of non-absorbable antibiotics for the management of IBS symptoms.

  8. Ruptured Jejunal Diverticulum Due to a Single-Band Small Bowel Obstruction

    Directory of Open Access Journals (Sweden)

    Rajaraman Durai

    2008-01-01

    Full Text Available Jejunal diverticulosis is rare and often goes unnoticed until complications occur. The diverticula are true, acquired diverticula and often asymptomatic. Jejunal diverticulosis can be associated with diverticulosis of the duodenum, ileum, and colon. Here we describe a patient with known severe diverticular disease of the large bowel, who presented acutely with abdominal pain and signs of generalised peritonitis. Laparotomy showed ruptured jejunal diverticulosis with a single band over the terminal ileum, causing small bowel obstruction. Spontaneous perforation of a jejunal diverticulum is rare and is usually an intraoperative finding. One should exclude a precipitating cause, such as coexisting distal obstruction, stricture, or a foreign body.

  9. Stagnant loop syndrome resulting from small-bowel irradiation injury and intestinal by-pass

    International Nuclear Information System (INIS)

    Swan, R.W.

    1974-01-01

    Stagnant or blind-loop syndrome includes vitamin B12 malabsorption, steatorrhea, and bacterial overgrowth of the small intestine. A case is presented to demonstrate this syndrome occurring after small-bowel irradiation injury with exaggeration postenterocolic by-pass. Alteration of normal small-bowel flora is basic to development of the stagnant-loop syndrome. Certain strains of bacteria as Bacteriodes and E. coli are capable of producing a malabsorption state. Definitive therapy for this syndrome developing after severe irradiation injury and intestinal by-pass includes antibiotics. Rapid symptomatic relief from diarrhea and improved malabsorption studies usually follow appropriate antibiotic therapy. Recolonization of the loop(s) with the offending bacterial species may produce exacerbation of symptoms. Since antibiotics are effective, recognition of this syndrome is important. Foul diarrheal stools should not be considered a necessary consequence of irradiation injury and intestinal by-pass

  10. The Dose-Volume Relationship of Small Bowel Irradiation and Acute Grade 3 Diarrhea During Chemoradiotherapy for Rectal Cancer

    International Nuclear Information System (INIS)

    Robertson, John M.; Lockman, David; Yan Di; Wallace, Michelle

    2008-01-01

    Purpose: Previous work has found a highly significant relationship between the irradiated small-bowel volume and development of Grade 3 small-bowel toxicity in patients with rectal cancer. This study tested the previously defined parameters in a much larger group of patients. Methods and Materials: A total of 96 consecutive patients receiving pelvic radiation therapy for rectal cancer had treatment planning computed tomographic scans with small-bowel contrast that allowed the small bowel to be outlined with calculation of a small-bowel dose-volume histogram for the initial intended pelvic treatment to 45 Gy. Patients with at least one parameter above the previously determined dose-volume parameters were considered high risk, whereas those with all parameters below these levels were low risk. The grade of diarrhea and presence of liquid stool was determined prospectively. Results: There was a highly significant association with small-bowel dose-volume and Grade 3 diarrhea (p ≤ 0.008). The high-risk and low-risk parameters were predictive with Grade 3 diarrhea in 16 of 51 high-risk patients and in 4 of 45 low-risk patients (p = 0.01). Patients who had undergone irradiation preoperatively had a lower incidence of Grade 3 diarrhea than those treated postoperatively (18% vs. 28%; p = 0.31); however, the predictive ability of the high-risk/low-risk parameters was better for preoperatively (p = 0.03) than for postoperatively treated patients (p = 0.15). Revised risk parameters were derived that improved the overall predictive ability (p = 0.004). Conclusions: The highly significant dose-volume relationship and validity of the high-risk and low-risk parameters were confirmed in a large group of patients. The risk parameters provided better modeling for the preoperative patients than for the postoperative patients

  11. Segmental small bowel necrosis associated with antiphospholipid syndrome: a case report.

    Science.gov (United States)

    Wang, Qun-Ying; Ye, Xiao-Hua; Ding, Jin; Wu, Xiao-Kang

    2015-04-07

    Antiphospholipid syndrome is a multi-system disease characterized by the formation of thromboembolic complications and/or pregnancy morbidity, and with persistently increased titers of antiphospholipid antibodies. We report the case of a 50-year-old, previously healthy man who presented with fever and new-onset, dull abdominal pain. A contrast-enhanced computed tomography scan showed segmental small bowel obstruction, for which an emergency laparotomy was performed. Histopathologic examination of resected tissues revealed multiple intestinal and mesenteric thromboses of small vessels. Laboratory tests for serum antiphospholipid (anticardiolipin IgM) and anti-β2-glycoprotein I antibodies were positive. Despite proactive implementation of anticoagulation, steroid, and antibiotic therapies, the patient's condition rapidly deteriorated, and he died 22 d after admission. This case highlights that antiphospholipid syndrome should be suspected in patients with unexplainable ischemic bowel and intestinal necrosis presenting with insidious clinical features that may be secondary to the disease, as early diagnosis is critical to implement timely treatments in order to ameliorate the disease course.

  12. Protective fibrin-sealed plication of the small bowel in recurrent laparotomy.

    Science.gov (United States)

    Holland-Cunz, S; Boelter, A V; Waag, K L

    2003-09-01

    Adhesions after recurrent abdominal operations remain extremely common and are sources of severe morbidity. Fibrin-glued plication of the small gut in a meander-like formation is supposed to guarantee a decreased risk of intestinal obstruction postoperatively. This retrospective study analyses the clinical outcome after recurrent laparotomy in children treated with bowel plication by fibrin sealant. The surgical technique of performing the fibrin-glued plication is rather simple and quick: after taking off all adhesions two to four loops of the small gut are positioned so that they lie side by side. Beginning proximal fibrin [Tissucol fibrin sealant (Baxter)] is applied between the loops; approximately 20-30 s are needed to keep the loops in position until the fibrin dries. This manoeuvre is continued until all of the small gut is fixed in one block. The gut is brought back into the abdominal cavity without loosening the loops. This fixed formation by sero-serosal adhesions or mesenterial plications is supposed to guarantee postoperative free passage. The charts of 60 children who had undergone a fibrin plication of the small bowel between 1991 and 1999 were evaluated. Additionally, questionnaires were sent to all patients, and they were invited for an examination. Sixty patients (38 boys and 22 girls) received a fibrin sealant plication because of recurrent laparotomies with heavily serosal defects or recurrent ileus because of adhesions. The youngest baby was 10 days. Since 23 patients were premature the oldest patient was 11 years old. There were no intraoperative complications attributed to the method. In the postoperative period 7/60 (12%) patients had a recurrent ileus or subileus, leading in three (5%) patients to an early relaparotomy. The fibrin-glued plication of the small bowel decreases the risk of recurrent ileus or subileus considering the high figures in the literature concerning this issue. The time-saving method is very simple and easily feasible

  13. Contribution of multi-detector row CT (MDCT) to decision making in the management of patients with small bowel obstruction or ileus

    International Nuclear Information System (INIS)

    Osada, Hisato; Watanabe, Wataru; Okada, Taketomo

    2007-01-01

    We retrospectively evaluated the contribution of multi-detector row CT (MDCT) to patient management decisions in 62 patients with small bowel obstruction or ileus. The sensitivity and specificity of MDCT diagnosis of small bowel obstruction with strangulation or closed loop were 78.9% (15/19) and 93.0% (40/43), respectively. In 19 patients with small bowel obstruction with strangulation or closed loop, the median interval between CT examination and the commencement of surgery was significantly longer in misdiagnosed patients than in those correctly diagnosed (43.3 vs. 4.5 hours, p<0.05). Only two patients displayed severe physical signs that required urgent surgical treatment. Our results suggest that MDCT plays a key role in the management of patients with small bowel obstruction. (author)

  14. Non-steroidal anti-inflammatory drug-induced small bowel injuries identified by double-balloon endoscopy

    Science.gov (United States)

    Hayashi, Yoshikazu; Yamamoto, Hironori; Kita, Hiroto; Sunada, Keijiro; Sato, Hiroyuki; Yano, Tomonori; Iwamoto, Michiko; Sekine, Yutaka; Miyata, Tomohiko; Kuno, Akiko; Iwaki, Takaaki; Kawamura, Yoshiyuki; Ajibe, Hironari; Ido, Kenichi; Sugano, Kentaro

    2005-01-01

    AIM: To clarify clinical features of the NSAID-induced small bowel lesions using a new method of endoscopy. METHODS: This is a retrospective study and we analyzed seven patients with small bowel lesions while taking NSAIDs among 61 patients who had undergone double-balloon endoscopy because of gastro-intestinal bleeding or anemia between September 2000 and March 2004, at Jichi Medical School Hospital in Japan. Neither conventional EGD nor colonoscopy revealed any lesions of potential bleeding sources including ulcerations. Double-balloon endoscopy was carried out from oral approach in three patients, from anal approach in three patients, and from both approaches in one patient. RESULTS: Ulcers or erosions were observed in the ileum in six patients and in the jejunum in one patient, respectively. The ulcers were multiple in all the patients with different features from tiny punched out ulcers to deep ulcerations with oozing hemorrhage or scar. All the patients recovered uneventfully and had full resolution of symptoms after suspension of the drug. CONCLUSION: NSAIDs can induce injuries in the small bowel even in patients without any lesions in both the stomach and colon. PMID:16097059

  15. Correction of MRI-induced geometric distortions in whole-body small animal PET-MRI

    International Nuclear Information System (INIS)

    Frohwein, Lynn J.; Schäfers, Klaus P.; Hoerr, Verena; Faber, Cornelius

    2015-01-01

    Purpose: The fusion of positron emission tomography (PET) and magnetic resonance imaging (MRI) data can be a challenging task in whole-body PET-MRI. The quality of the registration between these two modalities in large field-of-views (FOV) is often degraded by geometric distortions of the MRI data. The distortions at the edges of large FOVs mainly originate from MRI gradient nonlinearities. This work describes a method to measure and correct for these kind of geometric distortions in small animal MRI scanners to improve the registration accuracy of PET and MRI data. Methods: The authors have developed a geometric phantom which allows the measurement of geometric distortions in all spatial axes via control points. These control points are detected semiautomatically in both PET and MRI data with a subpixel accuracy. The spatial transformation between PET and MRI data is determined with these control points via 3D thin-plate splines (3D TPS). The transformation derived from the 3D TPS is finally applied to real MRI mouse data, which were acquired with the same scan parameters used in the phantom data acquisitions. Additionally, the influence of the phantom material on the homogeneity of the magnetic field is determined via field mapping. Results: The spatial shift according to the magnetic field homogeneity caused by the phantom material was determined to a mean of 0.1 mm. The results of the correction show that distortion with a maximum error of 4 mm could be reduced to less than 1 mm with the proposed correction method. Furthermore, the control point-based registration of PET and MRI data showed improved congruence after correction. Conclusions: The developed phantom has been shown to have no considerable negative effect on the homogeneity of the magnetic field. The proposed method yields an appropriate correction of the measured MRI distortion and is able to improve the PET and MRI registration. Furthermore, the method is applicable to whole-body small animal

  16. Correction of MRI-induced geometric distortions in whole-body small animal PET-MRI

    Energy Technology Data Exchange (ETDEWEB)

    Frohwein, Lynn J., E-mail: frohwein@uni-muenster.de; Schäfers, Klaus P. [European Institute for Molecular Imaging, University of Münster, Münster 48149 (Germany); Hoerr, Verena; Faber, Cornelius [Department of Clinical Radiology, University Hospital of Münster, Münster 48149 (Germany)

    2015-07-15

    Purpose: The fusion of positron emission tomography (PET) and magnetic resonance imaging (MRI) data can be a challenging task in whole-body PET-MRI. The quality of the registration between these two modalities in large field-of-views (FOV) is often degraded by geometric distortions of the MRI data. The distortions at the edges of large FOVs mainly originate from MRI gradient nonlinearities. This work describes a method to measure and correct for these kind of geometric distortions in small animal MRI scanners to improve the registration accuracy of PET and MRI data. Methods: The authors have developed a geometric phantom which allows the measurement of geometric distortions in all spatial axes via control points. These control points are detected semiautomatically in both PET and MRI data with a subpixel accuracy. The spatial transformation between PET and MRI data is determined with these control points via 3D thin-plate splines (3D TPS). The transformation derived from the 3D TPS is finally applied to real MRI mouse data, which were acquired with the same scan parameters used in the phantom data acquisitions. Additionally, the influence of the phantom material on the homogeneity of the magnetic field is determined via field mapping. Results: The spatial shift according to the magnetic field homogeneity caused by the phantom material was determined to a mean of 0.1 mm. The results of the correction show that distortion with a maximum error of 4 mm could be reduced to less than 1 mm with the proposed correction method. Furthermore, the control point-based registration of PET and MRI data showed improved congruence after correction. Conclusions: The developed phantom has been shown to have no considerable negative effect on the homogeneity of the magnetic field. The proposed method yields an appropriate correction of the measured MRI distortion and is able to improve the PET and MRI registration. Furthermore, the method is applicable to whole-body small animal

  17. Radiologic findings of small bowel rupture due to blunt abdominal trauma

    International Nuclear Information System (INIS)

    Ha, Hyeon Kweun; Bahk, Yong Whee

    1987-01-01

    Bowel rupture due to blunt abdominal trauma is no longer rare, and is among the most challenging problems that confront the physicians and radiologists. It is frequently difficult to diagnose because the symptoms may be trivial during the early stage and masked by more obvious, but less lethal injuries. It is well known that the roentgen examination of the abdomen is also of little value to exclude bowel rupture because of infrequency of positive findings and free gas. The plain films of 23 cases of jejunal rupture and 8 cases of ileal rupture were evaluated to sort and diagnostic features of small bowel rupture caused by blunt abdominal trauma. 1. Free intraperitoneal gas was noted in 6 cases of jejunal rupture (26%) and 1 case of ileal rupture (13%), and definite radiological evidence of free intraperitoneal fluid was present in 16 cases of patients (52%). 2. The contour change of bowel loops such as tapering or indentation were seen in 11 cases of patients (36%), and local opacity along the mesenteric root axis was demonstrated in 19 cases of patients (61%). 3. Paralytic ileus was localized to LUQ in jejunal rupture and to mid-abdomen in ileal rupture, and gastric and transverse-colon distension with gas was noticeable especially in jejunal rupture

  18. Magnetic resonance imaging of the small bowel in children with idiopathic inflammatory bowel disease: evaluation of disease activity

    International Nuclear Information System (INIS)

    Alexopoulou, Efthymia; Loggitsi, Dimitra; Economopoulos, Nikos; Papakonstantinou, Olympia; Kelekis, Nikolaos L.; Roma, Eleftheria; Panagiotou, Ioanna; Pahoula, Ioanna

    2009-01-01

    Examinations using ionizing radiation are frequently used in the evaluation of disease activity in children affected by idiopathic inflammatory bowel disease (IBD). To develop an MR imaging protocol without the need for fluoroscopic insertion of an enteral tube and to assess the disease activity in children with IBD. Included in the study were 37 children (22 girls and 15 boys; age range 7-15 years, mean 11.67 years) with IBD who underwent MR imaging of the small bowel. Of these 37 children, 32 had Crohn disease and 5 had indeterminate colitis. A water solution containing herbal fibres was administered orally or through a nasogastric tube. Patients were imaged on a 1.5-T MR scanner with T1-weighted and Τ2-weighted sequences followed by a dynamic study using 3-D T1-W images after intravenous administration of gadolinium. The percentage enhancement of the bowel wall was significantly increased in patients with abnormal C-reactive protein (CRP) values compared to patients with CRP values in the normal range (P<0.001). A relatively weak but significant correlation between percentage enhancement of the bowel wall and CRP values was noted during all phases of enhancement. This MR imaging protocol is a safe and well-tolerated method for evaluating disease activity and extraintestinal manifestations of IBD in children. (orig.)

  19. Magnetic resonance imaging of the small bowel in children with idiopathic inflammatory bowel disease: evaluation of disease activity

    Energy Technology Data Exchange (ETDEWEB)

    Alexopoulou, Efthymia; Loggitsi, Dimitra; Economopoulos, Nikos; Papakonstantinou, Olympia; Kelekis, Nikolaos L. [National and Kapodistrian University of Athens, General University Hospital, Second Department of Radiology, Athens (Greece); Roma, Eleftheria; Panagiotou, Ioanna; Pahoula, Ioanna [National and Kapodistrian University of Athens, Aghia Sofia Children' s Hospital, First Department of Paediatrics, Athens (Greece)

    2009-08-15

    Examinations using ionizing radiation are frequently used in the evaluation of disease activity in children affected by idiopathic inflammatory bowel disease (IBD). To develop an MR imaging protocol without the need for fluoroscopic insertion of an enteral tube and to assess the disease activity in children with IBD. Included in the study were 37 children (22 girls and 15 boys; age range 7-15 years, mean 11.67 years) with IBD who underwent MR imaging of the small bowel. Of these 37 children, 32 had Crohn disease and 5 had indeterminate colitis. A water solution containing herbal fibres was administered orally or through a nasogastric tube. Patients were imaged on a 1.5-T MR scanner with T1-weighted and {tau}2-weighted sequences followed by a dynamic study using 3-D T1-W images after intravenous administration of gadolinium. The percentage enhancement of the bowel wall was significantly increased in patients with abnormal C-reactive protein (CRP) values compared to patients with CRP values in the normal range (P<0.001). A relatively weak but significant correlation between percentage enhancement of the bowel wall and CRP values was noted during all phases of enhancement. This MR imaging protocol is a safe and well-tolerated method for evaluating disease activity and extraintestinal manifestations of IBD in children. (orig.)

  20. Localization of bleeding small bowel lesions for conservative resection: a simple radiographic technique

    Energy Technology Data Exchange (ETDEWEB)

    Stevens, J M; Northover, J M.A.; Raphael, M J; Slack, W W [Middlesex Hospital, London (UK)

    1981-10-01

    Haemorrhage from the small bowel is a serious diagnostic and therapeutic problem. The value of selective superior mesenteric angiography to localize the source accurately does not require emphasizing. However, many of the lesions demonstrated are notoriously difficult to find at operation unless they are actively bleeding at the time. A simple method of intra-operative angiography is described which, because demonstration of the bleeding lesion on the operative films is not an essential requirement, does not involve the use of specialized angiographic equipment. Although only one case is offered to illustrate the method, it seems to possess sufficient versatility to be useful in most situations where intra-operative assistance in isolating a specific loop of small bowel for resection is anticipated.

  1. Small bowel obstruction complicating colonoscopy: a case report

    Directory of Open Access Journals (Sweden)

    Hunter Iain A

    2008-05-01

    Full Text Available Abstract Introduction This report describes a rare complication of colonoscopy and reviews the literature with regard to other rare causes of acute abdominal presentations following colonoscopy. Case presentation After a therapeutic colonoscopy a 60-year-old woman developed an acute abdomen. At laparotomy she was discovered to have small bowel obstruction secondary to incarceration through a congenital band adhesion. Conclusion Although there is no practical way in which such rare complications can be predicted, this case report emphasises the wide array of pathologies that can result in acute abdominal symptoms following colonoscopy.

  2. Small bowel lymphangiectasia and angiodysplasia: a positive association; novel clinical marker or shared pathophysiology?

    Science.gov (United States)

    Macdonald, Jonathan; Porter, Victoria; Scott, Neil W; McNamara, Deirdre

    2010-10-01

    Small bowel angiodysplasia accounts for 30 to 40% of cases of obscure gastrointestinal bleeding and is associated with significant morbidity and mortality. Identifying lesions can be difficult. Small bowel capsule endoscopy (SBCE) is a significant advance on earlier diagnostic techniques. The cause of angiodysplasia is unknown and the natural history poorly understood. Many lesions are thought to arise from a degenerative process associated with ageing, local vascular anomalies, and tissue hypoxia. Nonpathologic lymphangiectasias are commonly seen throughout the small bowel and are considered a normal finding. To determine whether there is an association between lymphangiectasias, angiodysplasia, and atherosclerosis related conditions. Relevant information was collected from a dedicated SBCE database. Logistic regression analysis was used to examine associations between angiodysplasia, lymphangiectasia, patient demographics, and comorbidity. In all, 180 patients underwent SBCE during the study period, 46 (25%) had angiodysplasia and 47 (26%) lymphangiectasia. Lymphangiectasia were seen in 24 (52%) of 46 with angiodysplasia, in 16 (19%) of 84 with obscure gastrointestinal bleeding without angiodysplasia and in 7 (14%) of 50 without gastrointestinal bleeding. Logistic regression analysis confirmed a strong positive association between angiodysplasia and lymphangiectasia; odds ratio 4.42, PLymphangiectasia are strongly associated with the presence of small intestinal angiodysplasia and may represent a useful clinical marker for this condition. Angiodysplasia are also associated with increasing age. Conditions associated with systemic atherosclerosis did not increase the risk of angiodysplasia.

  3. MRI of vulvar Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Pai, Deepa; Dillman, Jonathan R.; Mahani, Maryam Ghadimi; Strouse, Peter J. [University of Michigan Health System, Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children' s Hospital, F3503, Ann Arbor, MI (United States); Adler, Jeremy [University of Michigan Health System, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, C. S. Mott Children' s Hospital, Ann Arbor, MI (United States)

    2011-04-15

    Crohn disease is a chronic granulomatous inflammatory disorder that most commonly affects the gastrointestinal tract, particularly the distal small bowel and colon. While certain extraintestinal manifestations of Crohn disease are relatively common and well-known, others, such as metastatic cutaneous involvement, are quite rare and may be difficult to recognize, particularly in the pediatric population. This case report illustrates the magnetic resonance imaging (MRI) appearance of vulvar region cutaneous Crohn disease in an 11-year-old girl. (orig.)

  4. Microscopy of bacterial translocation during small bowel obstruction and ischemia in vivo – a new animal model

    Directory of Open Access Journals (Sweden)

    Hafner Mathias

    2002-08-01

    Full Text Available Abstract Background Existing animal models provide only indirect information about the pathogenesis of infections caused by indigenous gastrointestinal microflora and the kinetics of bacterial translocation. The aim of this study was to develop a novel animal model to assess bacterial translocation and intestinal barrier function in vivo. Methods In anaesthetized male Wistar rats, 0.5 ml of a suspension of green fluorescent protein-transfected E. coli was administered by intraluminal injection in a model of small bowel obstruction. Animals were randomly subjected to non-ischemic or ischemic bowel obstruction. Ischemia was induced by selective clamping of the terminal mesenteric vessels feeding the obstructed bowel loop. Time intervals necessary for translocation of E. coli into the submucosal stroma and the muscularis propria was assessed using intravital microscopy. Results Bacterial translocation into the submucosa and muscularis propria took a mean of 36 ± 8 min and 80 ± 10 min, respectively, in small bowel obstruction. Intestinal ischemia significantly accelerated bacterial translocation into the submucosa (11 ± 5 min, p E. coli were visible in frozen sections of small bowel, mesentery, liver and spleen taken two hours after E. coli administration. Conclusions Intravital microscopy of fluorescent bacteria is a novel approach to study bacterial translocation in vivo. We have applied this technique to define minimal bacterial transit time as a functional parameter of intestinal barrier function.

  5. The Accuracy of Point-of-Care Ultrasound in Detecting Small Bowel Obstruction in Emergency Department

    Directory of Open Access Journals (Sweden)

    A. Pourmand

    2018-01-01

    Full Text Available Radiological imaging plays an essential role in the evaluation of a patient with suspected small bowel obstruction (SBO. In a few studies, point-of-care ultrasound (POCUS has been utilized as a primary imaging modality in patients with suspected SBO. POCUS has been shown to be an accurate tool in the diagnosis of SBO with multiple research studies noting a consistent high sensitivity with a range of 94–100% and specificity of 81–100%. Specific sonographic findings that increase the likelihood of SBO include dilatation of small bowel loops > 25 mm, altered intestinal peristalsis, increased thickness of the bowel wall, and intraperitoneal fluid accumulation. Studies also reported that emergency physicians could apply this technique with limited and short-term ultrasound training. In this article, we aim to review the sensitivity and specificity of ultrasound examinations performed by emergency physicians in patients with suspected SBO.

  6. MDCT in the diagnosis of small-bowel obstruction by a retained ...

    African Journals Online (AJOL)

    assessment of complications such as abscess formation, fistula. MDCT in the diagnosis of small-bowel obstruction by a retained surgical swab. M. Bindapersad, M.B. Ch.B., F.C.Rad. (Diag.) N. Govender, M.B. Ch.B. Department of Radiology, Chris Hani Baragwanath Hospital and Faculty of Health Sciences, University of the ...

  7. Imaging features of colovesical fistulae on MRI.

    Science.gov (United States)

    Tang, Y Z; Booth, T C; Swallow, D; Shahabuddin, K; Thomas, M; Hanbury, D; Chang, S; King, C

    2012-10-01

    MRI is routinely used in the investigation of colovesical fistulae at our institute. Several papers have alluded to its usefulness in achieving the diagnosis; however, there is a paucity of literature on its imaging findings. Our objective was to quantify the MRI characteristics of these fistulae. We selected all cases over a 4-year period with a final clinical diagnosis of colovesical fistula which had been investigated with MRI. The MRI scans were reviewed in a consensus fashion by two consultant uroradiologists. Their MRI features were quantified. There were 40 cases of colovesical fistulae. On MRI, the fistula morphology consistently fell into three patterns. The most common pattern (71%) demonstrated an intervening abscess between the bowel wall and bladder wall. The second pattern (15%) had a visible track between the affected bowel and bladder. The third pattern (13%) was a complete loss of fat plane between the affected bladder and bowel wall. MRI correctly determined the underlying aetiology in 63% of cases. MRI is a useful imaging modality in the diagnosis of colovesical fistulae. The fistulae appear to have three characteristic morphological patterns that may aid future diagnoses of colovesical fistulae. To the authors' knowledge, this is the first publication of the MRI findings in colovesical fistulae.

  8. Virtual endoscopy of the small bowel: phantom study and preliminary clinical results

    International Nuclear Information System (INIS)

    Rogalla, P.; Werner-Rustner, M.; Meiri, N.; Hamm, B.; Huitema, A.; van Est, A.

    1998-01-01

    The purpose of this study was to determine the optimal scanning technique for lesion detection in a small bowel phantom and to evaluate the virtual endoscopy (VE) technique in patients. A small bowel phantom with a fold thickness of 7 mm and length of 115 cm was prepared with nine round lesions (3 x 1 mm, 2 x 2 mm, 2 x 3 mm, 2 x 4 mm). Spiral CT parameters were 7/7/4, 3/5/2, 3/5/1, 1.5/3/1 (slice thickness/table feed/reconstruction interval). VE was done using volume rendering technique with 1 cm distance between images and 120 viewing angle. Two masked readers were asked to determine the number and location of the lesions. Seven patients underwent an abdominal CT during one breathhold after placement of a duodenal tube and filling of the small bowel with methyl cellulose contrast solution. VE images were compared with the axial slices with respect to detectability of pathology. With the 7/7/4 protocol only the 4-mm lesions were visualised with fuzzy contours. The 3/5/2 protocol showed both 4-mm lesions, one 3-mm lesion and one false positive lesion. The 3/5/1 protocol showed both 4-mm and both 3-mm (one uncertain) lesions with improved sharpness, and no false positive lesions. One 2-mm and one 1-mm lesion were additionally seen with the 1.5/3/1 protocol. Path definition was difficult in sharp turns or kinks in the lumen. In all patients, no difference was found between VE and axial slices for bowel pathology; however, axial slices showed 'outside' information that was not included in VE. We conclude that the 3/5/2 protocol may be regarded as an optimal compromise between lesion detection, coverage during one breathhold, and number of reconstructed images in patients; round lesions of 4 mm in diameter can be detected with high certainty. (orig.)

  9. Intestinal myoelectric activity and contractile motility in dogs with a reversed jejunal segment after extensive small bowel resection.

    Science.gov (United States)

    Uchiyama, M; Iwafuchi, M; Ohsawa, Y; Yagi, M; Iinuma, Y; Ohtani, S

    1992-06-01

    To evaluate the functioning and effectiveness of a reversed jejunal segment after extensive small bowel resection, we continuously measured the postoperative bowel motility (using bipolar electrodes and/or contractile strain gage force transducers) in interdigestive and postprandial conscious dogs at 2 to 5 weeks after surgery. The fasting duodenal migrating myoelectric (or motor) complex (MMC) occurred at markedly longer intervals in dogs with a 20-cm reversed jejunal segment created after 75% to 80% extensive small bowel resection (group 3) than in dogs that received extensive resection alone (group 2) or dogs that underwent construction of a reversed jejunal segment without bowel resection (group 1). The MMC arising from the duodenum was often interrupted at the jejunum above the proximal anastomosis and did not migrate smoothly to the reversed segment or terminal ileum in group 3. In addition, brief small discordant contractions were frequent in the reversed segment and the jejunum above the proximal anastomosis in group 3. The duration of the postprandial period without duodenal MMC activity was significantly prolonged in groups 2 and 3. These results suggest that the transit time and passage of intestinal contents were delayed and that the periodical MMC was disturbed in group 3. The delay of transit time was due to prolongation of the interval between duodenal MMCs, the interruption of MMC propagation at the jejunum above the proximal anastomosis, the dominance of MMCs that followed the inherent anatomical continuity of the bowel, and discordant movements across the proximal anastomosis. Functional obstruction could be a potential problem in a 20-cm reversed jejunal segment inserted after extensive small bowel resection.

  10. Detection of unsuspected colonic abnormalities using the pneumocolon technique during small bowel meal examination

    International Nuclear Information System (INIS)

    Chou, S.; Skehan, S.J.; Brown, A.L.; Rawlinson, J.; Somers, S.

    2000-01-01

    AIMS: The pneumocolon technique in small bowel meal examination is used to obtain double-contrast views of the distal ileum. The purpose of this study was to determine the proportion of cases in which an overhead pneumocolon radiograph demonstrated clinically relevant findings in the colon. METHODS: The overhead pneumocolon radiographs in 151 patients who underwent small bowel meals were evaluated retrospectively. A chart review was performed on those patients with positive colonic findings to determine if the suspected abnormalities affected patient management. RESULTS: Colonic abnormalities were identified in 34 of the 151 patients. One patient had a previously undiagnosed ascending colonic cancer; 17 had evidence of acute or chronic colitis; 13 had diverticulosis; one had a caecal polyp; one had an ileosigmoid fistula; one had a filling defect in the ascending colon. In 25 cases the colonic abnormality was visible only on the pneumocolon radiograph and not on the preceding single-contrast images. Management was altered by the colonic findings in seven cases. False-positive findings occurred in two cases. CONCLUSIONS: A routine overhead radiograph following use of the pneumocolon technique is a useful adjunct to small bowel meal examination as it can yield unsuspected and clinically significant colonic findings. Chou, S. (2000)

  11. Small-bowel volvulus in late pregnancy due to internal hernia after laparoscopic Roux-en-Y gastric bypass.

    Science.gov (United States)

    Naef, Markus; Mouton, Wolfgang G; Wagner, Hans E

    2010-12-01

    Internal hernias are a specific cause of acute abdominal pain and are a well-known complication after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Although internal hernias are a rare cause of intestinal obstruction, they may evolve towards serious complications, such as extensive bowel ischemia and gangrene, with the need for bowel resection and sometimes for a challenging reconstruction of intestinal continuity. The antecolic position of the Roux limb is associated with a decrease in the incidence of small-bowel obstruction and internal hernias. The best prevention of the formation of these hernias is probably by closure of potential mesenteric defects at the initial operation with a non-absorbable running suture. We present a patient in late pregnancy with a small-bowel volvulus following laparoscopic Roux-en-Y gastric bypass for morbid obesity and discuss the available literature. For a favorable obstetric and neonatal outcome, it is crucial not to delay surgical exploration and an emergency operation usually is mandatory.

  12. Closed loop obstructions of the small bowel: role of Computed Tomography

    International Nuclear Information System (INIS)

    Barbiera, F.; Ciraulo, R.; Cusma', S.

    1999-01-01

    Small bowel obstructions can be distinguished into more simple and closed loop obstructions. The latter is a more severe condition which is often complicated by strangulation with vascular impairment, edema and intramural and mesenteric hemorrhage. Consequent arterial insufficiency rapidly leads to ischemia, infarction and necrosis. The radiologist plays a role in the early recognition of the closed loop obstruction and of any sign of strangulation. The role of CT in the diagnosis and workup of patients with suspected intestinal occlusion has been analyzed in the literature with reported 63% sensitivity, 78% specificity and 66% accuracy. CT is also capable of revealing the causes of occlusion in 73-95% of cases. The above CT signs allow to identify closed loop obstruction and also small bowel strangulation, thus supplying a valuable contribution to diagnosis and accurate preoperative evaluation. The conclusion is that CT can accurately demonstrate the presence of closed loop obstruction and can be the technique of choice in patients in whom obstruction is associated with clinical signs suggestive of strangulation [it

  13. Small animal simultaneous PET/MRI: initial experiences in a 9.4 T microMRI

    Energy Technology Data Exchange (ETDEWEB)

    Maramraju, Sri Harsha; Ravindranath, Bosky; Vaska, Paul; Schlyer, David J [Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY (United States); Smith, S David; Schulz, Daniela [Medical Department, Brookhaven National Laboratory, Upton, NY (United States); Junnarkar, Sachin S; Rescia, Sergio [Instrumentation Division, Brookhaven National Laboratory, Upton, NY (United States); Stoll, Sean; Purschke, Martin L; Woody, Craig L [Physics Department, Brookhaven National Laboratory, Upton, NY (United States); Southekal, Sudeepti [Brigham and Women' s Hospital, Boston, MA (United States); Pratte, Jean-Francois, E-mail: schlyer@bnl.gov [Universite de Sherbrooke, Sherbrooke, Quebec (Canada)

    2011-04-21

    We developed a non-magnetic positron-emission tomography (PET) device based on the rat conscious animal PET that operates in a small-animal magnetic resonance imaging (MRI) scanner, thereby enabling us to carry out simultaneous PET/MRI studies. The PET detector comprises 12 detector blocks, each being a 4 x 8 array of lutetium oxyorthosilicate crystals (2.22 x 2.22 x 5 mm{sup 3}) coupled to a matching non-magnetic avalanche photodiode array. The detector blocks, housed in a plastic case, form a 38 mm inner diameter ring with an 18 mm axial extent. Custom-built MRI coils fit inside the positron-emission tomography (PET) device, operating in transceiver mode. The PET insert is integrated with a Bruker 9.4 T 210 mm clear-bore diameter MRI scanner. We acquired simultaneous PET/MR images of phantoms, of in vivo rat brain, and of cardiac-gated mouse heart using [{sup 11}C]raclopride and 2-deoxy-2-[{sup 18}F]fluoro-d-glucose PET radiotracers. There was minor interference between the PET electronics and the MRI during simultaneous operation, and small effects on the signal-to-noise ratio in the MR images in the presence of the PET, but no noticeable visual artifacts. Gradient echo and high-duty-cycle spin echo radio frequency (RF) pulses resulted in a 7% and a 28% loss in PET counts, respectively, due to high PET counts during the RF pulses that had to be gated out. The calibration of the activity concentration of PET data during MR pulsing is reproducible within less than 6%. Our initial results demonstrate the feasibility of performing simultaneous PET and MRI studies in adult rats and mice using the same PET insert in a small-bore 9.4 T MRI.

  14. Polyethylene glycol and contrast-enhanced MRI of Crohn's disease in children: preliminary experience.

    Science.gov (United States)

    Magnano, Gianmichele; Granata, Claudio; Barabino, Arrigo; Magnaguagno, Francesca; Rossi, Umberto; Calevo, Maria Grazia; Toma, Paolo

    2003-06-01

    To assess the ability of MRI to detect bowel abnormalities in children affected by Crohn's disease (CD). We studied 22 children (age range 8-18 years) referred to us with a known history of CD. MRI was carried out using a 1.5-T unit with a maximum gradient field strength of 16 mT and a phased-array body coil. The sequences performed were breath-hold coronal and axial T2-weighted, express fat saturation, followed by T1-weighted, spoiled gradient, fast fat saturation after IV injection of gadolinium chelate (0.3 mmol/kg) for contrast enhancement of the bowel wall. Bowel distension was achieved using oral administration of isosmotic polyethylene glycol solution. Ileo-colonoscopy was considered the gold standard for evaluation of superficial abnormalities and stenoses of the colon and terminal ileum. MRI findings of bowel-wall thickening, increased vascularisation and extramural involvement were compared with the findings using B-mode and Doppler US. Concordance between MRI and endoscopy, B-mode US and Doppler US findings was determined by the Kappa statistical method. Superficial lesions were not shown by MRI. MR enteroclysis easily detected stenoses, thickening and hyperaemia of bowel wall. Concordance of findings between MRI and endoscopy was 90% (K=0.79, substantial concordance). Concordance of findings between MRI and US concerning bowel-wall thickening and increased vascularisation was 95% (K=0.875, excellent concordance) and 80% (K=0.6, fairly good concordance), respectively. Our initial results show that MRI can detect intra- and extra-mural lesions of CD. The high concordance observed between MRI, endoscopy, US and Doppler US findings suggests that MRI is at least comparable for diagnostic capability with these techniques offering, thanks to multiplanar projections, an improved visualisation of the bowel without ionising radiation.

  15. Polyethylene glycol and contrast-enhanced MRI of Crohn's disease in children: preliminary experience

    International Nuclear Information System (INIS)

    Magnano, Gianmichele; Granata, Claudio; Magnaguagno, Francesca; Rossi, Umberto; Toma, Paolo; Barabino, Arrigo; Calevo, Maria Grazia

    2003-01-01

    To assess the ability of MRI to detect bowel abnormalities in children affected by Crohn's disease (CD). We studied 22 children (age range 8-18 years) referred to us with a known history of CD. MRI was carried out using a 1.5-T unit with a maximum gradient field strength of 16 mT and a phased-array body coil. The sequences performed were breath-hold coronal and axial T2-weighted, express fat saturation, followed by T1-weighted, spoiled gradient, fast fat saturation after IV injection of gadolinium chelate (0.3 mmol/kg) for contrast enhancement of the bowel wall. Bowel distension was achieved using oral administration of isosmotic polyethylene glycol solution. Ileo-colonoscopy was considered the gold standard for evaluation of superficial abnormalities and stenoses of the colon and terminal ileum. MRI findings of bowel-wall thickening, increased vascularisation and extramural involvement were compared with the findings using B-mode and Doppler US. Concordance between MRI and endoscopy, B-mode US and Doppler US findings was determined by the Kappa statistical method. Superficial lesions were not shown by MRI. MR enteroclysis easily detected stenoses, thickening and hyperaemia of bowel wall. Concordance of findings between MRI and endoscopy was 90% (K=0.79, substantial concordance). Concordance of findings between MRI and US concerning bowel-wall thickening and increased vascularisation was 95% (K=0.875, excellent concordance) and 80% (K=0.6, fairly good concordance), respectively. Our initial results show that MRI can detect intra- and extra-mural lesions of CD. The high concordance observed between MRI, endoscopy, US and Doppler US findings suggests that MRI is at least comparable for diagnostic capability with these techniques offering, thanks to multiplanar projections, an improved visualisation of the bowel without ionising radiation. (orig.)

  16. Supra-transumbilical laparotomy (STL approach for small bowel atresia repair: Our experience and review of the literature

    Directory of Open Access Journals (Sweden)

    Ernesto Leva

    2013-01-01

    Full Text Available Background: Supra-Transumbilical Laparotomy (STL has been used in paediatric surgery for a broad spectrum of abdominal procedures. We report our experience with STL approach for small bowel atresia repair in newborns and review previous published series on the topic. Patients and Methods: Fourteen patients with small bowel atresia were treated via STL approach at our Institution over a 5-year period and their charts were retrospectively reviewed. Results: STL procedure was performed at mean age of 3.1 day. No malrotation disorders were detected with pre-operative contrast enema. Eight patients (54.1% presented jejunal atresia, five (35.7% ileal atresia, and one (7.1% multiple ileal and jejunal atresias. Standard repair with primary end-to-back anastomosis was performed in all but one patient. In the newborn with multiple atresia, STL incision was converted in supra-umbilical transverse incision due to difficulty of exposition. After surgery, one patient developed anastomotic stricture, and another developed occlusion due to adhesions: Both infants required second laparotomy. No infections of the umbilical site were recorded, and cosmetic results were excellent in all patients. Conclusions: Increasing evidence suggests that STL approach for small bowel atresia is feasible, safe and provides adequate exposure for small bowel atresia surgery. When malrotation and colonic/multiple atresia are pre-operatively ruled out, STL procedure can be choosen as first approach.

  17. Use of 5-mm Laparoscopic Stapler to Perform Open Small Bowel Anastomosis in a Neonatal Animal Model.

    Science.gov (United States)

    Glenn, Ian C; Bruns, Nicholas E; Ponsky, Todd A

    2016-10-01

    While adult bowel anastomoses are typically performed with staplers, neonatal small bowel anastomoses have traditionally been performed in a hand-sewn manner due to the large size of surgical staplers. The purpose of this study was to compare stapled anastomosis using a newly available, 5-mm laparoscopic stapler to a hand-sewn anastomosis in an open animal model. Twenty anastomoses were performed by two general surgery residents (10 stapled and 10 hand-sewn) in an adult New Zealand white rabbit. The small bowel was divided with a scalpel. Surgical technique was alternated between single-layer hand-sewn and stapled anastomoses. Each anastomosis was resected for ex vivo testing. Measurements collected were outer diameter of the bowel before division, time to perform the anastomosis, anastomosis inner diameter (ID), and leak test. IDs were measured by cutting the anastomosis in cross-section, taking a photograph, and measuring the diameter by computer software. In addition, the surgeons qualitatively evaluated the anastomoses for hemostasis and overall quality. Statistical significance was determined using the Student's t-test. There were statistically significant differences between stapled and hand-sewn anastomosis, respectively, for average operative time (4 minutes 2 seconds versus 16 minutes 6 seconds, P animal model, a 5-mm stapled anastomosis is an acceptable alternative to hand-sewn small bowel anastomosis. The stapler is faster and creates a larger diameter anastomosis, however, there was one leak when closing the enterotomy in the stapled group and overlapping staple lines should be avoided.

  18. Multifocal small bowel stromal tumours presenting with peritonitis in an HIV positive patient.

    Science.gov (United States)

    Mansoor, Ebrahim

    2014-01-01

    The most common mesenchymal tumour of the gastrointestinal tract is stromal tumours (GISTs). Symptomatic GISTs can present with complications such as haemorrhage, obstruction and perforation. Complete surgical resection with negative margins is the mainstay of treatment but may be imprudent on emergent occasion. Tyrosine-kinase inhibitors (TKIs) have been revolutionary in the treatment of GISTs and have resulted in improved outcomes. A 41 year old HIV positive male presented with an acute history of abdominal pain and obstructive symptoms. Clinical examination revealed sepsis and peritonitis. One of the several small bowel tumours discovered at exploratory laparotomy was necrotic and perforated. The perforated tumour alone was resected and a small bowel internal hernia reduced. The patient made an uneventful recovery and will be considered for TKI therapy with a view to later re-operation. GISTs very rarely perforate. The pathophysiology of stromal tumour necrosis is poorly understood. Multifocality and small bowel location are poor prognosticators and may occur in the setting of familial GISTs, specific syndromes and sporadic cases. There is no established association between HIV and GISTs. Perforation occurs infrequently in ≤8% of symptomatic cases and poses increased risk of local recurrence. The surgical management of perforation takes precedence in an emergency. The surgeon must however take cognisance of the adherence to ideal oncologic principles where feasible. TKI therapy is invaluable if a re-exploration is to be later considered. Copyright © 2014 The Author. Published by Elsevier Ltd.. All rights reserved.

  19. Gd-DTPA: a bowel contrast agent for magnetic resonance imaging of the abdomen

    International Nuclear Information System (INIS)

    Vlahos, L.; Gouliamos, A.; Clauss, W.; Kalovidouris, A.; Hadjiioannou, A.; Athanasopoulou, A.; Trakadas, S.; Papavasiliou, C.

    1992-01-01

    Forty patients with suspected pathology in the abdomen and pelvis have been investigated with MRI before and after administration of Gd-DTPA as an oral or rectal solution. The findings are analysed with respect to: (a) filling of the GI tract; (b) contrast in the region of interest, surrounding fat and vessels; (c) diagnostic yield in comparison to non-enhanced MRI and contrast CT. At a concentration of 1 mmol/l Gd-DTPA provided consistent positive contrast in the stomach and bowel in all cases. In 57.5% of cases we achieved complete filling of the GI tract. The opacification in the region of interest was good or satisfactory in 90% of cases. The diagnostic value of contrast MRI was better in 93% of cases than the non-enhanced MRI of the abdomen. In comparison with contrast CT, the contrast MRI was better or of the same value in 92% of cases. Despite the disadvantage of poor fat-to-bowel contrast (35% of cases were classified as poor), it is concluded that Gd-DTPA-enhanced MRI provides good delineation of organs adjacent to the bowel so this contrast agent has potential for a future role in abdominal MRI. (orig.)

  20. Gd-DTPA: a bowel contrast agent for magnetic resonance imaging of the abdomen

    Energy Technology Data Exchange (ETDEWEB)

    Vlahos, L. [Dept. of Radiology, Univ. of Athens, Areteion Hospital (Greece); Gouliamos, A. [Dept. of Radiology, Univ. of Athens, Areteion Hospital (Greece); Clauss, W. [Schering A. G., Berlin (Germany); Kalovidouris, A. [Dept. of Radiology, Univ. of Athens, Areteion Hospital (Greece); Hadjiioannou, A. [Dept. of Radiology, Univ. of Athens, Areteion Hospital (Greece); Athanasopoulou, A. [Dept. of Radiology, Univ. of Athens, Areteion Hospital (Greece); Trakadas, S. [Dept. of Radiology, Univ. of Athens, Areteion Hospital (Greece); Papavasiliou, C. [Dept. of Radiology, Univ. of Athens, Areteion Hospital (Greece)

    1992-08-01

    Forty patients with suspected pathology in the abdomen and pelvis have been investigated with MRI before and after administration of Gd-DTPA as an oral or rectal solution. The findings are analysed with respect to: (a) filling of the GI tract; (b) contrast in the region of interest, surrounding fat and vessels; (c) diagnostic yield in comparison to non-enhanced MRI and contrast CT. At a concentration of 1 mmol/l Gd-DTPA provided consistent positive contrast in the stomach and bowel in all cases. In 57.5% of cases we achieved complete filling of the GI tract. The opacification in the region of interest was good or satisfactory in 90% of cases. The diagnostic value of contrast MRI was better in 93% of cases than the non-enhanced MRI of the abdomen. In comparison with contrast CT, the contrast MRI was better or of the same value in 92% of cases. Despite the disadvantage of poor fat-to-bowel contrast (35% of cases were classified as poor), it is concluded that Gd-DTPA-enhanced MRI provides good delineation of organs adjacent to the bowel so this contrast agent has potential for a future role in abdominal MRI. (orig.)

  1. The localization of bleeding small bowel lesions for conservative resection: a simple radiographic technique

    International Nuclear Information System (INIS)

    Stevens, J.M.; Northover, J.M.A.; Raphael, M.J.; Slack, W.W.

    1981-01-01

    Haemorrhage from the small bowel is a serious diagnostic and therapeutic problem. The value of selective superior mesenteric angiography to localize the source accurately does not require emphasizing. However, many of the lesions demonstrated are notoriously difficult to find at operation unless they are actively bleeding at the time. A simple method of intra-operative angiography is described which, because demonstration of the bleeding lesion on the operative films is not an essential requirement, does not involve the use of specialized angiographic equipment. Although only one case is offered to illustrate the method, it seems to possess sufficient versatility to be useful in most situations where intra-operative assistance in isolating a specific loop of small bowel for resection is anticipated. (author)

  2. Acute Portomesenteric Venous Thrombosis following Laparoscopic Small Bowel Resection and Ventral Hernia Repair

    Directory of Open Access Journals (Sweden)

    Bhradeev Sivasambu

    2015-01-01

    Full Text Available Acute portomesenteric venous thrombosis is a rare but life-threatening complication of laparoscopic surgery that has been described in literature. Prompt diagnosis and early initiation of treatment are vital to prevent life-threatening complications such as mesenteric ischemia and infarction. A 51-year-old lady had laparoscopic small bowel resection and primary anastomosis with ventral hernia repair 4 weeks earlier for partial small bowel obstruction. Her postoperative period was uneventful and she was discharged home. Four weeks after surgery she developed watery diarrhea and generalized abdominal pain for four-day duration. A computed tomography of the abdomen revealed portomesenteric venous thrombosis although a computed tomography of abdomen before surgery 4 weeks back did not show any portomesenteric venous thrombosis. We are reporting a case of acute portomesenteric venous thrombosis as a complication of laparoscopic surgery.

  3. [Small bowel tumors: experience at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"].

    Science.gov (United States)

    Sánchez-Ramón, A; Cerino-Palomino, V; Medina-Franco, H

    2012-01-01

    Malignant tumors of the small bowel are uncommon and include multiple histologic strains, which helps explain the existing limited understanding of them. The aim of this study was to evaluate surgically treated small bowel tumors and to determine the clinical and pathological characteristics that can have an impact on patient outcome. A retrospective, observational, and descriptive study was carried out. The case records of patients with small bowel tumor that were surgically treated at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" from 1990 to August 2011 were analyzed using the SPSS version 17.0 statistical package. Thirty-eight small bowel tumor patients were found that had been operated on within the time frame studied. Fifteen of them were women (39.50%) and 23 were men (60.50%), and the mean age was 55.6 years. The histologic distribution was 13 adenocarcinomas (34.20%), 10 neuroendocrine tumors (26.30%), 8 sarcomas (21.10%) and 4 lymphomas (10.50%). There was an increase in the incidence of sarcomas and adenocarcinomas, whereas lymphomas and neuroendocrine tumors were evenly distributed. An increase in small bowel tumor incidence in the last few years was observed and adenocarcinoma was the most frequent tumor in the study population. It is important to have a high degree of suspicion for this disease when patients present with symptoms such as gastrointestinal bleeding, bowel obstruction, anemia, and weight loss, because early diagnosis is essential for guaranteeing favorable outcome. Copyright © 2012 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  4. Small Bowel Perforation as a Postoperative Complication from a Laminectomy

    Directory of Open Access Journals (Sweden)

    Robert H. Krieger

    2015-01-01

    Full Text Available Chronic low back pain is one of the leading chief complaints affecting adults in the United States. As a result, this increases the percentage of patients that will eventually undergo surgical intervention to alleviate debilitating, chronic symptoms. A 37-year-old woman presented ten hours postoperatively after a lumbar laminectomy with an acute abdomen due to the extraordinarily rare complication of small bowel injury secondary to deep surgical penetration.

  5. The volume effect in radiation-related late small bowel complications. Results of a clinical study of the EORTC Radiotherapy Cooperative Group in patients treated for rectal carcinoma

    International Nuclear Information System (INIS)

    Letschert, J.G.J.; Lebesque, J.V.; Aleman, B.M.P.; Bartelink, H.; Bosset, J.F.; Horiot, J.C.; Cionini, L.; Hamers, J.P.; Leer, J.W.H.; van Glabbele, M.

    1994-01-01

    The purpose of this study was to quantify the correlation between irradiated small bowel volume and late occurring small bowel complications. Methods: Small bowel volumes in the high-dose region were measured using orthogonal barium films for 203 patients treated for rectal carcinoma with pelvic postoperative radiotherapy to 50 Gy in an EORTC multicentric study. Results: The 5-year estimate of lat pelvic small bowel obstruction requiring surgery was 11%. No correlation between the irradiated small bowel volume and obstruction was detected. The actuarial 5-year estimate of chronic diarrhea varied from 31% in patients with irradiated small bowel volumes below 77 cm 3 to 42% in patients with volumes over 328 cm 3 . This correlation was significant in the univariate and multivariate analysis (p=0.025). The type of rectal surgery significantly influenced the incidence of chronic diarrhea and malabsorption, the actuarial 5-year estimate being 49% and 26% after low anterior resection and abdominoperineal resection, respectively (p=0.04). Conclusions: This study demonstrated that there is a volume-effect in radiation-induced diarrhea atr a dose of 50 Gy in 25 fractions. No volume-effect for small bowel obstruction was detected at this dose-level in pelvic postoperative radiotherapy. A review of the literature data on small bowel obstruction indicates that the volume effect at this dose level can only be demonstrated in patients who were treated with extended field radiotherapy (estimated small bowel volume 800 cm 3 ) after intra-abdominal surgery. (author). 22 refs., 5 tabs

  6. Sequential change in MRI in two cases with small brainstem infarctions

    International Nuclear Information System (INIS)

    Masuda, Ryoichi; Fukuda, Osamu; Endoh, Shunro; Takaku, Akira; Suzuki, Takashi; Satoh, Shuji

    1987-01-01

    Magnetic resonance imaging (MRI) has been found to be very useful for the diagnosis of a small brainstem infarction. However, most reported cases have shown the changes at only the chronic stage. In this report, sequential changes in the MRI in two cases with small brainstem infarctions are presented. In Case 1, a 67-year-old man with a pure sensory stroke on the right side, a small infarcted area was observed at the left medial side of the pontomedullary junction on MRI. In Case 2, a 62-year-old man with a pure motor hemiparesis of the left side, MRI revealed a small infarcted area on the right ventral of the middle pons. The initial changes were confirmed 5 days (Case 1) and 18 hours (Case 2) after the onset of the completed stroke. No abnormal findings could be found in the computed tomography in either case. (author)

  7. Prevalence of small-bowel neoplasia in Lynch syndrome assessed by video capsule endoscopy

    NARCIS (Netherlands)

    Haanstra, Jasmijn F.; Al-Toma, Abdul; Dekker, Evelien; Vanhoutvin, Steven A. L. W.; Nagengast, Fokko M.; Mathus-Vliegen, Elisabeth M.; van Leerdam, Monique E.; Cappel, Wouter H. de Vos tot Nederveen; Sanduleanu, Silvia; Veenendaal, Roeland A.; Cats, Annemieke; Vasen, Hans F. A.; Kleibeuker, Jan H.; Koornstra, Jan J.

    2015-01-01

    Objective The aim was to determine the prevalence of small-bowel neoplasia in asymptomatic patients with Lynch syndrome (LS) by video capsule endoscopy (VCE). Design After obtaining informed consent, asymptomatic proven gene mutation carriers aged 3570 years were included in this prospective

  8. Circulating Zonulin Correlates with Density of Enteroviruses and Tolerogenic Dendritic Cells in the Small Bowel Mucosa of Celiac Disease Patients.

    Science.gov (United States)

    Vorobjova, Tamara; Raikkerus, Helerin; Kadaja, Lumme; Talja, Ija; Uibo, Oivi; Heilman, Kaire; Uibo, Raivo

    2017-02-01

    Impaired intestinal integrity, including increased permeability of the small bowel mucosa, has been shown in patients with celiac disease (CD) as well as with type 1 diabetes (T1D). Zonulin (ZO, pre-haptoglobin), a tight junction regulator, plays a particular role in the regulation of intestinal barrier function and in the pathogenesis of the above-mentioned diseases. To investigate whether enteroviruses (EVs) and immunoregulatory cells are associated with intestinal permeability in patients with CD alone and with coexistent T1D. Altogether 80 patients (mean age 10.68 ± 6.69 years) who had undergone small bowel biopsy were studied. Forty patients with functional dyspepsia and normal small bowel mucosa formed the control group. The circulating ZO level in sera was evaluated using ELISA. The densities of EV, FOXP3+ regulatory T cells (Tregs), indoleamine 2,3-dioxygenase (IDO+) dendritic cells (DCs) and glutamic acid dexarboxylase (GAD)65+ cells in small bowel mucosa were investigated by immunohistochemistry. The expression analysis of FOXP3, tight junction protein 1 (TJP1), gap junction (GJA1), IDO and CD103 genes was evaluated by real-time PCR. The ZO level was higher in CD patients compared to subjects with a normal small bowel mucosa, particularly in those with Marsh IIIc atrophy (p = 0.01), and correlated with the density of EV (r = 0.63; p = 0.0003) and IDO+ DCs (r = 0.58; p = 0.01) in the small bowel mucosa. The density of GAD65+ epithelial cells was correlated with the density of EV (r = 0.59; p = 0.03) and IDO+ DCs (r = 0.78; p = 0.004) in CD patients. The relative expression of FOXP3 mRNA in the small bowel mucosa tissue was significantly higher in patients with CD, compared to subjects with a normal mucosa, and correlated with the density of EV (r = 0.62; p = 0.017) as well as with the relative expression of IDO mRNA (r = 0.54; p = 0.019). The CD is associated with elevation of the circulating ZO level, the value of which

  9. An experimental study on radiological examination of obstructed small bowel with various contrast media

    International Nuclear Information System (INIS)

    Lee, Yong; Kim, Sung Jin; Han, Moon Hee; Park, Jae Hyung

    1991-01-01

    For the evaluation of the level and cause of small bowel obstruction, an oral barium study is usually chosen. When perforation is whether barium or a water-soluble contrast agent should be used, because barium causes from foreign body reactions as well as adhesions in the extraluminal tissues. Water-soluble contrast agent, on the other hand, are less satisfactory but in general have no untoward effects in the extraluminal tissues. Because of hyperosomolarity, water-soluble contrast agents attract large amounts of fluid with subsequent dilution and loss of contrast and pose a risk of pulmonary edema if aspirated. The use of the newer non-ionic and low-osmolarity water-soluble contrast will likely avoid pulmonary complications due to aspiration. The author performed this experimental study to compare the radiological efficacy of different contrast media in enteric follow-through examinations of obstructed small bowel. Rate had a ligature applied to the distal ileum via laparotomy. Four contrast media were subjected to testing by instillation via oro-gastric tube immediately after laparotomy. Radiographs were exposed at 1, 4 and 8 hours and evaluated later. After 24 hours the animals were sacrificed and the stomach and small bowels, free from mesentery and omental tissue, were weighted with contrasts. The progression in the bowel was proportionate to the osmolarity of the contrast media. After 1 hour, the observations indicated sodium diatrizoate (Gastrografin, Schering) to be the least favorable medium with respect to sharpness of the mucosal border. After 8 hours, barium gave a poorer delineation compared to Ioxaglate (Hexabric, Guerbet) and Iopromide (Ultravist, Schering). Early deaths were noted in the sodium diatrizoate and ioxaglate groups. So we conclude that when using a rather high-volume bolus, low-osmolar non-ionic contrast media seem to have significant prospects for general diagnostic use in patients with suspected intestinal obstruction

  10. Obstructive Bezoars of the Small Bowel Treated with Coca-Cola Zero through a Long Intestinal Tube and Endoscopic Manipulation.

    Science.gov (United States)

    Endo, Kei; Kakisaka, Keisuke; Suzuki, Yuji; Matsumoto, Takayuki; Takikawa, Yasuhiro

    2017-11-15

    An 82-year-old Japanese man visited our hospital with abdominal fullness accompanied by lower abdominal pain. He presented with small bowel obstruction due to multiple diospyrobezoars. The bezoars were successfully removed without any surgical intervention by the administration of Coca-Cola Zero through a long intestinal tube and subsequent endoscopic manipulation. Such a combination may be the treatment of choice for small bowel obstruction due to bezoars.

  11. The glucose breath test: a diagnostic test for small bowel stricture(s) in Crohn's disease.

    Science.gov (United States)

    Mishkin, Daniel; Boston, Francis M; Blank, David; Yalovsky, Morty; Mishkin, Seymour

    2002-03-01

    The aim of this study was to determine whether an indirect noninvasive indicator of proximal bacterial overgrowth, the glucose breath test, was of diagnostic value in inflammatory bowel disease. Twenty four of 71 Crohn's disease patients tested had a positive glucose breath test. No statistical conclusions could be drawn between the Crohn's disease activity index and glucose breath test status. Of patients with radiologic evidence of small bowel stricture(s), 96.0% had a positive glucose breath test, while only one of 46 negative glucose breath test patients had a stricture. The positive and negative predictive values for a positive glucose breath test as an indicator of stricture formation were 96.0% and 97.8%, respectively. This correlation was not altered in Crohn's disease patients with fistulae or status postresection of the terminal ileum. The data in ulcerative colitis were nondiagnostic. In conclusion, the glucose breath test appears to be an accurate noninvasive inexpensive diagnostic test for small bowel stricture(s) and secondary bacterial overgrowth in Crohn's disease.

  12. A case of closed loop small bowel obstruction within a strangulated incisional hernia in association with an acute gastric volvulus.

    Science.gov (United States)

    Kosai, Nik Ritza; Gendeh, H S; Noorharisman, M; Sutton, Paul Anthony; Das, Srijit

    2014-01-01

    Small bowel obstruction is a common clinical problem presenting with abdominal distention, colicky pain, absolute constipation and bilious vomiting. There are numerous causes, most commonly attributed to an incarcerated hernia, adhesions or obstructing mass secondary to malignancy. Here we present an unusual cause of a small bowel obstruction secondary to an incarcerated incisional hernia in association with an acute organoaxial gastric volvulus.

  13. Prevalence of small-bowel neoplasia in Lynch syndrome assessed by video capsule endoscopy

    NARCIS (Netherlands)

    Haanstra, Jasmijn F.; Al-Toma, Abdul; Dekker, Evelien; Vanhoutvin, Steven A. L. W.; Nagengast, Fokko M.; Mathus-Vliegen, Elisabeth M.; van Leerdam, Monique E.; de Vos tot Nederveen Cappel, Wouter H.; Sanduleanu, Silvia; Veenendaal, Roeland A.; Cats, Annemieke; Vasen, Hans F. A.; Kleibeuker, Jan H.; Koornstra, Jan J.

    2015-01-01

    The aim was to determine the prevalence of small-bowel neoplasia in asymptomatic patients with Lynch syndrome (LS) by video capsule endoscopy (VCE). After obtaining informed consent, asymptomatic proven gene mutation carriers aged 35-70 years were included in this prospective multicentre study in

  14. Risk factors affecting morbidity and mortality following emergency laparotomy for small bowel obstruction

    DEFF Research Database (Denmark)

    Jeppesen, Maja Haunstrup; Tolstrup, Mai-Britt; Kehlet Watt, Sara

    2016-01-01

    laparotomy for small bowel obstruction at a Copenhagen University Hospital (2009-2013). Complications were evaluated according to the Clavien-Dindo classification. RESULTS: A total of 323 patients were included. The overall 30-day morbidity and mortality rates were 28% and 13%, respectively. Six covariates...

  15. Polyethylene glycol and contrast-enhanced MRI of Crohn's disease in children: preliminary experience

    Energy Technology Data Exchange (ETDEWEB)

    Magnano, Gianmichele; Granata, Claudio; Magnaguagno, Francesca; Rossi, Umberto; Toma, Paolo [Service of Radiology, Giannina Gaslini Hospital, Genoa (Italy); Barabino, Arrigo [Department of Gastroenterology, Giannina Gaslini Hospital, Genoa (Italy); Calevo, Maria Grazia [Service of Epidemiology and Biostatistics, Giannina Gaslini Hospital, Genoa (Italy)

    2003-06-01

    To assess the ability of MRI to detect bowel abnormalities in children affected by Crohn's disease (CD). We studied 22 children (age range 8-18 years) referred to us with a known history of CD. MRI was carried out using a 1.5-T unit with a maximum gradient field strength of 16 mT and a phased-array body coil. The sequences performed were breath-hold coronal and axial T2-weighted, express fat saturation, followed by T1-weighted, spoiled gradient, fast fat saturation after IV injection of gadolinium chelate (0.3 mmol/kg) for contrast enhancement of the bowel wall. Bowel distension was achieved using oral administration of isosmotic polyethylene glycol solution. Ileo-colonoscopy was considered the gold standard for evaluation of superficial abnormalities and stenoses of the colon and terminal ileum. MRI findings of bowel-wall thickening, increased vascularisation and extramural involvement were compared with the findings using B-mode and Doppler US. Concordance between MRI and endoscopy, B-mode US and Doppler US findings was determined by the Kappa statistical method. Superficial lesions were not shown by MRI. MR enteroclysis easily detected stenoses, thickening and hyperaemia of bowel wall. Concordance of findings between MRI and endoscopy was 90% (K=0.79, substantial concordance). Concordance of findings between MRI and US concerning bowel-wall thickening and increased vascularisation was 95% (K=0.875, excellent concordance) and 80% (K=0.6, fairly good concordance), respectively. Our initial results show that MRI can detect intra- and extra-mural lesions of CD. The high concordance observed between MRI, endoscopy, US and Doppler US findings suggests that MRI is at least comparable for diagnostic capability with these techniques offering, thanks to multiplanar projections, an improved visualisation of the bowel without ionising radiation. (orig.)

  16. Accelerating the transit time of barium sulphate suspensions in small bowel examinations

    International Nuclear Information System (INIS)

    Summers, David S.; Roger, Mark D.; Allan, Paul L.; Murchison, John T.

    2007-01-01

    Purpose: To determine whether hyperosmolar and effervescent agents proven individually to accelerate transit time in the barium small bowel examination have an additive effect when combined, surpassing that of either agent alone. Materials and methods: One hundred and forty-nine patients were randomised to four groups. Three hundred milliliters of barium sulphate alone was given to the first group. Fifteen milliliters of iodinated hyperosmolar contrast agent (Gastrografin, meglumine/sodium diatrizoate, Schering) was given in addition to barium sulphate to the second group while six packets of effervescent granules (Carbex, Ferring) were added for the third group. The final group was given a combination of both additives and barium sulphate. The time taken following ingestion for the contrast column to reach the caecum, as assessed by frequent interval fluoroscopy, was recorded. A subgroup of 32 patients were selected randomly from the four groups, 8 from each and assessed for quality of examination. Statistical assessments were made using Kruskal-Wallis and Mann-Whitney tests. Results: One hundred and nineteen patients were analysed after exclusions. The addition of accelerant to barium sulphate, both individually and in combination significantly reduced the small bowel transit time (p < 0.001). No significant difference existed between the additives when used with barium alone. The combined group had significantly faster transit times compared to the hyperosmolar group (p = 0.02). Differences between combined and effervescent groups tended towards significance (p = 0.09). No significant difference existed between groups when examination quality was assessed. Conclusion: These results suggest that the addition of combined effervescent and hyperosmolar agents to the barium suspension may significantly shorten the small bowel transit time without adversely affecting examination quality. This has implications for patient acceptability of the examination as well as

  17. Optimal assessment of paediatric IBD with MRI and barium follow-through.

    Science.gov (United States)

    Giles, Edward; Hanci, Ozan; McLean, Alison; Power, Niall; Cole, Angela; Croft, Nicholas M; McDonald, Kirsteen; Chippington, Sam; Naik, Sandhia

    2012-06-01

    The present UK criterion standard for assessing children with suspected inflammatory bowel disease (IBD) is upper endoscopy, ileocolonoscopy, and barium follow-through (BaFT). Significant doses of radiation, unpalatable contrast, and volume intolerance are involved with BaFT. Practice in investigating Crohn disease (CD) is changing with the increasing use of magnetic resonance imaging (MRI). The aim of the present study was to compare BaFT and a new abdominal MRI protocol in a paediatric IBD population. All consecutive patients with a new diagnosis of IBD or requiring reassessment from September 2008 to December 2010 were investigated with both abdominal MRI and BaFT in accordance with a specific local paediatric IBD protocol. The studies were reported by nonblinded radiologists with an interest in gastrointestinal imaging. The reports were compared in conjunction with case note review. Eighty-seven patients underwent both BaFT and MRI abdomen. Thirty-one percent of patients had additional pathology on MRI, not seen on the BaFT. Sixty-seven percent of patients (n=59) had an MRI finding equivalent to BaFT. Using histology as a criterion standard for detecting terminal ileal disease, BaFT had a sensitivity and specificity of 76% and 67%, and MRI had a sensitivity and specificity of 83% and 95%, respectively. This is the largest series of small bowel MRI in a paediatric population. MRI reports were at least equivalent to BaFT. MRI had higher sensitivity and, particularly, specificity in detecting terminal ileal pathology. These findings suggest that MRI should become the criterion standard investigation in children with IBD in centres with appropriate expertise, with zero radiation exposure being highly advantageous.

  18. Wernicke-Korsakoff Syndrome following Small Bowel Obstruction

    Directory of Open Access Journals (Sweden)

    Shoumitro Deb

    2002-01-01

    Full Text Available We report a case of a 64-year-old lady who developed clinical features of Wernicke-Korsakoff syndrome following a laparotomy for small bowel obstruction. Following the operation she developed paralytic ileus and required total parenteral nutrition for one month. A suspected history of average 40 units of weekly alcohol consumption prior to the operation could not be confirmed and the patient did not show any sign of alcohol dependence. Within a few months of treatment with a daily oral dose of thiamine 200 mgs supplemented by multivitamins the patient showed subjective evidence of improvement in confusion, confabulation, and anterograde amnesia, although objective tests showed residual deficits in many areas of cognitive functioning, including immediate and delayed recall of verbal and non-verbal materials, planning and switching of attention.

  19. Wernicke-Korsakoff Syndrome following Small Bowel Obstruction

    Science.gov (United States)

    Deb, Shoumitro; Law-Min, Richard; Fearnley, David

    2002-01-01

    We report a case of a 64-year-old lady who developed clinical features of Wernicke-Korsakoff syndrome following a laparotomy for small bowel obstruction. Following the operation she developed paralytic ileus and required total parenteral nutrition for one month. A suspected history of average 40 units of weekly alcohol consumption prior to the operation could not be confirmed and the patient did not show any sign of alcohol dependence. Within a few months of treatment with a daily oral dose of thiamine 200 mgs supplemented by multivitamins the patient showed subjective evidence of improvement in confusion, confabulation, and anterograde amnesia, although objective tests showed residual deficits in many areas of cognitive functioning, including immediate and delayed recall of verbal and non-verbal materials, planning and switching of attention. PMID:12446948

  20. Yeast mediates lactic acidosis suppression after antibiotic cocktail treatment in short small bowel?

    NARCIS (Netherlands)

    Bongaerts, G.P.A.; Severijnen, R.S.V.M.; Skladal, D.; Bakkeren, J.A.J.; Sperl, W.

    2005-01-01

    During acidotic periods in a girl with a short small bowel, very high D-lactic acid concentrations were measured in blood and urine; the patient's characteristic faecal flora contained mainly lactobacilli, and during antibiotic cocktail treatment also many yeasts. In this case report we sought to

  1. Open table-top device positioning technique to reduce small bowel obstruction. Positioning accuracy and impact on conformal radiation therapy techniques

    International Nuclear Information System (INIS)

    Rudat, V.; Flentje, M.; Engenhart, R.; Metzger, M.; Wannenmacher, M.

    1995-01-01

    The immobilization error of patients positioned on the opern table-top device in prone prosition as well as the movement of the small bowel out of the pelvis by this positioning technique was determined. The positioning error is of special importance for the 3-dimensional treatment planning for conformal radiotherapy. The positioning error was determined by superposing 106 portal films with the corresponding simultor films from 21 patients with carcinoma of the rectum who received 3D-planned conformal radiotherapy (o-field technique with irregular blocks). The movement of the small bowel out of the pelvis was studied by comparing simulator films after barium swallow in supine and open table-top position as well with 3D-treatment plans of the same patient in both positions in 3 cases. The positioning error along the medio-lateral, dorso-ventral und cranio-caudal axis was 1.4/-0.6/1.8 mm and the standard deviation 4.4/6.8/6.3 mm, respectively. In comparison to the supine position more rotation errors in the sagittal view were observed (37% and 9% respectively) with a media of 5.1 . Six out of 22 patients showed no adhesions of the small bowel and a complete movement out of the tratment field was achieved. 14 out of 16 Patients with adhesions revealed a partial movement of the small bowel out of the treatment field. Comparing 3D-treatment plans in both positions again demonstrated a marked reduction of the irradiated small bowel volume with the use of the open table-top decive. (orig.) [de

  2. Effect of acetylcysteine on adaptation of intestinal smooth muscle after small bowel bypass

    International Nuclear Information System (INIS)

    Weisbrodt, N.W.; Belloso, R.M.; Biskin, L.C.; Dudrick, P.S.; Dudrick, S.J.

    1986-01-01

    The authors have postulated that the adaptive changes in function and structure of bypassed segments of small bowel are due in part to the change in intestinal contents following operation. The purpose of these experiments was to determine if a mucolytic agent could alter the adaptation. Rats were anesthetized and a 70% jejunoileal bypass was performed. The bypassed segments then were perfused with either saline or acetylcysteine for 3-12 days. Then, either intestinal transit was determined using Cr-51, or segments were taken for morphometric analysis. Transit, as assessed by the geometric center, was increased 32% by acetylcysteine treatment. Treatment also caused a decrease in hypertrophy of the muscularis. Muscle wet weight, muscle cross-sectional area, and muscle layer thickness all were significantly less in those animals infused with acetyl-cysteine. No decreases in hypertrophy were seen in the in-continuity segments. These data indicate that alterations in intestinal content can affect the course of adaptation of intestinal muscle in response to small bowel bypass

  3. Resulting long-term intestinal motility in dogs following construction of a reversed jejunal segment after extensive small bowel resection.

    Science.gov (United States)

    Uchiyama, M; Iwafuchi, M; Ohsawa, Y; Yagi, M; Iinuma, Y; Ohtani, S

    1994-10-01

    To evaluate the long-term function and effective motility of a reversed jejunal segment after extensive small bowel resection, the authors continuously measured postoperative bowel motility during interdigestive and postprandial periods in conscious dogs 6 to 10 months after surgery. The long-term findings were compared with previously reported short-term results measured 2 to 4 weeks after the operation. In the long-term follow-up dogs with a 20-cm reversed jejunal segment constructed after extensive (75% to 80%) small bowel resection, the fasting duodenal migrating myoelectric (or motor) complex (MMC) was often interrupted in the jejunum above the reversed segment, and did not migrate smoothly to the reversed segment or terminal ileum. The MMCs arising from the duodenum predominantly propagated to the ileum through the inherent anatomic continuity of the bowel. In addition, brief small discordant contractions were frequent in the reversed segment and the jejunum, above the proximal anastomosis. These findings are similar to those of the MMC propagation pattern noted 2 to 4 weeks after surgery. However, the postprandial duration without duodenal MMC activity was significantly shorter in the dogs with long-term follow-up than in those with short-term follow-up (both were longer than in control dogs). Marked dilatation of the jejunum and reversed jejunal segment was noted across the proximal anastomosis. These results suggest that the transit time and passage of intestinal contents can be delayed and stagnated for at least 10 months after extensive small bowel resection with a 20-cm reversed jejunal segment.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. A CASE OF CLOSED LOOP SMALL BOWEL OBSTRUCTION WITHIN A STRANGULATED INCISIONAL HERNIA IN ASSOCIATION WITH AN ACUTE GASTRIC VOLVULUS

    Directory of Open Access Journals (Sweden)

    Nik Ritza Kosai

    2014-01-01

    Full Text Available Small bowel obstruction is a common clinical problem presenting with abdominal distention, colicky pain, absolute constipation and bilious vomiting. There are numerous causes, most commonly attributed to an incarcerated hernia, adhesions or obstructing mass secondary to malignancy. Here we present an unusual cause of a small bowel obstruction secondary to an incarcerated incisional hernia in association with an acute organoaxial gastric volvulus.

  5. Dual registration of abdominal motion for motility assessment in free-breathing data sets acquired using dynamic MRI

    International Nuclear Information System (INIS)

    Menys, A; Hamy, V; Makanyanga, J; Taylor, S A; Atkinson, D; Hoad, C; Gowland, P; Odille, F

    2014-01-01

    At present, registration-based quantification of bowel motility from dynamic MRI is limited to breath-hold studies. Here we validate a dual-registration technique robust to respiratory motion for the assessment of small bowel and colonic motility. Small bowel datasets were acquired in breath-hold and free-breathing in 20 healthy individuals. A pre-processing step using an iterative registration of the low rank component of the data was applied to remove respiratory motion from the free breathing data. Motility was then quantified with an existing optic-flow (OF) based registration technique to form a dual-stage approach, termed Dual Registration of Abdominal Motion (DRAM). The benefit of respiratory motion correction was assessed by (1) assessing the fidelity of automatically propagated segmental regions of interest (ROIs) in the small bowel and colon and (2) comparing parametric motility maps to a breath-hold ground truth. DRAM demonstrated an improved ability to propagate ROIs through free-breathing small bowel and colonic motility data, with median error decreased by 90% and 55%, respectively. Comparison between global parametric maps showed high concordance between breath-hold data and free-breathing DRAM. Quantification of segmental and global motility in dynamic MR data is more accurate and robust to respiration when using the DRAM approach. (paper)

  6. Appropriateness of the study of iron deficiency anemia prior to referral for small bowel evaluation at a tertiary center.

    Science.gov (United States)

    Rodrigues, Jaime Pereira; Pinho, Rolando; Silva, Joana; Ponte, Ana; Sousa, Mafalda; Silva, João Carlos; Carvalho, João

    2017-06-28

    To evaluate the adequacy of the study of iron deficiency anemia (IDA) in real life practice prior to referral to a gastroenterology department for small bowel evaluation. All consecutive patients referred to a gastroenterology department for small bowel investigation due to iron deficiency anemia, between January 2013 and December 2015 were included. Both patients referred from general practitioners or directly from different hospital departments were selected. Relevant clinical information regarding prior anemia workup was retrospectively collected from medical records. An appropriate pre-referral study was considered the execution of esophagogastroduodenoscopy (EGD) with Helicobacter pylori ( H. pylori ) investigation, colonoscopy with quality standards (recent, total and with adequate preparation) and celiac disease (CD) screening (through serologic testing and/or histopathological investigation). A total of 77 patients (58.4% female, mean age 67.1 ± 16.7 years) were included. Most (53.2%) patients were referred from general practitioners, 41.6% from other hospital specialties and 5.2% directly from the emergency department. The mean pre-referral hemoglobin concentration was 8.8 ± 2.0 g/dL and the majority of anemias had microcytic (71.4%) and hypochromic (72.7%) characteristics. 77.9% of patients presented with an incomplete pre-referral study: EGD in 97.4%, with H. pylori investigation in 58.3%, colonoscopy with quality criteria in 63.6%, and CD screening in 24.7%. Patients with an appropriate study at the time of referral were younger (48.7 ± 17.7 vs 72.3 ± 12.3 years, P < 0.001). Small bowel evaluation was ultimately undertaken in 72.7% of patients, with a more frequent evaluation in patients with a quality colonoscopy at referral (78.6% vs 23.8%); P < 0.001 (OR = 11.7, 95%CI: 3.6-38.6). The most common diagnosis regarded as the likely cause of IDA was small bowel angioectasia (18.2%) but additional causes were also found in the upper and lower

  7. Effect of prolonged general anesthesia with sevoflurane and laparoscopic surgery on gastric and small bowel propulsive motility and pH in dogs.

    Science.gov (United States)

    Boscan, Pedro; Cochran, Shannon; Monnet, Eric; Webb, Craig; Twedt, David

    2014-01-01

    To determine if general anesthesia with sevoflurane and laparoscopic surgery changed gastric and small bowel propulsive motility or pH in dogs. Prospective, controlled trial. Twelve, 19-24 months old, female, Treeing Walker Hound dogs, weighing 23-30 kg. Dogs were anesthetized for a median of 8.5 hours during another study to determine the minimum alveolar concentration of sevoflurane using a visceral stimulus. Gastric and small bowel motility were determined using a sensor capsule that measures pressure, pH and temperature. Gastric transit time and motility index were calculated. For 8/12 dogs, gastric motility, pH and transit time were measured. In 4/12 dogs, small bowel motility and pH were measured. Anesthesia decreased gastric and small bowel motility but did not change luminal pH. Mean gastric contraction force decreased from median (range) 11 (8-20) to 3 (1-10) mmHg (p < 0.01) and gastric motility index decreased from 0.63 (0-1.58) to 0 (0-0.31; p = 0.01). Frequency of contractions did not change, 3.7 (1.6-4.4) versus 2.8 (0.1-5.1) contractions minute(-1) (p = 0.1). Gastric motility returned to normal 12-15 hours following anesthesia. Gastric emptying was prolonged from 12 (5.3-16) to 49 (9.75-56.25) hours (p < 0.01). Mean small bowel contraction force decreased from 34 (24-37) to 3 (0.9-17) mmHg (p < 0.02) and motility index decreased from 3.75 (1-4.56) to 0 (0-1.53; p = 0.02). Frequency of contractions did not change, 0.5 (0.3-1.4) versus 1.4 (0.3-4.6) contractions minute(-1) (p = 0.11). Small bowel motility returned within 2 hours after anesthesia. Laparoscopy did not result in changes to gastric or small bowel parameters beyond those produced by general anesthesia. The force of gastric and small bowel contractions decreased during sevoflurane anesthesia for laparoscopy. Although gastric motility returned to normal within 12-15 hours the impairment of gastric emptying lasted 30-40 hours, predisposing dogs to postoperative ileus.

  8. Inflammatory Bowel Disease and Small Bowel Cancer Risk, Clinical Characteristics, and Histopathology

    DEFF Research Database (Denmark)

    Bojesen, Rasmus Dahlin; Riis, Lene Buhl; Høgdall, Estrid

    2017-01-01

    descriptions, we identified 40 cases of IBD-SBC. Risk was calculated by standardized incidence ratio (SIR) (observed/expected); patient characteristics were derived from medical files, and surgery specimens were obtained from hospitals nationwide for histopathological and molecular analyses. RESULTS: During...... 241,620 person-years of follow-up, 23 patients with Crohn's disease developed small bowel adenocarcinoma (SIR, 14.38; 95% confidence interval, 8.78-22.20) and 9 developed neuroendocrine tumors (SIR, 6.83; 95% confidence interval, 3.13-12.97). No significantly increased risk of SBC was found among...... had evidence of microsatellite instability. CONCLUSIONS: In a population-based study of patients in Denmark with IBD and SBC, we found risk of adenocarcinomas and neuroendocrine tumors to be increased among persons with Crohn's disease. Most patients with IBD-SBC had extensive IBD of moderate...

  9. Small bowel obstruction: the role of computed tomography in its diagnosis and management with reference to other imaging modalities

    International Nuclear Information System (INIS)

    Burkill, G.; Bell, J.; Healy, J.

    2001-01-01

    Small bowel obstruction is a leading cause of acute surgical admissions for abdominal pain. There is an increasing tendency for initial conservative management rather than immediate operative intervention, as a proportion of cases will resolve spontaneously. This has resulted in a growing reliance on radiological investigations to reassure the surgeon that medical therapy can be safely instituted. The onus therefore rests with radiologists to guide their surgical colleagues by correctly interpreting the plain abdominal radiograph and suggesting appropriate further investigation if warranted. Recently, computed tomography (CT) has been proposed as the test of choice to define the level and cause of acute small bowel obstruction and to identify complications such as ischaemia and perforation which will prompt surgical intervention. This review will discuss the utility of early CT in the diagnosis of acute small bowel obstruction and outline its impact on patient management. (orig.)

  10. Modified small bowel follow-through using methylcellulose after administration of barium suspension : comparison with conventional series

    International Nuclear Information System (INIS)

    Shin, Ji Hoon; Ha, Hyun Kwon; Park, Sung Tae; Yoon, Soo Woong; Kim, Ho Sung; Kim, Sun Mi

    1998-01-01

    To compare modified small bowel follow-through (SBFT) using methylcellulose after the administration of barium suspension with a conventional series. Materials and Methods : In order to evaluate small bowel pathology, modified SBFT was performed in 155 patients during a 15 month period. All patients received 600 mL of methylcellulose ; 98 had taken 250 mL of 40% wt/vol barium suspension and 57 had taken 150 mL of 70% barium. For the group of 98, the barium suspension was prepared by mixing barium powder with water (n=46) or with methylcellulose in(n=52). For comparison with a modified series, 49 patients who underwent conventional SBFT using 500 mL of 40 %wt/vol barium were lso included. Image quality was rated by three radiologists as p oor , f air , g ood , or e xcellent . We analyzed the relationship between image quality, transit time and small bowel pathology;the sensitivity and specificity of each technique was also determined. Results : Among the four techniques, modified SBFT with 250 mL of 40% wt/vol barium suspension, prepared by mixing barium powder with methylcellulose, showed the best image quality ['excellent' result in 33 of the 52 patients (63%)] and shortest transit time to the cecum. The high image quality of this technique was not affected by the presence of small bowel pathology;its use resulted in the lowest incidence and slowest development of flocculation. The sensitivity (91-95%) of the three modified SBFT procedures was superior to that of a conventional series(76%), but there was no difference in specificity.Conclusion : Modified SBFT using methylcellulose after administering barium suspension with barium powder as a mixing agent is a simple technique. Its use easily improves the image quality and diagnostic accuracy of peroral SBFT

  11. Detected peritoneal fluid in small bowel obstruction is associated with the need for surgical intervention.

    LENUS (Irish Health Repository)

    O'Daly, Brendan J

    2009-06-01

    BACKGROUND: Predicting the clinical course in adhesional small bowel obstruction is difficult. There are no validated clinical or radiologic features that allow early identification of patients likely to require surgical intervention. METHODS: We conducted a retrospective review of 100 patients consecutively admitted to a tertiary level teaching hospital over a 3-year period (2002-2004) who had acute adhesional small bowel obstruction and underwent computed tomography (CT). The primary outcomes that we assessed were conservative management or the need for surgical intervention. We investigated time to physiologic gastrointestinal function recovery as a secondary outcome. We examined independent predictors of surgical intervention in a bivariate analysis using a stepwise logistic regression analysis. RESULTS: Of the 100 patients investigated, we excluded 12. Of the 88 remaining patients, 58 (66%) were managed conservatively and 30 (34%) underwent surgery. Peritoneal fluid detected on a CT scan (n = 37) was associated more frequently with surgery than conservative management (46% v. 29%, p = 0.046, chi(2)). Logistical regression identified peritoneal fluid detected on a CT scan as an independent predictor of surgical intervention (odds ratio 3.0, 95% confidence interval 1.15-7.84). CONCLUSION: The presence of peritoneal fluid on a CT scan in patients with adhesional small bowel obstruction is an independent predictor of surgical intervention and should alert the clinician that the patient is 3 times more likely to require surgery.

  12. Small- bowel mucosal changes and antibody responses after low- and moderate-dose gluten challenge in celiac disease

    Directory of Open Access Journals (Sweden)

    Lähdeaho Marja-Leena

    2011-11-01

    Full Text Available Abstract Background Due to the restrictive nature of a gluten-free diet, celiac patients are looking for alternative therapies. While drug-development programs include gluten challenges, knowledge regarding the duration of gluten challenge and gluten dosage is insufficient. We challenged adult celiac patients with gluten with a view to assessing the amount needed to cause some small-bowel mucosal deterioration. Methods Twenty-five celiac disease adults were challenged with low (1-3 g or moderate (3-5g doses of gluten daily for 12 weeks. Symptoms, small-bowel morphology, densities of CD3+ intraepithelial lymphocytes (IELs and celiac serology were determined. Results Both moderate and low amounts of gluten induced small-bowel morphological damage in 67% of celiac patients. Moderate gluten doses also triggered mucosal inflammation and more gastrointestinal symptoms leading to premature withdrawals in seven cases. In 22% of those who developed significant small- intestinal damage, symptoms remained absent. Celiac antibodies seroconverted in 43% of the patients. Conclusions Low amounts of gluten can also cause significant mucosal deterioration in the majority of the patients. As there are always some celiac disease patients who will not respond within these conditions, sample sizes must be sufficiently large to attain to statistical power in analysis.

  13. Incidence of bloodstream infections in small bowel transplant recipients receiving selective decontamination of the digestive tract: A single-center experience

    OpenAIRE

    Galloway, David; Danziger-Isakov, Lara; Goldschmidt, Monique; Hemmelgarn, Trina; Courter, Joshua; Nathan, Jaimie D.; Alonso, Maria; Tiao, Greg; Fei, Lin; Kocoshis, Samuel

    2015-01-01

    Pediatric patients undergoing small bowel transplantation are susceptible to postoperative CLABSI. SDD directed against enteric microbes is a strategy for reducing CLABSI. We hypothesized that SDD reduces the frequency of CLABSI, infections outside the bloodstream, and allograft rejection during the first 30 days following transplant. A retrospective chart review of 38 pediatric small bowel transplant recipients at CCHMC from 2003 to 2011 was conducted. SDD antimicrobials were oral colistin, ...

  14. Functional brain imaging in irritable bowel syndrome with rectal balloon-distention by using fMRI.

    Science.gov (United States)

    Yuan, Yao-Zong; Tao, Ran-Jun; Xu, Bin; Sun, Jing; Chen, Ke-Min; Miao, Fei; Zhang, Zhong-Wei; Xu, Jia-Yu

    2003-06-01

    Irritable bowel syndrome (IBS) is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity is a key factor in the pathophysiology of IBS. The aim of this study was to examine the effect of rectal balloon-distention stimulus by blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) in visceral pain center and to compare the distribution, extent, and intensity of activated areas between IBS patients and normal controls. Twenty-six patients with IBS and eleven normal controls were tested for rectal sensation, and the subjective pain intensity at 90 ml and 120 ml rectal balloon-distention was reported by using Visual Analogue Scale. Then, BOLD-fMRI was performed at 30 ml, 60 ml, 90 ml, and 120 ml rectal balloon-distention in all subjects. Rectal distention stimulation increased the activity of anterior cingulate cortex (35/37), insular cortex (37/37), prefrontal cortex (37/37), and thalamus (35/37) in most cases. At 120 ml of rectal balloon-distention, the activation area and percentage change in MR signal intensity of the regions of interest (ROI) at IC, PFC, and THAL were significantly greater in patients with IBS than that in controls. Score of pain sensation at 90 ml and 120 ml rectal balloon-distention was significantly higher in patients with IBS than that in controls. Using fMRI, some patients with IBS can be detected having visceral hypersensitivity in response to painful rectal balloon-distention. fMRI is an objective brain imaging technique to measure the change in regional cerebral activation more precisely. In this study, IC and PFC of the IBS patients were the major loci of the CNS processing of visceral perception.

  15. A long-Segmental Vascular Malformation in the Small Bowel Presenting With Gastrointestinal Bleeding in a Preschool-Aged Child

    International Nuclear Information System (INIS)

    Lee, Yeoun Joo; Hwang, Jae-Yeon; Cho, Yong Hoon; Kim, Yong-Woo; Kim, Tae Un; Shin, Dong Hoon

    2016-01-01

    Gastrointestinal (GI) bleeding in pediatric patients has several causes. Vascular malformation of the small bowel is a rare disease leading to pediatric GI bleeding. To our knowledge, few reports describe ultrasound and computed tomography findings of venous malformations involving the small bowel. We present a case of long-segmental and circumferential vascular malformation that led to GI bleeding in a pre-school aged child, focusing on the radiologic findings. Although vascular malformation including of the GI tract is rare in children, it should be considered when GI bleeding occurs in pediatric patients

  16. Churg-Strauss Syndrome Leading to Small Bowel Infarction: An Unusual Case of Abdominal Pain in a Young Patient

    Directory of Open Access Journals (Sweden)

    Sunil Sookram

    1998-01-01

    Full Text Available A 33-year-old man with a history of severe asthma presented to the emergency department with a week-long history of severe unrelenting abdominal pain, nausea and decreased appetite. He was admitted to hospital, and routine gastrointestinal investigations were performed, which did not elucidate the cause of his abdominal pain. Exploratory laparotomy demonstrated patchy infarction of the entire small bowel, characteristic of Churg-Strauss syndrome. The patient subsequently underwent 12 separate laparotomies to salvage surviving small bowel. The patient is maintained on total parenteral nutrition.

  17. Oral versus intravenous premedication for small bowel biopsy in children: effect on procedure and fluoroscopy times.

    Science.gov (United States)

    Stenhammar, L; Wärngård, O; Lewander, P; Nordvall, M

    1993-01-01

    Oral alimemazine and cisapride, or diazepam and cisapride, or iv midazolam and metoclopramide were given as premedication for small bowel biopsy to three groups of children from a total population of 185 individuals. The biopsy procedures were performed under intermittent fluoroscopy and times for both were recorded. The median biopsy procedure time was significantly shorter in children given iv midazolam and metoclopramide (6 min) compared to those given oral premedication (10 min) (p < 0.001). The median fluoroscopy time was very short in all groups, ranging between 3 and 6 s. It is concluded that iv premedication is superior to oral premedication for small bowel biopsy in children because more effective sedation is obtained.

  18. Assessment of dynamic contrast enhancement of the small bowel in active Crohn's disease using 3D MR enterography

    International Nuclear Information System (INIS)

    Knuesel, Patrick R.; Kubik, Rahel A.; Crook, David W.; Eigenmann, Franz; Froehlich, Johannes M.

    2010-01-01

    Purpose: To retrospectively compare the dynamic contrast enhancement of the small bowel segments with and without active Crohn's disease at 3D MR enterography (MRE). Materials and methods: Thirteen patients (five men, eight women; mean age 41.2 years; range 29-56) were imaged on a 1.5-T MR scanner (Sonata, Siemens Medical) with standard MR sequences after having ingested 1000 ml of a 3% mannitol solution. Subsequently, high resolution 3D gradient-echo (volumetric interpolated breath-hold examination = VIBE) data sets were obtained pre-contrast and 20-40 s, 60-80 s, and 120-140 s after i.v. Gd-DOTA administration (0.2 mmol/kg). Signal enhancement was measured on single slices both in normal and histologically confirmed (12/13) inflamed small bowel wall segments as well as in the aorta, the psoas muscle, and the background to calculate signal-to-noise (SNR) and contrast-to-noise ratios (CNR). Results: Small bowel wall enhancement was significantly higher (p < 0.05) in inflamed compared to normal segments at 20-40 s (SNR inflamed: 58.7 ± 33.8 vs normal: 36.0 ± 19.8; p = 0.048; CNR inflamed: 34.8 ± 23.4 vs normal: 16.3 ± 11.2; p = 0.017) and at 60-80 s (SNR: 60.3 ± 25.1 vs 41.9 ± 20.0; p = 0.049; CNR: 34.9 ± 15.1 vs 19.3 ± 13.2; p = 0.01) after i.v. contrast administration, respectively. Even at 120-140 s CNR was still increased in inflamed segments (33.7 ± 16.0 vs 18.1 ± 13.2; p = 0.04), while differences in SNR did not attain statistical significance (63.0 ± 26.2 vs 45.3 ± 23.3; p = 0.15). Conclusion: In active Crohn's disease, histologically confirmed inflamed small bowel wall segments demonstrate a significantly increased early uptake of gadolinium on 3D VIBE sequences compared to normal small bowel segments.

  19. An Intestinal Occlusion Device for Prevention of Small Bowel Distention During Transgastric Natural Orifice Transluminal Endoscopic Surgery

    OpenAIRE

    Tomasko, Jonathan M.; Mathew, Abraham; Moyer, Matthew T.; Haluck, Randy S.; Pauli, Eric M.

    2013-01-01

    Background and Objectives: Bowel distention from luminal gas insufflation reduces the peritoneal operative domain during natural orifice transluminal endoscopic surgery (NOTES) procedures, increases the risk for iatrogenic injury, and leads to postoperative patient discomfort. Methods: A prototype duodenal occlusion device was placed in the duodenum before NOTES in 28 female pigs. The occlusion balloon was inflated and left in place during the procedure, and small bowel distension was subject...

  20. Defining probabilities of bowel resection in deep endometriosis of the rectum: Prediction with preoperative magnetic resonance imaging.

    Science.gov (United States)

    Perandini, Alessio; Perandini, Simone; Montemezzi, Stefania; Bonin, Cecilia; Bellini, Gaia; Bergamini, Valentino

    2018-02-01

    Deep endometriosis of the rectum is a highly challenging disease, and a surgical approach is often needed to restore anatomy and function. Two kinds of surgeries may be performed: radical with segmental bowel resection or conservative without resection. Most patients undergo magnetic resonance imaging (MRI) before surgery, but there is currently no method to predict if conservative surgery is feasible or whether bowel resection is required. The aim of this study was to create an algorithm that could predict bowel resection using MRI images, that was easy to apply and could be useful in a clinical setting, in order to adequately discuss informed consent with the patient and plan the an appropriate and efficient surgical session. We collected medical records from 2010 to 2016 and reviewed the MRI results of 52 patients to detect any parameters that could predict bowel resection. Parameters that were reproducible and with a significant correlation to radical surgery were investigated by statistical regression and combined in an algorithm to give the best prediction of resection. The calculation of two parameters in MRI, impact angle and lesion size, and their use in a mathematical algorithm permit us to predict bowel resection with a positive predictive value of 87% and a negative predictive value of 83%. MRI could be of value in predicting the need for bowel resection in deep endometriosis of the rectum. Further research is required to assess the possibility of a wider application of this algorithm outside our single-center study. © 2017 Japan Society of Obstetrics and Gynecology.

  1. Determining the efficiency of a commercial belly board device in reducing small bowel volume in rectal cancer patients

    International Nuclear Information System (INIS)

    Lukarski, Dusko; Petkovska, Sonja; Angelovska, Natalija; Grozdanovska, Biljana; Mitrevski, Nenad

    2010-01-01

    The purpose of this treatment planning study was to evaluate the efficiency of a commercial belly board device in reducing the irradiated volume of the small bowel. In this study 10 patients with rectal carcinoma receiving postoperative radiotherapy were included. For each of them we made two computer tomography series in prone position. In the first one the patients were lying on the flat table top, and in the second one they were lying on the belly board device which is under investigation. On both series we calculated and optimized plans according to the standing protocol of our department. From the dose-volume histograms of these plans we compared the volumes of the small bowel irradiated to three dose levels 15, 30 and 45 Gy. The results showed that the absolute irradiated volumes were significantly smaller in the plans with the belly board device. Based on these results we believe that the employment of this belly board device will reduce the acute and late small bowel toxicity. This should be verified with a clinical study.(Author)

  2. Determining the efficiency of a commercial belly board device in reducing small bowel volume in rectal cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Lukarski, Dusko; Petkovska, Sonja; Angelovska, Natalija; Grozdanovska, Biljana; Mitrevski, Nenad [University Clinic of Radiotherapy and Oncology, Skopje(Macedonia, The Former Yugoslav Republic of)

    2010-07-01

    The purpose of this treatment planning study was to evaluate the efficiency of a commercial belly board device in reducing the irradiated volume of the small bowel. In this study 10 patients with rectal carcinoma receiving postoperative radiotherapy were included. For each of them we made two computer tomography series in prone position. In the first one the patients were lying on the flat table top, and in the second one they were lying on the belly board device which is under investigation. On both series we calculated and optimized plans according to the standing protocol of our department. From the dose-volume histograms of these plans we compared the volumes of the small bowel irradiated to three dose levels 15, 30 and 45 Gy. The results showed that the absolute irradiated volumes were significantly smaller in the plans with the belly board device. Based on these results we believe that the employment of this belly board device will reduce the acute and late small bowel toxicity. This should be verified with a clinical study.(Author)

  3. Vaginal Cuff Dehiscence with Small Bowel Evisceration 14 Months after Total Abdominal Hysterectomy

    Directory of Open Access Journals (Sweden)

    Nida Jareemit, M.D.

    2017-11-01

    Full Text Available Introduction: Vaginal cuff dehiscence is a rare complication following hysterectomy. The condition coexisting with intraabdominal organ evisceration occurs even rarer. Nevertheless this should not be neglected owing to high morbidity and mortality. Case presentation: The reported case is a 48-year-old widow presenting with vaginal cuff dehiscence and small bowel evisceration after undergoing a total abdominal hysterectomy (TAH in the past 14 months due to myoma uteri. She denied having a history of sexual intercourse after the operation. The exposed bowel, 60 cm in length, appeared viable and no peritoneal sign was observed. There was a vaginal cuff defect approximately 3 cm in length. An exploratory laparotomy was then carried out. Eviscerated bowel was reduced back in the abdominal cavity and the vaginal cuff defect was repaired. No complications such as recurrent dehiscence were observed during one year follow-up. Conclusion: To minimize the incidence of vaginal cuff dehiscence after hysterectomy, surgical techniques should be of concern. Patient instructions, including delaying sexual intercourse and avoiding all possible causes of increased intra-abdominal pressure should be provided postoperatively.

  4. Bedside Ultrasound for the Diagnosis of Small Bowel Obstruction

    Directory of Open Access Journals (Sweden)

    Alexander Anshus

    2017-09-01

    Full Text Available History of present illness: An elderly female with no history of prior abdominal surgeries presented to the emergency department (ED with acute onset of abdominal pain and distention. Upon arrival, she began having large volume bilious emesis. While waiting for a computed tomography (CT scan of her abdomen and pelvis, a point of care ultrasound (POCUS was performed which showed evidence of a small bowel obstruction (SBO. The patient had a nasogastric tube placed that put out over two liters of bilious contents. A subsequent CT scan confirmed the diagnosis of SBO from a left inguinal hernia and the patient was admitted to the surgical service. Significant findings: The POCUS utilizing the low frequency curvilinear probe demonstrates fluid-filled, dilated bowel loops greater than 2.5cm with to-and-fro peristalsis, and thickened bowel walls greater than 3mm, concerning for SBO. Discussion: Gastrointestinal obstruction is a common diagnosis in the ED, accounting for approximately 15% of all ED visits for acute abdominal pain.1 SBO accounts for approximately 80% of all obstructions.2 In the diagnosis of SBO, studies show that abdominal x-rays have a sensitivity of 66-77% and specificity of 50-57%,3 CT scans have a sensitivity of 92% and specificity of 93%,4 and ultrasound has a sensitivity of 88% and specificity of 96%.5 While CT scan remains a widely accepted modality for diagnosing SBO, ultrasound is more cost effective, well tolerated, does not involve ionizing radiation, and can be done in a timely manner at the patient’s bedside. Ultrasound can also identify transition points as well as distinguish between functional and mechanical obstruction.6 In addition to SBO, ultrasound can be used to diagnose external hernias, intussusception, tumors, superior mesenteric artery (SMA syndrome, foreign bodies, bezoars, and ascariasis.7

  5. Autoimmune Hepatitis with Distal Renal Tubular Acidosis and Small Bowel Partial Malrotation.

    Science.gov (United States)

    Kanaiyalal Modi, Tejas; Parikh, Hardik; Sadalge, Abhishek; Gupte, Amit; Bhatt, Pratin; Shukla, Akash

    2015-01-01

    Renal tubular acidosis (RTA) is not uncommon in patient with chronic autoimmune hepatitis (AIH), but usually remains latent. Here, we report a case of renal tubular acidosis RTA who presented with AIH. She was also diagnosed to have partial bowel malrotation. A 9-year-old girl, a case of distal RTA, presented with jaundice, abdominal distension and altered sensorium. She was diagnosed to be AIH, which was successfully treated with steroids and azathioprine. Coexistent midgut partial malrotation with volvulus was diagnosed during the treatment. She was treated successfully with anti-tuberculous treatment for cervical lymphadenitis. Autoimmune hepatitis should not be ruled out in each case of RTA presenting with jaundice. Modi TK, Parikh H, Sadalge A, Gupte A, Bhatt P, Shukla A. Autoimmune Hepatitis with Distal Renal Tubular Acidosis and Small Bowel Partial Malrotation. Euroasian J Hepato-Gastroenterol 2015;5(2):107-109.

  6. Abnormal diffusion-weighted MRI in medulloblastoma: does it reflect small cell histology?

    International Nuclear Information System (INIS)

    Kotsenas, A.L.; Roth, T.C.; Manness, W.K.; Faerber, E.N.

    1999-01-01

    A 12-year-old boy presented with the classic CT and MRI findings of medulloblastoma and the unusual finding of increased signal on diffusion MRI. The small-cell histology of medulloblastoma may account for the increased signal seen on diffusion MRI. Diffusion MRI with echoplanar technique may be useful in evaluation of these tumors and metastatic disease. (orig.)

  7. SU-F-J-169: A Feasibility Study of Using MRI Alone in Abdominal Radiotherapy

    International Nuclear Information System (INIS)

    Zawisza, I; Hsu, S; Peng, Q; Tome, W

    2016-01-01

    Purpose: To demonstrate the feasibility of a MRI alone workflow to support treatment planning and image guidance for abdominal radiotherapy. Methods: Abdominal MR images (in-phase/out-phase/fat/water) were acquired for a patient with breath-hold using a Dixon pulse sequence. Air masks were created on in-phase images using intensity thresholding and morphological processing methods in order to separate air from bone. Pseudo-CT and DRRs were generated using a published method. To investigate the effect of heterogeneity corrections on dose calculations using pseudo-CT, three different plans (3-field 3D, 5-field IMRT and 2-arc VMAT) were performed to mimic pancreatic treatments (1.8Gy/fraction over 28 fractions). Results: The DRRs created from pseudo-CT were of comparable quality as those created from CT. Comparing dose calculations with and without heterogeneity corrections between the 3 different plans, the biggest dosimetric differences were seen in the VMAT plan where modulation must occur across air-tissue interfaces such as those of the stomach and bowel. The DVHs for the VMAT plan showed ∼84cc difference at V50Gy in the small bowel. In terms of pseudo-CT quality, some small volumes of air in the bowel and stomach were misclassified as bone. The VMAT plan was re-optimized on pseudo-CT with 0 HU in the misclassified areas. The V50Gy in the small bowel differed by ∼90cc between the new VMAT plan with and without heterogeneity corrections. Conclusion: We found that the use of MRI alone is feasible for abdominal treatment planning and image guidance. A difference between calculations with and without heterogeneity corrections was found that is most pronounced for VMAT where the traversal of air-tissue interfaces is unavoidable. Future work will be performed to minimize misclassification between bone and air.

  8. SU-F-J-169: A Feasibility Study of Using MRI Alone in Abdominal Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Zawisza, I; Hsu, S; Peng, Q; Tome, W [Montefiore Medical Center, Bronx, NY (United States)

    2016-06-15

    Purpose: To demonstrate the feasibility of a MRI alone workflow to support treatment planning and image guidance for abdominal radiotherapy. Methods: Abdominal MR images (in-phase/out-phase/fat/water) were acquired for a patient with breath-hold using a Dixon pulse sequence. Air masks were created on in-phase images using intensity thresholding and morphological processing methods in order to separate air from bone. Pseudo-CT and DRRs were generated using a published method. To investigate the effect of heterogeneity corrections on dose calculations using pseudo-CT, three different plans (3-field 3D, 5-field IMRT and 2-arc VMAT) were performed to mimic pancreatic treatments (1.8Gy/fraction over 28 fractions). Results: The DRRs created from pseudo-CT were of comparable quality as those created from CT. Comparing dose calculations with and without heterogeneity corrections between the 3 different plans, the biggest dosimetric differences were seen in the VMAT plan where modulation must occur across air-tissue interfaces such as those of the stomach and bowel. The DVHs for the VMAT plan showed ∼84cc difference at V50Gy in the small bowel. In terms of pseudo-CT quality, some small volumes of air in the bowel and stomach were misclassified as bone. The VMAT plan was re-optimized on pseudo-CT with 0 HU in the misclassified areas. The V50Gy in the small bowel differed by ∼90cc between the new VMAT plan with and without heterogeneity corrections. Conclusion: We found that the use of MRI alone is feasible for abdominal treatment planning and image guidance. A difference between calculations with and without heterogeneity corrections was found that is most pronounced for VMAT where the traversal of air-tissue interfaces is unavoidable. Future work will be performed to minimize misclassification between bone and air.

  9. Small intestinal bacterial overgrowth prevalence in celiac disease patients is similar in healthy subjects and lower in irritable bowel syndrome patients.

    Science.gov (United States)

    Lasa, J S; Zubiaurre, I; Fanjul, I; Olivera, P; Soifer, L

    2015-01-01

    Untreated celiac disease has traditionally been linked to a greater risk for small intestinal bacterial overgrowth, but the existing evidence is inconclusive. To compare the prevalence of small intestinal bacterial overgrowth in subjects with celiac disease compared with control subjects and patients with irritable bowel syndrome. The study included 15 untreated celiac disease patients, 15 subjects with irritable bowel syndrome, and 15 healthy controls. All enrolled patients underwent a lactulose breath test measuring hydrogen and methane. Small intestinal bacterial overgrowth was defined according to previously published criteria. No differences were found in relation to age or sex. The prevalence of small intestinal bacterial overgrowth was similar between the celiac disease patients and the controls (20 vs. 13.33%, P=NS), whereas it was higher in patients with irritable bowel syndrome (66.66%, Pintestinal bacterial overgrowth between the untreated celiac disease patients and healthy controls. Copyright © 2015 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  10. Small bowel permeability to 51Cr-EDTA in children with recurrent abdominal pain

    International Nuclear Information System (INIS)

    Meer, S.B. van der.; Forget, P.P.

    1990-01-01

    Small bowel permeability was investigated in 87 children with recurrent abdominal pain by measuring the 24-h urinary excretion of orally administered 51 Cr-EDTA. The mean excreation was 3.64% ± 1.49% per 24 h. The difference between the mean urinary excretion in children with recurrent abdominal pain and control children (2.51% ± 0.70%), was significant (p<0.01, two sample t-test). The increased small permeability in children with recurrent abdominal pain might indicate an intestinal etiology for the patients complaints

  11. Differential diagnosis of mechanical bowel obstruction and paralytic ileus on CT features

    International Nuclear Information System (INIS)

    Jeon, Yong Sun; Kim, Mi Young; Suh, Chang Hae; Chung, Won Kyun; Kim, Kyung Rae; Kim, Kyung Kook; Shin, Yong Woon

    1997-01-01

    To evaluate CT findings for the differential diagnosis of mechanical bowel obstruction and paralytic ileus. Without information relating to clinical or operative findings, we retrospectively analyzed the CT scans of 24 patients with mechanical bowel obstruction and 19 patients with paralytic ileus. Final diagnosis was confirmed by operation (n=26), or by clinical symptoms, radiologic findings and follow-up study CT findings were obtained:1) the diameter of the most dilated part of the small bowel, and the thickness and enhancing pattern of the dilated small bowel wall;2) the diameter of the most dilated part of the descending colon and the ratio of the diameter of the small bowel to that of the descending colon;3) the number of transitional zones, length and thickness and 4) associated ascites and its location. The mean diameters of the most dilated part of the small bowel in mechanical bowel obstruction and paralytic ileus were 3.6cm and 2.9cm, respectively. The diameter of the small bowel in mechanical bowel obstruction was significantly greater than in paralytic ileus(p<.05). The mean thickness of dilated small bowel wall was 4.0mm in mechanical bowel obstruction and 2.4mm in paralytic ileus, and target-like enhancement was prominent in mechanical bowel obstruction(46%)(p<.05). The mean diameter of the most dilated part of the descending colon was not significantly different to that of the most dilated part of the small bowel, but the ratio of the diameter of the small bowel to that of the colon was 2.9 in mechanical bowel obstruction and 1.9 in paralytic ileus, respectively, which was statistically significant(p<.05). A transitional zone was seen in 23 cases(96%) of mechanical bowel obstruction and in nine (47%) of paralytic ileus. In mechanical bowel obstruction, mean transitional zone length was 2cm, shorter than that of paralytic ileus(3.4cm)(p<.05) The thickness of transitional zone and the presence of ascites and its locations were not significantly

  12. Circulating blocking factors of lymphoid-cell cytotoxicity in x-ray-induced rat small-bowel adenocarcinoma

    International Nuclear Information System (INIS)

    Stevens, R.H.; Brooks, G.P.; Osborne, J.W.

    1979-01-01

    Circulating blocking factors capable of abrogating cell-mediated immune responses measured by in vitro lymphoid-cell cytotoxicity were identified in the sera of Holtzman outbred rats 6 to 9 months after a single exposure of only the temporarily exteriorized, hypoxic ileum and jejunum to 1700 to 2000 R of X radiation. Such factors were found to exist in the serum of every animal exposed to the ionizing radiation regardless of whether a visibly identifiable small-bowel adenocarcinoma existed or subsequently would develop. Protection of cultured x-ray-induced rat small-bowel cancer cells from destruction by tumor-sensitized lymphoid cells as measured by the release of lactoperoxidase-catalyzed radioiodinated membrane proteins from the tumor target cells was conferred by the action of the blocking factors at both effector and target cell levels. The results of this study demonstrate that exposure of only the rat small intestine to ionizing radiation leads to elaboration of circulating factors identifiable several months postirradiation which will block cell-mediated immune responses directed against cancer cells developing in the exposed tissue

  13. Bowel injury following gynecological laparoscopic surgery.

    African Journals Online (AJOL)

    nique did not reduce bowel injuries.6 Majority of gyne- .... showed (A-B) distended small bowel loops (yellow arrows) and an incarcerated bowel loop in one of the ... intolerance of oral intake, bloating, nausea, fever or diar- ..... Strategies in.

  14. The role of computed tomography in the diagnosis and management of clinically occult post-traumatic small bowel perforation

    International Nuclear Information System (INIS)

    Ahmed, I.; Ahmed, N.; Bell, D.J.; Hughes, D.V.; Evans, G.H.; Howlett, D.C.

    2009-01-01

    Purpose: To evaluate the use of computed tomography [CT] in the diagnosis of occult post-traumatic small bowel perforation and to discuss the role of CT in the management of this patient group. Method: This review includes three patients who presented with mild abdominal symptoms following minor blunt abdominal trauma. Initial radiographs and laboratory investigations were unremarkable but their symptoms failed to resolve and contrast-enhanced CT was performed for further evaluation. Results: In each case the CT appearances were indicative of localised small bowel perforation, with no evidence of other visceral injury. In two patients pockets of free intraperitoneal air were present closely related to the second part of the duodenum suggesting injury at this site. In the third case, a thickened proximal jejunal loop was demonstrated with free air and fluid in the adjacent mesentery consistent with a focal perforation. These CT findings were subsequently confirmed at laparotomy. Conclusion: CT is an accurate diagnostic tool in the assessment of clinically and radiologically occult traumatic small bowel injury. The use of CT should be considered in patients who have unresolving abdominal symptoms even after apparently insignificant abdominal trauma.

  15. Anaesthetic Management of a patient with Myasthenia Gravis and Small Bowel Intussusception for Jejuno-Ileal Anastomoses

    Directory of Open Access Journals (Sweden)

    Pawan Kumar Jain

    2016-01-01

    Full Text Available Myasthenia gravis is a chronic autoimmune disease affecting voluntary skeletal muscles. The altered sensitivity of acetylcholine receptors to muscle relaxants and concomitant treatment with anticholinesterase in these patients affect their anaesthetic management. Patients who have undergone bowel anastomosis and are on regular anticholinesterase treatment are susceptible to anastomotic leaks. We report successful anaesthetic management of class I myasthenic patient with coexisting small bowel intussusception operated for jejuno-ileal anastomoses using regional, inhalational and intravenous (i.v anaesthesia based on train of four responses, and avoiding the use of reversal (anticholinesterase.

  16. A very rare case of a small bowel leiomyosarcoma leading to ileocaecal intussusception treated with a laparoscopic resection: a case report and a literature review.

    Science.gov (United States)

    Guzel, Tomasz; Mech, Katarzyna; Mazurkiewicz, Michał; Dąbrowski, Bohdan; Lech, Gustaw; Chaber, Andrzej; Słodkowski, Maciej

    2016-02-24

    Small bowel tumours are rare and comprise less than 2% of all primary gastrointestinal neoplasms. Among these tumours, a leiomyosarcoma belonging to soft tissue sarcomas is extremely rare and accounts for about 1 % of malignant mesenchymal lesions in the gastrointestinal tract. Due to its aggressive nature and slow growth, it is often diagnosed at the late stage when curative treatment is impossible. Authors report a first case of leiomyosarcoma with chronic recurrent ileocaecal intussusception and literature review to analyse diagnosis and treatment features of the ileum mesenchymal tumours. We present a case of an 87-year-old Caucasian man suffering from cramp-like abdominal pain for months. Due to lack of clinical signs and unspecific complaints, a diagnosis was delayed. Despite a detailed in-hospital examination, a proper diagnosis was established as late as during an operation. The patient was treated by surgery with good results. An uncommon laparoscopic resection of the small bowel with a tumour was performed. A histopathological investigation confirmed a very rare mesenchymal lesion of the distal ileum. The patient is under control with no recurrence for 1 year of the follow-up period. Reported case indicates that a usually asymptomatic tumour can cause uncommon chronic recurrent ileus signs. CT and MRI scans are investigation of choice in such cases, but they are sometimes inconclusive. It might be worth highlighting the good results of laparoscopic leiomyosarcoma lesion resection with a very good outcome.

  17. The 3-Dimensional Analysis of the Efficacy of a Belly-Board Device for the Displacement of Small Bowel During Pelvic Irradiation

    International Nuclear Information System (INIS)

    Lee, Kyung Ja

    2008-01-01

    To evaluate the efficacy of a belly-board device (BBD) in reducing the volume of small bowel during four-field pelvic irradiation. Materials and Methods: Twenty-two cancer patients (14 uterine cervical cancer, 6 rectal cancer, and 2 endometrial cancer) scheduled to receive pelvic irradiation were selected for this study. Two sets of CT images were taken with and without the belly-board device using the Siemens 16 channel CT scanner. All patients were set in the prone position. The CT images were transferred to a treatment planning system for dose calculation and volume measurements. The external surfaces of small bowel and the bladder were contoured on all CT scans and the 4-pelvic fields were added. The dose-volume-histogram of the bladder and small bowel, with and without the BBD, were plotted and analyzed. Results: In all patients, the total small bowel volume included in the irradiated fields was reduced when the BBD was used. The mean volume reduction was 35% (range, 1-79%) and was statistically significant (p<0.001). The reduction in small bowel volume receiving 10-100% of the prescribed dose was statistically significant when the BBD was used in all cases. Almost no change in the total bladder volume involved was observed in the field (<8 cc, p=0.762). However, the bladder volume receiving 90% of the prescribed dose was 100% in 15/22 patients (68%) and 90-99% in 7/22 patients (32%) with the BBD. In comparison, the bladder volume receiving 90% of the prescribed dose was 100% in 10/22 patients (45%), 90-99% in 7/22 patients (32%), and 80-89% in 5/22 patients (23%) without the BBD. When the BBD was used, an increase in the bladder volume receiving a high dose range was observed Conclusion: This study shows that the use of a BBD for the treatment of cancer in the pelvic area significantly improves small bowel sparing. However, since the BBD pushed the bladder into the treatment field, the bladder volume receiving the high dose could increase. Therefore it is

  18. Fetal gastrointestinal MRI: all that glitters in T1 is not necessarily colon

    Energy Technology Data Exchange (ETDEWEB)

    Colombani, Marina [La Timone Children' s Hospital, Service de Radiopediatrie, Marseille (France); Ferry, Mathilde [Groupe Rennais d' Imagerie Medicale, Service de Radiologie, Rennes (France); Garel, Catherine [Hopital d' Enfants Armand-Trousseau, Service de Radiologie, Paris (France); Cassart, Marie [Erasme Hospital, Medical Imaging, Brussels (Belgium); Couture, Alain [Hopital Arnaud de Villeneuve, Pediatric Radiology, Montpellier (France); Guibaud, Laurent [Hopital Femme Mere Enfant, Pediatric and Fetal Imaging, Lyon (France); Avni, Fred [Erasme Hospital, Radiology, Brussels (Belgium); Gorincour, Guillaume [La Timone Children' s Hospital, Pediatric Radiology, Marseille (France)

    2010-07-15

    It has been described that both the colon and distal ileum present with a physiological hypersignal on T1-weighted sequences during the second and third trimesters of pregnancy because of their protein-rich meconium content, it was unclear whether the normal characteristics that have been described on fetal MRI can be applied to gastrointestinal (GI) obstructions. To analyse the localisation value of T1 hypersignal within dilated bowel loops in fetuses with gastrointestinal tract obstruction. A retrospective 4-year multicentre study analysing cases of fetal GI obstruction in which MRI demonstrated T1 hypersignal content in the dilated loops. Data collected included gestational age (GA) at diagnosis, bowel appearance on US, CFTR gene mutations and amniotic levels of gastrointestinal enzymes. The suggested prenatal diagnosis was eventually compared to postnatal imaging and surgery. Eleven patients were included. The median GA at US diagnosis was 23 weeks (range 13-32). In eight cases there was a single dilated loop, while several segments were affected in three. The median GA at MRI was 29 weeks (range 23-35). One case presented with cystic fibrosis mutations. Final prenatally suspected diagnoses were distal ileal atresia or colon in nine cases and proximal atresia in two. Postnatal findings were proximal jejunal atresia in nine cases and meconium ileus in two. In five cases the surgical findings demonstrated short bowel syndrome. In cases of fetal occlusion, T1 hypersignal should not be considered as a sign of distal ileal or colonic occlusion. The obstruction may be proximal, implying a risk of small bowel syndrome, which requires adequate parental counselling. (orig.)

  19. Bowel-associated dermatosis-arthritis syndrome in an adolescent with short bowel syndrome.

    Science.gov (United States)

    Pereira, Ester; Estanqueiro, Paula; Almeida, Susana; Ferreira, Ricardo; Tellechea, Oscar; Salgado, Manuel

    2014-09-01

    Bowel-associated dermatosis-arthritis syndrome (BADAS) is a neutrophilic dermatosis, characterized by the occurrence of arthritis and skin lesions related to bowel disease with or without bowel bypass. We report an unusual case of BADAS in a 15-year-old white male with congenital aganglionosis of the colon and hypoganglionosis of the small intestine and multiple bowel surgeries in childhood complicated by short bowel syndrome. He presented with recurrent peripheral polyarthritis, tenosynovitis, and painful erythematous subcutaneous nodules located on the dorsolateral regions of the legs and on the dorsa of the feet. Histological examination disclosed a neutrophilic dermatosis confirming the diagnosis of BADAS.Although an uncommon disease, especially at pediatric age, it is important to evoke the diagnosis of BADAS in children and adolescents with bowel disease, because treatment options and prognosis are distinct from other rheumatologic conditions.

  20. Nutritive support in short Bowel syndrome (sbs

    Directory of Open Access Journals (Sweden)

    Simić Dušica

    2003-01-01

    Full Text Available Short bowel syndrome most commonly result after bowel resection for necrosis of the bowel. It may be caused by arterial or venous thrombosis, volvolus and in children, necrotizing enterocolitis. The other causes are Crohn,s disease intestinal atresia. The factors influencing the risk on short bowel syndrome are the remaining length of the small bowel, the age of onset, the length of the colon, the presence or absence of the ileo-coecal valve and the time after resection. Besides nutritional deficiencies there some other consequences of extensive resections of the small intestine (gastric acid hypersecretion, d-lactic acidosis, nephrolithiasis, cholelithiasis, which must be diagnosed, treated, and if possible, prevented. With current therapy most patients with short bowel have normal body mass index and good quality of life.

  1. New Evidence on the Impact of Antithrombotics in Patients Submitted to Small Bowel Capsule Endoscopy for the Evaluation of Obscure Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Pedro Boal Carvalho

    2014-01-01

    Full Text Available Objectives. Small bowel capsule endoscopy (SBCE plays a decisive role in the obscure gastrointestinal bleeding (OGIB diagnosis. Antithrombotics may increase bleeding risk in patients with preexistent lesions or through direct mucosal aggression. We aimed to correlate antithrombotics usage with lesions with bleeding potential found in SBCE. Methods. Retrospective single-center study including 274 consecutive SBCE performed over 7 years for OGIB. The lesions were classified as P0 (no bleeding potential, P1 (uncertain bleeding potential: erosions, and P2 (high bleeding potential: angioectasias, ulcers, and tumors. We assessed antiplatelet and anticoagulant drug use during the 60 days preceding SBCE. Results. One-third of the patients were under antithrombotic therapy. The diagnostic yield of SBCE for P2 lesions was 30.0%. Angioectasias (20.4% were the most frequently observed lesions. There was a significant correlation between anticoagulant drug use and a higher incidence of P2 lesions in the small bowel (43.2% versus 26.5%; OR = 2.11, P=0.026. We found no significant correlation between antiplatelets and lesions with bleeding potential in SBCE. Conclusions. Small bowel lesions with high bleeding potential were more frequently detected when the patient was on anticoagulant drugs, resulting in a twofold risk. Antiplatelet drugs were not associated with small bowel lesions.

  2. Laparoscopic Treatment of a Rare Right Diaphragmatic Rupture with Small Bowel Herniation after Blunt Thoracic Trauma

    Directory of Open Access Journals (Sweden)

    H. Hoffmann

    2010-01-01

    Full Text Available Blunt traumatic diaphragmatic rupture (BTDR is a life-threatening condition with an incidence from 0,8%–1,6% in blunt trauma, mostly located on the left side. The main prognostic factors are severe side injuries and the delay of diagnosis. We present a rare case of a 68-year-old female, with an isolated right diaphragm rupture. The diagnosis was done with a delay of 4 days by thoracic radiographs, which showed a herniation of small bowel into the right thoracic cavity. A reposition of the small bowel and a closure of the diaphragmatic defect by running suture were carried out laparoscopicly. Although large prospective studies concerning the outcome of laparoscopic approach to right BTDR are still missing, we could show, that laparoscopy can be performed safely in right traumatic diaphragm rupture.

  3. Growing indications for CEUS: The kidney, testis, lymph nodes, thyroid, prostate, and small bowel

    International Nuclear Information System (INIS)

    Cantisani, V.; Bertolotto, M.; Weskott, H.P.; Romanini, L.; Grazhdani, H.; Passamonti, M.; Drudi, F.M.; Malpassini, F.; Isidori, A.; Meloni, F.M.; Calliada, F.; D’Ambrosio, F.

    2015-01-01

    Highlights: • Contrast enhanced ultrasonography (CEUS) is increasingly used for non-hepatic applications. • There is a growing clinical use for a variety of pathologies of the kidney, testis, and small bowel. • Updated knowledge for proper use of CEUS in uncommon fields is provided. - Abstract: Contrast enhanced ultrasonography (CEUS) is increasingly used for non-hepatic applications as well, so that nearly all organs have been investigated. Among them, there is a growing clinical use for a variety of pathologies of the kidney, testis, and small bowel. The possibility to differentiate benign from malignant nodes in cancer patients has been investigated. A new application is in the detection of sentinel nodes after intradermal microbubble injection. The need to distinguish thyroid nodules eligible for fine needle aspiration cytology has led to the use of CEUS in thyroid examinations as well. The potential of CEUS for prostate cancer detection has been extensively investigated, with encouraging initial results. Early promise, however, has not been fulfilled. New perspective regards evaluation of the extent of prostate tissue devascularization following ablative treatments

  4. Growing indications for CEUS: The kidney, testis, lymph nodes, thyroid, prostate, and small bowel

    Energy Technology Data Exchange (ETDEWEB)

    Cantisani, V., E-mail: vito.cantisani@uniroma1.it [Department of Radiology, Anatomopathology and Oncology, “Sapienza” University of Rome (Italy); Bertolotto, M. [Department of Radiology, University of Trieste (Italy); Weskott, H.P. [Central Ultrasound Department, Klinikum Siloah , Hannover (Germany); Romanini, L. [University Hospital of Pavia (Italy); Grazhdani, H. [Department of Radiology, Anatomopathology and Oncology, “Sapienza” University of Rome (Italy); Passamonti, M. [Dipartimento di Scienze Radiologiche, Ospedale di Lodi (Italy); Drudi, F.M.; Malpassini, F. [Department of Radiology, Anatomopathology and Oncology, “Sapienza” University of Rome (Italy); Isidori, A. [Department of Experimental Medicine, “Sapienza” University of Rome, Rome (Italy); Meloni, F.M. [Dipartimento servizi diagnostici, Ospedale Valduce, Como (Italy); Calliada, F. [University Hospital of Pavia (Italy); D’Ambrosio, F. [Department of Radiology, Anatomopathology and Oncology, “Sapienza” University of Rome (Italy)

    2015-09-15

    Highlights: • Contrast enhanced ultrasonography (CEUS) is increasingly used for non-hepatic applications. • There is a growing clinical use for a variety of pathologies of the kidney, testis, and small bowel. • Updated knowledge for proper use of CEUS in uncommon fields is provided. - Abstract: Contrast enhanced ultrasonography (CEUS) is increasingly used for non-hepatic applications as well, so that nearly all organs have been investigated. Among them, there is a growing clinical use for a variety of pathologies of the kidney, testis, and small bowel. The possibility to differentiate benign from malignant nodes in cancer patients has been investigated. A new application is in the detection of sentinel nodes after intradermal microbubble injection. The need to distinguish thyroid nodules eligible for fine needle aspiration cytology has led to the use of CEUS in thyroid examinations as well. The potential of CEUS for prostate cancer detection has been extensively investigated, with encouraging initial results. Early promise, however, has not been fulfilled. New perspective regards evaluation of the extent of prostate tissue devascularization following ablative treatments.

  5. Single-balloon enteroscopy following videocapsule endoscopy for diagnosis of small bowel tumors: preliminary experiences.

    Science.gov (United States)

    Trifan, A; Singeap, A M; Cojocariu, C; Sfarti, C; Tarcoveanu, E; Georgescu, S

    2010-01-01

    Small bowel tumors (SBTs), either benign or malignant, are rare, accounting for 3-6% of all digestive neoplasms. Videocapsule endoscopy (VCE) and double-balloon enteroscopy (DBE) have revolutionized the diagnosis and management of patients with small bowel diseases, including SBTs. A novel method using the single-balloon enteroscopy (SBE) has recently been developed. The aim of present study was to present our preliminary experience with SBE in patients with suspected SBTs on VCE examination. Patients in whom VCE showed one or more lesions suggesting SBTs underwent SBE. Three patients (2 males, 1 female; mean age 52 +/- 11 years) underwent SBE, and then surgery. There were two gastrointestinal stromal tumors and one adenocarcinoma. Clinically, all patients had iron-deficiency anemia and abdominal pain, and one patient had episodes of nausea/ vomiting. SBE was well tolerated without adverse events. SBE is a safe procedure and overcomes the limitations of VCE. Both procedures are complimentary in patients with suspected SBTs. VCE should be used first for initial diagnosis, followed by SBE for histopathological confrmation of the diagnosis and, if necessary, endoscopic therapy.

  6. Ectopic intestinal glands after segmental small bowel irradiation in the cat

    International Nuclear Information System (INIS)

    Rubio, C.A.; Eriksson, B.; Johnsson, L.

    1983-01-01

    Following segmental irradiation of the small bowel, 5 of 64 cats demonstrated ectopic intestinal glands in the submucosal tissue. In addition, one of these 5 cats had foci of abnormal glands in the muscularis mucosae. In 2 of the 5 animals, cellular polymorphism, nucleolar irregularity and loss of cellular polarity were present in irradiation-induced ectopic intestinal glands. The review of the literature indicates that intestinal irradiation may induce intestinal adenocarcinomas with metastatic growth. The possibility that ectopic intestinal glands are precancerous lesions in the irradiated cat is discussed. (Auth.)

  7. Meckel’s diverticulitis causing small bowel obstruction by a novel mechanism

    Directory of Open Access Journals (Sweden)

    Vishalkumar G. Shelat

    2011-07-01

    Full Text Available Meckel’s diverticulum occurs in 2% of the general population and majority of patients remain asymptomatic. Gastrointestinal bleeding is the most common presentation in the paediatric population. While asymptomatic and incidentally found Meckel’s diverticulum may be left alone, surgery is essential for treating a symptomatic patient. Despite advances in imaging and technology, pre-operative diagnosis is often difficult. We present a first report of an unusual mechanism of small bowel obstruction due to Meckel’s diverticulitis in a paediatric patient. The diagnosis was only apparent at laparotomy.

  8. Metastatic osteosarcoma to the small bowel with resultant intussusception: a case report and review of the literature

    International Nuclear Information System (INIS)

    Wootton-Gorges, Sandra L.; Stein-Wexler, Rebecca; West, Danel C.

    2003-01-01

    Intussusception resulting from osteosarcoma metastasis to the small bowel is a rare diagnosis. This case report describes a patient with this diagnosis, demonstrates the CT appearance of this lesion, and reviews the literature. (orig.)

  9. Prognostic relevance of lymph node ratio and total lymph node count for small bowel adenocarcinoma.

    Science.gov (United States)

    Tran, Thuy B; Qadan, Motaz; Dua, Monica M; Norton, Jeffrey A; Poultsides, George A; Visser, Brendan C

    2015-08-01

    Nodal metastasis is a known prognostic factor for small bowel adenocarcinoma. The goals of this study were to evaluate the number of lymph nodes (LNs) that should be retrieved and the impact of lymph node ratio (LNR) on survival. Surveillance, Epidemiology, and End Results was queried to identify patients with small bowel adenocarcinoma who underwent resection from 1988 to 2010. Survival was calculated with the Kaplan-Meier method. Multivariate analysis identified predictors of survival. A total of 2,772 patients underwent resection with at least one node retrieved, and this sample included equal numbers of duodenal (n = 1,387) and jejunoileal (n = 1,386) adenocarcinomas. There were 1,371 patients with no nodal metastasis (N0, 49.4%), 928 N1 (33.5%), and 474 N2 (17.1%). The median numbers of LNs examined for duodenal and jejunoileal cancers were 9 and 8, respectively. Cut-point analysis demonstrated that harvesting at least 9 for jejunoileal and 5 LN for duodenal cancers resulted in the greatest survival difference. Increasing LNR at both sites was associated with decreased overall median survival (LNR = 0, 71 months; LNR 0-0.02, 35 months; LNR 0.21-0.4, 25 months; and LNR >0.4, 16 months; P < .001). Multivariate analysis confirmed number of LNs examined, T-stage, LN positivity, and LNR were independent predictors of survival. LNR has a profound impact on survival in patients with small bowel adenocarcinoma. To achieve adequate staging, we recommend retrieving a minimum of 5 LN for duodenal and 9 LN for jejunoileal adenocarcinomas. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Studies of the small bowel surface by scanning electron microscopy in infants with persistent diarrhea

    Directory of Open Access Journals (Sweden)

    U. Fagundes-Neto

    2000-12-01

    Full Text Available We describe the ultrastructural abnormalities of the small bowel surface in 16 infants with persistent diarrhea. The age range of the patients was 2 to 10 months, mean 4.8 months. All patients had diarrhea lasting 14 or more days. Bacterial overgrowth of the colonic microflora in the jejunal secretion, at concentrations above 10(4 colonies/ml, was present in 11 (68.7% patients. The stool culture was positive for an enteropathogenic agent in 8 (50.0% patients: for EPEC O111 in 2, EPEC O119 in 1, EAEC in 1, and Shigella flexneri in 1; mixed infections due to EPEC O111 and EAEC in 1 patient, EPEC O119 and EAEC in 1 and EPEC O55, EPEC O111, EAEC and Shigella sonnei in 1. Morphological abnormalities in the small bowel mucosa were observed in all 16 patients, varying in intensity from moderate 9 (56.3% to severe 7 (43.7%. The scanning electron microscopic study of small bowel biopsies from these subjects showed several surface abnormalities. At low magnification (100X most of the villi showed mild to moderate stunting, but on several occasions there was subtotal villus atrophy. At higher magnification (7,500X photomicrographs showed derangement of the enterocytes; on several occasions the cell borders were not clearly defined and very often microvilli were decreased in number and height; in some areas there was a total disappearance of the microvilli. In half of the patients a mucus-fibrinoid pseudomembrane was seen partially coating the enterocytes, a finding that provides additional information on the pathophysiology of persistent diarrhea.

  11. Segmental reversal of distal small intestine in short bowel syndrome

    DEFF Research Database (Denmark)

    Grave, Pernille Kock; Thomsen, Sabrina Valentin; Clark, Pia Susanne

    2018-01-01

    were the influence on cell proliferation and mucosal architecture shown by histological analysis. Methods: Sixteen piglets underwent a 60% resection of the distal small intestine and were randomized into two groups. Group 1 short bowel syndrome alone (SBS) (n = 8) and group 2 with reversal of a distal...... small intestinal segment (SBS-RS) (n = 8). Body weight was measured daily and the pigs were euthanized after 1 month. Crypt depths, villus heights and muscle layers thicknesses were measured. For the evaluation of microvilli of the brush border of the epithelium and cell proliferation...... was found in the SBS group and increase in the thickness of the circular and longitudinal muscle layers in the SBS-RS group. In the distal ileal segment the longitudinal muscle layer thicknesses were increased in the SBS group. Otherwise, no significant changes were found. Conclusion: Reversal of a 20-cm...

  12. Microscopic colitis and small intestinal bacterial overgrowth--diagnosis behind the irritable bowel syndrome?

    Science.gov (United States)

    Stoicescu, Adriana; Andrei, M; Becheanu, G; Stoicescu, M; Nicolaie, T; Diculescu, M

    2012-01-01

    Some patients previously diagnosed with irritable bowel syndrome (IBS) may develop microscopic colitis or small intestinal bacterial overgrowth (SIBO). To estimate the prevalence of microscopic colitis and SIBO in patients with IBS, to evaluate the symptoms and the efficacy of treatment. We examined patients with IBS admitted in our clinic during a three-year period. We identified patients with microscopic colitis by performing total colonoscopy with multiple biopsies from normal intestinal mucosa and those with SIBO by performing a H2-breath test with glucose. We compared the symptoms and the effectiveness of the treatment. Out of the 132 patients initially diagnosed with IBS 3% (n=4) had microscopic colitis and 43.9% (n=58) had SIBO. Diarrhea was the main symptom in patients with microscopic colitis and SIBO (p=0.041), while abdominal pain, abdominal bloating and flatulence were prominent in IBS patients (p=0.042; p=0.039; p=0.048). Specific treatment with rifaximin in SIBO patients negativated H2-breath test in 70.9% cases. Patients suspected to have irritable bowel syndrome should be evaluated for microscopic colitis and SIBO. The proper diagnosis and the specific treatment may cure some difficult cases of the so called "irritable bowel syndrome".

  13. Small bowel adenocarcinoma of the jejunum: a case report and literature review.

    Science.gov (United States)

    Li, Jie; Wang, Zhiliang; Liu, Na; Hao, Junfeng; Xu, Xin

    2016-07-04

    In practice, small bowel cancer is a rare entity. The most common histologic subtype is adenocarcinoma. Adenocarcinoma of the small bowel (SBA) is challenging to diagnose, often presents at a late stage and has a poor prognosis. The treatment of early-stage SBA is surgical resection. No standard protocol has been established for unresectable or metastatic disease. We report here on a 26-year-old man with SBA in the jejunum, lacking specific symptoms and with a delay of 6 months in diagnosis. The diagnosis was finally achieved with a combination of balloon-assisted enteroscopy, computed tomography scans, positron emission computed tomography scans and the values of carcino-embryonic antigen and carbohydrate antigen 19-9. The patient underwent segmental intestine with lymph node resection, followed by eight cycles of FOLFOX palliative chemotherapy with good tolerance. As of the 11-month postoperative follow-up, there has been no evidence of recurrent disease. This case is reported to arouse a clinical suspicion of SBA in patients with abdominal pain of unknown cause. We also provided evidence in this case of a response to palliative chemotherapy with FOLFOX. Because the incidence of SBA is very low, there is a need for further studies to evaluate the possible application of newer investigative agents and strategies to obtain a better outcome within the framework of international collaborations.

  14. The relationship between physical activity level and completion rate of small bowel examination in patients undergoing capsule endoscopy.

    Science.gov (United States)

    Shibuya, Tomoyoshi; Mori, Hiroki; Takeda, Tsutomu; Konishi, Masae; Fukuo, Yuka; Matsumoto, Kenshi; Beppu, Kazuko; Sakamoto, Naoto; Osada, Taro; Nagahara, Akihito; Otaka, Michiro; Ogihara, Tatsuo; Watanabe, Sumio

    2012-01-01

    Capsule endoscopy (CE) allows direct examination of the small bowel in a safe, noninvasive and well-tolerated manner. Nonetheless, experience indicates failure to reach the cecum in 20-30% of patients within the 8 hour battery life. Attempts to improve the completion rate (CR) as defined by reaching the cecum have been unsuccessful. This study was to investigate the relationship between patients' physical activity and CR. Between January 2009 and January 2010, 76 patients (44 men, 32 women; median age 64.5 yr) underwent CE for the diagnosis of small intestinal disorders. Indications for CE were obscure gastrointestinal bleeding/anemia (62 cases), others (14 cases). Patients were divided into an outpatient group (n=23), mild bed rest group (n=35) and strict bed rest group (n=18). For all patients, the average gastric transit time was 65.5 minutes, small bowel transit time was 301.4 minutes and the CR was 86.8%. However, the CR was 100% (23/23) in the outpatient group, an 85.7% (30/35) in the mild bed rest group, and 72.2% (13/18) in the strict bed rest group. The CR increased with physical activity of patients by Cochran-Armitage Trend Test (p=0.009). In multivariate logistic regression analyses, low physical activity was a significant risk factor for failure to reach the cecum during CE examination; adjusted OR: 3.39, 95% CI: 1.01-11.42 (p=0.048). Our observations suggested that increasing physical activity would increase the likelihood of a complete bowel examination by CE. Further, for CE, inconvenient bowel preparations like the use of polyethylene glycol may be avoided.

  15. Clinical variables related to small bowel obstruction: comparison of patients with and without Crohn’s disease

    Directory of Open Access Journals (Sweden)

    Awad Al Qahtani

    2012-06-01

    Full Text Available Small bowel obstruction is a known complication of Crohn’s disease. Determining need for operation is a demanding task. The aim of this study was to fine tune the decision-making process by evaluating standard clinical and laboratory parameters in small bowel obstruction of any cause and compare etiologies. Consecutive patients with Crohn’s disease and small bowel obstruction were selected retrospectively and compared to a randomly selected group of non Crohn’s patients with obstruction over a 9 year period. Twenty-two clinical, laboratory and radiological variables were assessed for the following outcomes: i diagnosis of Crohn’s; ii operative or non operative treatment in Crohn’s; iii operative or non operative treatment without Crohn’s; iv exacerbation or adhesions causing obstruction among Crohn’s patients. Multivariable models were developed for each outcome using logistic regression. Age less than 50, history of smoking, Jewish ethnicity, white count >11x10E9, neutrophils >7.5x10E9 and platelet volume <9.9 fL, supported the diagnosis of Crohn’s disease. Operation in Crohn’s disease within the same admission was associated with a history of smoking, temperature >38˚, high pulse >100, leukocytosis (>11x10E9 and obstruction on abdominal scan, while operation in patients without Crohn’s in the sentinel admission, was associated with temperature >38˚, tachycardia, leukocytosis (>11x10E9 and previous operation. Confirmation of these predictive patterns in a validation group could help in clinical decisions regarding therapeutic options in an emergency setting.

  16. Surgical treatment of bowel occlusion as late radiation effect

    International Nuclear Information System (INIS)

    Moeschl, P.; Miholic, J.; Wolner, E.

    1989-01-01

    67 patients were operated for intestinal complications following radiotherapy. The lesions were located in the small bowel (n = 41) and in the sigmoid colon/rectum (n = 33). 98.5% of the patients were females, the most frequent cause for irradiation being ovarian cancer. Bowel stenosis with resultant chronic or acute ileus was the most frequent indication for operation. Percutaneous irradiation resulted in a significantly higher proportion of small bowel lesions (77%, p = 0.001), whilst endocavitary irradiation was followed in 67% of cases by colorectal lesions. Different application modality of irradiation also resulted in completely different symptoms for small and large bowel lesions. The operative mortality was 9.5%. Peritonitis following anastomotic leakage was the cause of death in 6 of 7 cases. In the treatment of small bowel ileus mortality following bowel resection (9%, one of 11 cases) was comparable to that of the bypass operation (6%, one of 18 cases). Both operation methods seem to be justified. Single-layer anastomosis resulted in zero mortality (21 cases) for ileus operation compared with 19% mortality (16 cases) in double-layer anastomosis and should be prefered for operations on the irradiated bowel. (author)

  17. Spectral analysis of bowel sounds in intestinal obstruction using an electronic stethoscope.

    Science.gov (United States)

    Ching, Siok Siong; Tan, Yih Kai

    2012-09-07

    To determine the value of bowel sounds analysis using an electronic stethoscope to support a clinical diagnosis of intestinal obstruction. Subjects were patients who presented with a diagnosis of possible intestinal obstruction based on symptoms, signs, and radiological findings. A 3M™ Littmann(®) Model 4100 electronic stethoscope was used in this study. With the patients lying supine, six 8-second recordings of bowel sounds were taken from each patient from the lower abdomen. The recordings were analysed for sound duration, sound-to-sound interval, dominant frequency, and peak frequency. Clinical and radiological data were reviewed and the patients were classified as having either acute, subacute, or no bowel obstruction. Comparison of bowel sound characteristics was made between these subgroups of patients. In the presence of an obstruction, the site of obstruction was identified and bowel calibre was also measured to correlate with bowel sounds. A total of 71 patients were studied during the period July 2009 to January 2011. Forty patients had acute bowel obstruction (27 small bowel obstruction and 13 large bowel obstruction), 11 had subacute bowel obstruction (eight in the small bowel and three in large bowel) and 20 had no bowel obstruction (diagnoses of other conditions were made). Twenty-five patients received surgical intervention (35.2%) during the same admission for acute abdominal conditions. A total of 426 recordings were made and 420 recordings were used for analysis. There was no significant difference in sound-to-sound interval, dominant frequency, and peak frequency among patients with acute bowel obstruction, subacute bowel obstruction, and no bowel obstruction. In acute large bowel obstruction, the sound duration was significantly longer (median 0.81 s vs 0.55 s, P = 0.021) and the dominant frequency was significantly higher (median 440 Hz vs 288 Hz, P = 0.003) when compared to acute small bowel obstruction. No significant difference was seen

  18. Spontaneous transmesenteric hernia: a rare cause of small bowel obstruction in an adult

    Directory of Open Access Journals (Sweden)

    Poras Chaudhary

    2013-02-01

    Full Text Available The authors report a case of spontaneous transmesenteric hernia with strangulation in an adult. Transmesenteric hernia (TMH is a rare cause of small bowel obstruction and is seldom diagnosed preoperatively, and most TMHs in adults are related to predisposing factors, such as previous surgery, abdominal trauma, and peritonitis. TMH are more likely to develop volvulus and strangulation or ischemia. A brief review of etiology, clinical features, diagnosis, and treatment is discussed.

  19. Arterial hypertension due to fructose ingestion: model based on intermittent osmotic fluid trapping in the small bowel

    Directory of Open Access Journals (Sweden)

    Kurbel Sven

    2010-06-01

    Full Text Available Abstract Based on recently reported data that fructose ingestion is linked to arterial hypertension, a model of regulatory loops involving the colon role in maintenance of fluid and sodium homeostasis is proposed. In normal digestion of hyperosmolar fluids, also in cases of postprandial hypotension and in patients having the "dumping" syndrome after gastric surgery, any hyperosmolar intestinal content is diluted by water taken from circulation and being trapped in the bowel until reabsorption. High fructose corn sirup (HFCS soft drinks are among common hyperosmolar drinks. Fructose is slowly absorbed through passive carrier-mediated facilitated diffusion, along the entire small bowel, thus preventing absorption of the trapped water for several hours. Here presented interpretation is that ingestion of hyperosmolar HFCS drinks due to a transient fluid shift into the small bowel increases renin secretion and sympathetic activity, leading to rise in ADH and aldosterone secretions. Their actions spare water and sodium in the large bowel and kidneys. Alteration of colon absorption due to hormone exposure depends on cell renewal and takes days to develop, so the momentary capacity of sodium absorption in the colon depends on the average aldosterone and ADH exposure during few previous days. This inertia in modulation of the colon function can make an individual that often takes HFCS drinks prone to sodium retention, until a new balance is reached with an expanded ECF pool and arterial hypertension. In individuals with impaired fructose absorption, even a higher risk of arterial hypertension can be expected.

  20. [Estimation of small intestinal bacterial overgrowth in patients with constipation and diarrhea irritable bowel syndrome].

    Science.gov (United States)

    Łokieć, Katarzyna; Klupińska, Grazyna; Walecka-Kapica, Ewa; Błońska, Aleksandra

    2014-05-01

    Irritable bowel syndrome (IBS) is one of the most common reason for gastroenterology consultations. The diverse in symptomatology of the disease comes from its rich etiopathogenesis. Recently studies talk about infectious etiology of IBS and because of that it is necessary to expand its diagnostics by small intestinal bacterial overgrowth (SIBO) test. The aim of this study was to evaluate the prevalence of small intestinal bacterial overgrowth in patients with constipation (IBS-C) and diarrhea (IBS-D) irritable bowel syndrome with regard to nutrition. The study involved 46 subjects (33 women and 13 men) in average age of 44 years, which were divided into two groups: diarrhea and constipation IBS. All patients underwent hydrogen breath test studying bacterial overgrowth in the small intestine. In addition, each person had fulfilled a feeding questionnaire. Student's t-test, Pearson test. It has been shown that there is no statistical significances between the prevalence of SIBO in form of diarrheal IBS and constipation IBS and gender. Average value of increments of hydrogen in breath during the test was higher in IBS-C in comparison with IBS-D, which was the highest in the intestine bacterial overgrowth in patients with IBS-C. STATISTICAL ANALYSIS showed that there is no relationship between the type and frequency of consumption of milk, meat, fruit and vegetables, sweets and coffee and the prevalence of SIBO in form of diarrhea and constipation IBS. The occurrence of constipation or diarrhea irritable bowel syndrome is not related to gender. SIBO is more common in patients with IBS-C than in IBS-D group. There is no relationship between the type of food consumed and the amount of SIBO in people with IBS. Type of food intake do not affect the status of the intestinal flora of people with IBS.

  1. [Leiomyoma of the small bowel with hypercalcaemia: presence of a substance with parathormone activity (author's transl)].

    Science.gov (United States)

    Rathaus, M; Bernheim, J L; Griffel, B; Bernheim, J; Taragan, R; Gutman, A

    1979-10-22

    A leiomyoma of the small bowel produced laboratory features of hyperparathyroidism which disappeared promptly after tumour resection. Hypercalcaemia, hypophosphatemia, hyperchloremia, elevated chloride/phosphorus ratio, increased urinary cyclic AMP, and blood levels of immunoreactive parathormone were present. Electron microscopy showed dense round granules in the tumour cells.

  2. Small bowel adenocarcinoma copy number profiles are more closely related to colorectal than to gastric cancers

    NARCIS (Netherlands)

    Haan, J.C.; Buffart, T.E.; Eijk, P.P.; van de Wiel, M.A.; van Wieringen, W.N.; Howdle, P.D.; Mulder, C.J.J.; van de Velde, CJ; Quirke, P.; Nagtegaal, I.D.; van Grieken, N.C.T.; Grabsch, H.; Meijer, G.A.; Ylstra, B.

    2012-01-01

    Background: Small bowel adenocarcinoma (SBA) is a rare cancer and consequently, the options for clinical trials are limited. As they are treated according to either a colorectal or a gastric cancer regimen and the molecular biology of a tumor is a pivotal determinant for therapy response,

  3. Small bowel adenocarcinoma copy number profiles are more closely related to colorectal than to gastric cancers.

    NARCIS (Netherlands)

    Haan, J.C.; Buffart, T.E.; Eijk, P.P.; Wiel, M.A. van de; Wieringen, W.N. van; Howdle, P.D.; Mulder, C.J.; Velde, C.J. van de; Quirke, P.; Nagtegaal, I.D.; Grieken, N.C. van; Grabsch, H.; Meijer, G.A.; Ylstra, B.

    2012-01-01

    BACKGROUND: Small bowel adenocarcinoma (SBA) is a rare cancer and consequently, the options for clinical trials are limited. As they are treated according to either a colorectal or a gastric cancer regimen and the molecular biology of a tumor is a pivotal determinant for therapy response,

  4. Treatment with a belly-board device significantly reduces the volume of small bowel irradiated and results in low acute toxicity in adjuvant radiotherapy for gynecologic cancer: results of a prospective study

    International Nuclear Information System (INIS)

    Martin, Joseph; Fitzpatrick, Kathryn; Horan, Gail; McCloy, Roisin; Buckney, Steve; O'Neill, Louise; Faul, Clare

    2005-01-01

    Background and purpose: To determine whether treatment prone on a belly-board significantly reduces the volume of small bowel irradiated in women receiving adjuvant radiotherapy for gynecologic cancer, and to prospectively study acute small bowel toxicity using an accepted recording instrument. Material and methods: Thirty-two gynecologic patients underwent simulation with CT scanning supine and prone. Small bowel was delineated on every CT slice, and treatment was prone on the belly-board using 3-5 fields-typically Anterior, Right and Left Lateral, plus or minus Lateral Boosts. Median prescribed dose was 50.4 Gy and all treatments were delivered in 1.8 Gy fractions. Concomitant Cisplatin was administered in 13 patients with cervical carcinoma. Comparison of small bowel dose-volumes was made between supine and prone, with each subject acting as their own matched pair. Acute small bowel toxicity was prospectively measured using the Common Toxicity Criteria: Version 2.0. Results: Treatment prone on the belly-board significantly reduced the volume of small bowel receiving ≥100; ≥95; ≥90; and ≥80% of the prescribed dose, but not ≥50%. This was found whether volume was defined in cubic centimeters or % of total small bowel volume. Of 29 evaluable subjects, 2 (7%) experienced 1 episode each of grade 3 diarrhoea. All other toxicity events were grade 2 or less and comprised diarrhoea (59%), abdominal pain or cramping (48%), nausea (38%), anorexia (17%), vomiting (10%). There were no Grade 4 events and no treatment days were lost due to toxicity. Conclusions: Treatment prone on a belly-board device results in significant small bowel sparing, during adjuvant radiotherapy for gynecologic cancer. The absence of Grade 4 events or Treatment Days Lost compares favorably with the published literature

  5. Chromium-51-EDTA and technetium-99m-DTPA excretion for assessment of small bowel Crohn's disease

    International Nuclear Information System (INIS)

    O'Morain, C.; Chervu, L.; Milstein, D.M.; Das, K.M.

    1984-01-01

    In the present study, 4 patients with radiologically documented Crohn's disease were given 100 μCi of Cr-51-EDTA and 5 mCi of Tc-99m-DTPA together orally in 10ml of water, and urine was collected during the following 24 hr period. Sequential imaging of the stomach and the GI tract was done with a LFOV gamma camera at 10 min intervals until the activity cleared the small bowel. The images failed to show any localization of the activity in any disease process and no extraintestinal accumulation site was observed scintigraphically. Mean 24 hr urinary excretion for Tc-99m-DTPA was 4.8 +- 2.6% comparable to that of Cr-51-EDTA in these patients. This study suggests that a comparable oral dose of Tc-99m-DTPA could be substituted for Cr-51-EDTA as a far more readily available agent for documenting small bowel Crohn's disease by quantitative assessment of its urinary excretion

  6. Ultrasonographic findings of the intestinal wall being changed by small bowel obstruction in rabbits: Correlation with histopathology

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Deok Ho; Lee, Dong Ho; Ko, Young Tae; Kim, Youn Wha [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1999-09-15

    To evaluate the change of the wall of obstructed small bowel loop on ultrasonography (US), the changes of pre- and post-obstructed segments were examined by using US and correlated with histopathologic findings. Small bowel loops of seven rabbits were caused to be obstructed by surgery. One of them was sacrificed after 12 hours, and six were after 24 hours. The bowel loop of about 10 cm in length was cut and removed from obstructed site for evaluation with US and correlation with histopathologic findings. One control was also included and correlated by the same way, without bowel obstruction. After US examination, the bowel loops were opened at the mesenteric border. They were mounted into hard paper, and put in a plastic pail filled with 2 liters of physiologic saline. The specimens were imaged with 10 MHz linear array transducer with high definition zoom. After sonographic examination, the specimens were fixed with 10% formalin solution and stained by hematoxylin-eosin. The segments of small bowel showed three layers on US, which were hyperechoic, hypoechoic, and hyperechoic from the mucosal surface. The total thickness of the pre-obstructed segments was 1.65 {+-} 0.15 mm, and of post-obstructed was 1.62 {+-} 0.14 mm; there was no significant difference (p>0.05). The ratio of the second hypoechoic layer to total thickness was 23% at pre-obstructed segments, 17% at post-obstructed, and 7% at the control. Under microscopic examination, the total thickness of the pre-obstructed segments were measured as 0.95 {+-} 0.12 mm, and that of the post-obstructed was measured as 0.9{+-} 0.11 mm; there was no significant difference (p>0.05). The total thickness on US was about 0.7 mm thicker than in microscopic findings, so considering the ratio of each layers, the first hyperechoic and the second hypoechoic layers were assumed to be mucosal layer, and the third hyperechoic layer was assumed to be submucosal and muscle layers. Histopathologic findings of both pre- and post

  7. Laparoscopy in small bowel obstruction - current status - review.

    Science.gov (United States)

    Szeliga, Jacek; Jackowski, Marek

    2017-12-01

    Acute small bowel obstruction (SBO) is an urgent medical condition. Its diagnosis is based mainly on a clinical examination followed by confirmatory simple routine radiological examinations such as plain X-ray of the abdominal cavity or computed tomography (CT). However, a real surgical challenge is not a decision whether to perform a surgery, but a decision when and how to perform it. To determine the place of laparoscopy in contemporary management of acute SBO based on the current literature. A review of the literature based on the Medline database and including mainly the period of 2013-2017 was performed. With regard to SBO, laparoscopy is a technique showing its advantages resulting from a minimally invasive approach. However, SBO is still a condition where the use of laparoscopy is limited mainly to selected cases such as SBO caused by single adhesions or foreign bodies. A basic limitation of using this technique is advanced and complicated SBO and lack of sufficient technical skills of the surgeon.

  8. Comparison of upper gastrointestinal radiographic findings to histopathologic observations: a retrospective study of 41 dogs and cats with suspected small bowel infiltrative disease (1985 to 1990)

    International Nuclear Information System (INIS)

    Weichselbaum, R.C.; Feeney, D.A.; Hayden, D.W.

    1994-01-01

    It was the intent of this study to define which, if any, radiographic observations corresponded with specific causes of diffuse infiltrative small bowel disease and if radiographic findings could differentiate inflammatory disease from neoplastic disease and either of them from normal. Bowel spasticity, luminal narrowing, and thumb printing tend to indicate the presence of tumor more often than inflammatory disease. Increased bowel gas in cats and barium adhesion in dogs and cats suggest that a component of enteritis is present. Decreased bowel gas in dogs is more often associated with obstructive disease, but is not helpful in differentiating diffuse inflammatory disease from diffuse neoplastic disease. While several observations that can foster differentiation of neoplastic from inflammatory disease were found, this study also indicated that the UGI lacks a high degree of predictive value other than to indicate the presence of infiltrative small bowel disease

  9. Consolidating duodenal and small bowel toxicity data via isoeffective dose calculations based on compiled clinical data.

    Science.gov (United States)

    Prior, Phillip; Tai, An; Erickson, Beth; Li, X Allen

    2014-01-01

    To consolidate duodenum and small bowel toxicity data from clinical studies with different dose fractionation schedules using the modified linear quadratic (MLQ) model. A methodology of adjusting the dose-volume (D,v) parameters to different levels of normal tissue complication probability (NTCP) was presented. A set of NTCP model parameters for duodenum toxicity were estimated by the χ(2) fitting method using literature-based tolerance dose and generalized equivalent uniform dose (gEUD) data. These model parameters were then used to convert (D,v) data into the isoeffective dose in 2 Gy per fraction, (D(MLQED2),v) and convert these parameters to an isoeffective dose at another NTCP (D(MLQED2'),v). The literature search yielded 5 reports useful in making estimates of duodenum and small bowel toxicity. The NTCP model parameters were found to be TD50(1)(model) = 60.9 ± 7.9 Gy, m = 0.21 ± 0.05, and δ = 0.09 ± 0.03 Gy(-1). Isoeffective dose calculations and toxicity rates associated with hypofractionated radiation therapy reports were found to be consistent with clinical data having different fractionation schedules. Values of (D(MLQED2'),v) between different NTCP levels remain consistent over a range of 5%-20%. MLQ-based isoeffective calculations of dose-response data corresponding to grade ≥2 duodenum toxicity were found to be consistent with one another within the calculation uncertainty. The (D(MLQED2),v) data could be used to determine duodenum and small bowel dose-volume constraints for new dose escalation strategies. Copyright © 2014 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  10. Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease

    International Nuclear Information System (INIS)

    Rosenbaum, Daniel G.; Conrad, Maire A.; Kelsen, Judith R.; Biko, David M.; Anupindi, Sudha A.; Ruchelli, Eduardo D.

    2017-01-01

    Imaging predictors for surgery in children with Crohn disease are lacking. To identify imaging features of the terminal ileum on short-interval bowel ultrasound (US) and MR enterography (MRE) in children with Crohn disease requiring surgical bowel resection and those managed by medical therapy alone. This retrospective study evaluated patients 18 years and younger with Crohn disease undergoing short-interval bowel US and MRE (within 2 months of one another), as well as subsequent ileocecectomy or endoscopy within 3 months of imaging. Appearance of the terminal ileum on both modalities was compared between surgical patients and those managed with medical therapy, with the following parameters assessed: bowel wall thickness, mural stratification, vascularity, fibrofatty proliferation, abscess, fistula and stricture on bowel US; bowel wall thickness, T2 ratio, enhancement pattern, mesenteric edema, fibrofatty proliferation, abscess, fistula and stricture on MRE. A two-sided t-test was used to compare means, a Mann-Whitney U analysis was used for non-parametric parameter scores, and a chi-square or two-sided Fisher exact test compared categorical variables. Imaging findings in surgical patients were correlated with location-matched histopathological scores of inflammation and fibrosis using a scoring system adapted from the Simple Endoscopic Score for Crohn Disease, and a Spearman rank correlation coefficient was used to compare inflammation and fibrosis on histopathology. Twenty-two surgical patients (mean age: 16.5 years; male/female: 13/9) and 20 nonsurgical patients (mean age: 14.8; M/F: 8/12) were included in the final analysis. On US, the surgical group demonstrated significantly increased mean bowel wall thickness (6.1 mm vs. 4.7 mm for the nonsurgical group; P = 0.01), loss of mural stratification (odds ratio [OR] = 6.3; 95% confidence interval [CI]: 1.4-28.4; P = 0.02) and increased fibrofatty proliferation (P = 0.04). On MRE, the surgical group showed

  11. Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Rosenbaum, Daniel G. [NewYork-Presbyterian Hospital/Weill Cornell Medicine, Division of Pediatric Radiology, New York, NY (United States); Conrad, Maire A.; Kelsen, Judith R. [The Children' s Hospital of Philadelphia, Division of Gastroenterology, Hepatology and Nutrition, Philadelphia, PA (United States); Biko, David M.; Anupindi, Sudha A. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Ruchelli, Eduardo D. [The Children' s Hospital of Philadelphia, Division of Anatomic Pathology, Philadelphia, PA (United States)

    2017-01-15

    Imaging predictors for surgery in children with Crohn disease are lacking. To identify imaging features of the terminal ileum on short-interval bowel ultrasound (US) and MR enterography (MRE) in children with Crohn disease requiring surgical bowel resection and those managed by medical therapy alone. This retrospective study evaluated patients 18 years and younger with Crohn disease undergoing short-interval bowel US and MRE (within 2 months of one another), as well as subsequent ileocecectomy or endoscopy within 3 months of imaging. Appearance of the terminal ileum on both modalities was compared between surgical patients and those managed with medical therapy, with the following parameters assessed: bowel wall thickness, mural stratification, vascularity, fibrofatty proliferation, abscess, fistula and stricture on bowel US; bowel wall thickness, T2 ratio, enhancement pattern, mesenteric edema, fibrofatty proliferation, abscess, fistula and stricture on MRE. A two-sided t-test was used to compare means, a Mann-Whitney U analysis was used for non-parametric parameter scores, and a chi-square or two-sided Fisher exact test compared categorical variables. Imaging findings in surgical patients were correlated with location-matched histopathological scores of inflammation and fibrosis using a scoring system adapted from the Simple Endoscopic Score for Crohn Disease, and a Spearman rank correlation coefficient was used to compare inflammation and fibrosis on histopathology. Twenty-two surgical patients (mean age: 16.5 years; male/female: 13/9) and 20 nonsurgical patients (mean age: 14.8; M/F: 8/12) were included in the final analysis. On US, the surgical group demonstrated significantly increased mean bowel wall thickness (6.1 mm vs. 4.7 mm for the nonsurgical group; P = 0.01), loss of mural stratification (odds ratio [OR] = 6.3; 95% confidence interval [CI]: 1.4-28.4; P = 0.02) and increased fibrofatty proliferation (P = 0.04). On MRE, the surgical group showed

  12. Diagnostic evaluation of chronic inflammatory intestinal diseases in children and adolescents: MRI with true-FISP as new gold standard?

    International Nuclear Information System (INIS)

    Hohl, C.; Haage, P.; Krombach, G.A.; Schmidt, T.; Guenther, R.W.; Staatz, G.; Ahaus, M.

    2005-01-01

    Purpose: to evaluate the impact of magnetic resonance imaging (MRI) with use of True-FISP sequences in the evaluation of inflammatory bowel-wall changes in children and adolescents with Crohn's disease. Furthermore, the diagnostic procedure in children and adolescents with chronic inflammatory bowel disease (IBD) will be discussed in light of the relevant literature. Material and methods: twenty-four children and adolescents aged between 7 and 21 years with suspected or known IBD underwent MRI on a 1.5T-scanner (Philips ACS-NT, Best, Netherlands). One hour after 11 of a 2.5% mannitol solution was given orally, MR imaging was performed using coronal HASTE-M2D, coronal fat-suppressed T2-TSE, axial dynamic T1-weighted GE-sequences before and after i.v.-contrast material injection (0.1 mmol/kg Gd-DTPA) and using a 2D-balanced-FFE-sequence (True-FISP) before and after i.v.-contrast material injection in coronal and axial planes. The MR-images were correlated with endoscopy and the clinical findings. In 14 patients, a recently performed conventional radiographic enteroclysis was available. Each performed MRI sequence was evaluated by three experienced radiologists regarding the sensitivity and specificity of each sequence in the detection of inflammatory bowel wall changes. In addition, the image quality was assessed regarding the different tissue contrasts and the susceptibility to artifacts. The distension of the bowel wall and the patients' acceptance of the MRI examination were recorded. Results: with a sensitivity in detecting inflammatory small bowel changes of 93.3% (axial pre-contrast, coronal post-contrast) and 100% (axial post-contrast, coronal pre-contrast), the True-FISP outnumbers the other performed sequences (T1 = 80%, HASTE = 13.3% and T2-TSE = 53.3%). The difference between True-FISP and contrast-enhanced T1 was not statistically significant, whereas the difference between True-FISP and HASTE and T2-TSE, respectively. (orig.)

  13. Magnetic resonance imaging biomarkers of gastrointestinal motor function and fluid distribution

    Institute of Scientific and Technical Information of China (English)

    Asseel; Khalaf; Caroline; L; Hoad; Robin; C; Spiller; Penny; A; Gowland; Gordon; W; Moran; Luca; Marciani

    2015-01-01

    Magnetic resonance imaging(MRI) is a well established technique that has revolutionized diagnostic radiology. Until recently, the impact that MRI has had in the assessment of gastrointestinal motor function and bowel fluid distribution in health and in disease has been more limited, despite the novel insights that MRI can provide along the entire gastrointestinal tract. MRI biomarkers include intestinal motility indices, small bowel water content and whole gut transit time. The present review discusses new developments and applications of MRI in the upper gastrointestinal tract, the small bowel and the colon reported in the literature in the last 5 years.

  14. An unusual case of herniation of small bowel through an iatrogenic defect of the falciform ligament

    International Nuclear Information System (INIS)

    Sourtzis, S.; Canizares, C.; Damry, N.; Thibeau, J.F.; Philippart, P.

    2002-01-01

    Internal herniation through a congenital defect in the falciform ligament is extremely rare. We report an unusual observation of small bowel obstruction through an iatrogenic defect of the falciform ligament. Prompt diagnosis was made by helical CT, permitting a rapid surgical procedure to preserve the viability of the obstructed segment. (orig.)

  15. Small-bowel obstruction secondary to bezoar impaction: a diagnostic dilemma.

    Science.gov (United States)

    Ho, Thomas W; Koh, Dean C

    2007-05-01

    Gastrointestinal bezoar (GIB) is uncommon and is reported to occur in 4% of all admissions for small-bowel obstruction (SBO). Because of a lack of diagnostic features, it is often associated with a delay in treatment, with increased morbidity. In this article, we report our experience with managing bezoar-induced SBO and the role of early computed tomography (CT) imaging in establishing the diagnosis. We retrospectively reviewed all cases of bezoar-induced SBO treated in our unit between 1999 and 2005. There were 43 patients, of whom 2 had a recurrence, giving a total of 45 episodes. The frequency of bezoar in our patients presenting with SBO was 4.3%. All patients were of Asian origin: 41 Chinese, 1 Indian, and 1 Malay. Twenty-eight (65%) patients had previous abdominal surgery of which 26 were gastric surgery. Thirty-eight (88%) patients were edentulous. Forty-one (91%) underwent serial abdominal radiography, whereas only 4 patients (9%) had either CT imaging or contrast study alone. Only 11 (24%) cases had a correct diagnosis of bezoar impaction made preoperatively by CT imaging. The diagnostic accuracy of CT imaging in our series was 65%, with six cases of misdiagnosis. Overall, CT led to a change in management of 76% (13 in 17). The median time to surgery from admission was 2 (0-10) days. There were 2 cases of ischemic bowel that necessitated bowel resection. The median length of hospital stay was 11 (5-100) days. Ten patients (22%) had postoperative complications, and there was one death. Bezoar-induced SBO is uncommon and remains a diagnostic and management challenge. It should be suspected in patients with an increased risk of formation of GIB, such as previous gastric surgery, poor dentition, and a suggestive history of increased fibre intake. We advocate that CT imaging be performed early in these at-risk patients and in patients presenting with SBO with or without a history of abdominal surgery in order to reduce unnecessary delays before appropriate

  16. An unusual cause of small bowel obstruction: Gossypiboma – case report

    Directory of Open Access Journals (Sweden)

    Inceoglu Resit

    2003-09-01

    Full Text Available Abstract Background The term "gossypiboma" denotes a mass of cotton that is retained in the body following surgery. Gossypiboma is a medico-legal problem especially for surgeons. To the best of our knowledge, the patient presented herein is the second reported patient in whom the exact site of migration of a retained surgical textile material into the intestinal lumen could be demonstrated by preoperative imaging studies. Case presentation A 74-year-old woman presented with symptoms of small bowel obstruction due to incomplete intraluminal migration of a laparotomy towel 3 years after open cholecystectomy and umbilical hernia repair. Plain abdominal radiography did not show any sign of a radio-opaque marker in the abdomen. However, contrast enhanced abdominal computerized tomography revealed a round, well-defined soft-tissue mass with a dense, enhanced wall, containing an internal high-density area with air-bubbles in the mid-abdomen. A fistula between the abscess cavity containing the suspicious mass and gastrointestinal tract was identified by upper gastrointestinal series. The presence of a foreign body was considered. It was surgically removed with a partial small bowel resection followed by anastomosis. Conclusions Although gossypiboma is rarely seen in daily clinical practice, it should be considered in the differential diagnosis of acute mechanical intestinal obstruction in patients who underwent laparotomy previously. The best approach in the prevention of this condition can be achieved by meticulous count of surgical materials in addition to thorough exploration of surgical site at the conclusion of operations and also by routine use of surgical textile materials impregnated with a radio-opaque marker.

  17. Fetal MRI clues to diagnose cloacal malformations

    Energy Technology Data Exchange (ETDEWEB)

    Calvo-Garcia, Maria A.; Kline-Fath, Beth M.; Patel, Manish N.; Kraus, Steven [Cincinnati Children' s Hospital Medical Center, Department of Radiology, MLC 5031, Cincinnati, OH (United States); Levitt, Marc A.; Pena, Alberto [Cincinnati Children' s Hospital Medical Center, Colorectal Center for Children, Pediatric Surgery, Cincinnati, OH (United States); Lim, Foong-Yen; Crombleholme, Timothy M. [Cincinnati Children' s Hospital Medical Center, Fetal Care Center of Cincinnati, Pediatric Surgery, Cincinnati, OH (United States); Linam, Leann E. [Arkansas Children' s Hospital, Department of Radiology, Little Rock, AR (United States)

    2011-09-15

    Prenatal US detection of cloacal malformations is challenging and rarely confirms this diagnosis. To define the prenatal MRI findings in cloacal malformations. We performed a retrospective study of patients with cloacal malformations who had pre- and post-natal assessment at our institution. Fetal MRI was obtained in six singleton pregnancies between 26 and 32 weeks of gestation. Imaging analysis was focused on the distal bowel, the urinary system and the genital tract and compared with postnatal clinical, radiological and surgical diagnoses. The distal bowel was dilated and did not extend below the bladder in five fetuses. They had a long common cloacal channel (3.5-6 cm) and a rectum located over the bladder base. Only one fetus with a posterior cloacal variant had a normal rectum. Three fetuses had increased T2 signal in the bowel and two increased T1/decreased T2 signal bladder content. All had renal anomalies, four had abnormal bladders and two had hydrocolpos. Assessment of the anorectal signal and pelvic anatomy during the third trimester helps to detect cloacal malformations in the fetus. The specificity for this diagnosis was highly increased when bowel fluid or bladder meconium content was identified. (orig.)

  18. Small bowel volvulus in pregnancy with associated superior mesenteric artery occlusion.

    Science.gov (United States)

    Esterson, Yonah B; Villani, Robert; Dela Cruz, Ronald A; Friedman, Barak; Grimaldi, Gregory M

    Here we report the case of a pregnant 28-year-old who presented with acute upper abdominal pain. CT demonstrated midgut volvulus with short segment occlusion of the superior mesenteric artery (SMA). Emergent detorsion of the small bowel was performed, at which time underlying intestinal malrotation was discovered. Following detorsion, the SMA had a bounding pulse and did not require thrombectomy or revascularization. Fewer than 25 cases of midgut volvulus during pregnancy have been reported over the past 20years. To our knowledge, this is the first report of maternal midgut volvulus in which imaging captures the resultant occlusion of the SMA. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease.

    Science.gov (United States)

    Rosenbaum, Daniel G; Conrad, Maire A; Biko, David M; Ruchelli, Eduardo D; Kelsen, Judith R; Anupindi, Sudha A

    2017-01-01

    Imaging predictors for surgery in children with Crohn disease are lacking. To identify imaging features of the terminal ileum on short-interval bowel ultrasound (US) and MR enterography (MRE) in children with Crohn disease requiring surgical bowel resection and those managed by medical therapy alone. This retrospective study evaluated patients 18 years and younger with Crohn disease undergoing short-interval bowel US and MRE (within 2 months of one another), as well as subsequent ileocecectomy or endoscopy within 3 months of imaging. Appearance of the terminal ileum on both modalities was compared between surgical patients and those managed with medical therapy, with the following parameters assessed: bowel wall thickness, mural stratification, vascularity, fibrofatty proliferation, abscess, fistula and stricture on bowel US; bowel wall thickness, T2 ratio, enhancement pattern, mesenteric edema, fibrofatty proliferation, abscess, fistula and stricture on MRE. A two-sided t-test was used to compare means, a Mann-Whitney U analysis was used for non-parametric parameter scores, and a chi-square or two-sided Fisher exact test compared categorical variables. Imaging findings in surgical patients were correlated with location-matched histopathological scores of inflammation and fibrosis using a scoring system adapted from the Simple Endoscopic Score for Crohn Disease, and a Spearman rank correlation coefficient was used to compare inflammation and fibrosis on histopathology. Twenty-two surgical patients (mean age: 16.5 years; male/female: 13/9) and 20 nonsurgical patients (mean age: 14.8; M/F: 8/12) were included in the final analysis. On US, the surgical group demonstrated significantly increased mean bowel wall thickness (6.1 mm vs. 4.7 mm for the nonsurgical group; P = 0.01), loss of mural stratification (odds ratio [OR] = 6.3; 95% confidence interval [CI]: 1.4-28.4; P = 0.02) and increased fibrofatty proliferation (P = 0.04). On MRE, the

  20. Modified temporary end-to-side portocaval shunt in liver and small bowel transplantation.

    Science.gov (United States)

    Molmenti, E P; Marsh, J W; Molmenti, H; Reyes, J; Fung, J J

    2001-10-01

    Piggyback orthotopic liver transplantation (LTx) has permitted the elimination of extra-corporeal venovenous bypass. In some instances, an internal temporary portocaval shunt has to be constructed in order to prevent hemodynamic instability. We describe a technique in which a donor iliac vein graft is used to bridge the distance between the portal vein and vena cava in cases where a direct shunt cannot be constructed. This technique can be applied to liver Tx as well as to liver and small bowel Tx.

  1. Oral traditional Chinese medication for adhesive small bowel obstruction.

    Science.gov (United States)

    Suo, Tao; Gu, Xixi; Andersson, Roland; Ma, Huaixing; Zhang, Wei; Deng, Wei; Zhang, Boheng; Cai, Dingfang; Qin, Xinyu

    2012-05-16

    Small bowel obstruction (SBO) is one of the most common emergent complications of general surgery. Intra-abdominal adhesions are the leading cause of SBO. Because surgery can induce new adhesions, non-operative management is preferred in the absence of signs of peritonitis or strangulation. Oral traditional Chinese herbal medicine has long been used as a non-operative therapy to treat adhesive SBO in China. Many controlled trials have been conducted to investigate its therapeutic value in resolving adhesive SBO. The aim of this review was to assess the efficacy and safety of oral traditional Chinese medicine (TCM) for adhesive small bowel obstruction. We searched the following databases, without regard to language or publishing restrictions: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Chinese Biomedical Database (CBM), China National Knowledge Infrastructure/Chinese Academic Journals full-text Database (CNKI), and VIP (a full-text database of Chinese journals). The searches were conducted in November 2011. Randomised controlled trials and quasi-randomised controlled trials comparing Chinese medicines administered orally, via the gastric canal, or both with a placebo or conventional therapy in participants diagnosed with adhesive SBO were considered. We also considered trials of TCM (oral administration, gastric tube perfusion, or both) plus conventional therapy compared with conventional therapy alone for patients with adhesive SBO. Studies addressing the safety and efficacy of oral traditional Chinese medicinal agents in the treatment of adhesive SBO were also considered. Two authors collected the data independently. We assessed the risk of bias according to the following methodological criteria: random sequence generation, allocation concealment, blinding, incomplete outcome data, selective outcome reporting and other sources of bias. Dichotomous data are presented as risk ratios (OR) and 95% confidence intervals (CI

  2. Short bowel syndrome.

    LENUS (Irish Health Repository)

    Donohoe, Claire L

    2012-02-01

    The short bowel syndrome (SBS) is a state of malabsorption following intestinal resection where there is less than 200 cm of intestinal length. The management of short bowel syndrome can be challenging and is best managed by a specialised multidisciplinary team. A good understanding of the pathophysiological consequences of resection of different portions of the small intestine is necessary to anticipate and prevent, where possible, consequences of SBS. Nutrient absorption and fluid and electrolyte management in the initial stages are critical to stabilisation of the patient and to facilitate the process of adaptation. Pharmacological adjuncts to promote adaptation are in the early stages of development. Primary restoration of bowel continuity, if possible, is the principle mode of surgical treatment. Surgical procedures to increase the surface area of the small intestine or improve its function may be of benefit in experienced hands, particularly in the paediatric population. Intestinal transplant is indicated at present for patients who have failed to tolerate long-term parenteral nutrition but with increasing experience, there may be a potentially expanded role for its use in the future.

  3. Efficacy of an absorbable mesh in keeping the small bowel out of the human pelvis following surgery

    International Nuclear Information System (INIS)

    Devereux, D.F.; Chandler, J.J.; Eisenstat, T.; Zinkin, L.

    1988-01-01

    Patients with pelvic malignancies frequently require postoperative radiation therapy either as adjunctive or palliative treatment. Tumoricidal doses, however, are frequently associated with small-bowel damage. Animal experiments demonstrated tolerance to high-dose radiation therapy and protection from radiation enteritis by use of an absorbable polymer polyglycolic acid (PGA) that is used as an intestinal sling to elevate the small bowel away from the operated site. Sixty patients (42 with rectal carcinomas and 18 with gynecologic malignancies) underwent surgical treatment that included the intestinal sling procedure. Postoperative radiation was begun within three weeks following surgery and patients received a mean approximating 5500 rads in fractionated doses. A mean follow-up time of 28 months has not revealed a single case of radiation enteritis (by either contrast studies or physiologic studies) or PGA mesh-related complications. The authors believe that this surgical technique should be employed in patients who may require postoperative radiation treatment for pelvic malignancy

  4. Ultrasonographic findings of the intestinal wall being changed by small bowel obstruction in rabbits: Correlation with histopathology

    International Nuclear Information System (INIS)

    Nam, Deok Ho; Lee, Dong Ho; Ko, Young Tae; Kim, Youn Wha

    1999-01-01

    To evaluate the change of the wall of obstructed small bowel loop on ultrasonography (US), the changes of pre- and post-obstructed segments were examined by using US and correlated with histopathologic findings. Small bowel loops of seven rabbits were caused to be obstructed by surgery. One of them was sacrificed after 12 hours, and six were after 24 hours. The bowel loop of about 10 cm in length was cut and removed from obstructed site for evaluation with US and correlation with histopathologic findings. One control was also included and correlated by the same way, without bowel obstruction. After US examination, the bowel loops were opened at the mesenteric border. They were mounted into hard paper, and put in a plastic pail filled with 2 liters of physiologic saline. The specimens were imaged with 10 MHz linear array transducer with high definition zoom. After sonographic examination, the specimens were fixed with 10% formalin solution and stained by hematoxylin-eosin. The segments of small bowel showed three layers on US, which were hyperechoic, hypoechoic, and hyperechoic from the mucosal surface. The total thickness of the pre-obstructed segments was 1.65 ± 0.15 mm, and of post-obstructed was 1.62 ± 0.14 mm; there was no significant difference (p>0.05). The ratio of the second hypoechoic layer to total thickness was 23% at pre-obstructed segments, 17% at post-obstructed, and 7% at the control. Under microscopic examination, the total thickness of the pre-obstructed segments were measured as 0.95 ± 0.12 mm, and that of the post-obstructed was measured as 0.9± 0.11 mm; there was no significant difference (p>0.05). The total thickness on US was about 0.7 mm thicker than in microscopic findings, so considering the ratio of each layers, the first hyperechoic and the second hypoechoic layers were assumed to be mucosal layer, and the third hyperechoic layer was assumed to be submucosal and muscle layers. Histopathologic findings of both pre- and post

  5. Penetrating ectopic peptic ulcer in the absence of Meckel's diverticulum ultimately presenting as small bowel obstruction.

    LENUS (Irish Health Repository)

    Hurley, Hilary

    2012-02-03

    We report here how a heterotopic penetrating peptic ulcer progressed to cause small bowel obstruction in a patient with multiple previous negative investigations. The clinical presentation, radiographic features and pathological findings of this case are described, along with the salient lessons learnt. The added value of wireless capsule endoscopy (WCE) in such circumstances is debated.

  6. The stepchild of intestinal diagnostics. Evaluation of radiological methods to diagnose leiomyomas of the small bowel

    International Nuclear Information System (INIS)

    Keberle, M.; Wittenberg, G.; Jenett, M.; Hahn, D.; Mueller, J.G.

    1998-01-01

    Purpose: Various radiological methods to diagnose small bowel neoplasmas and problems of differential diagnosis specially considerating leiomyomas are discussed. Patients and methods: Two patients with leiomyoma of the ileum underwent enteroclysis, computed tomography of the abdomen, intra-arterial DSA and colour Doppler sonography. Another patient with leiomyosarcoma just underwent CT of the abdomen with CT-guided biopsy. Results: Due to the homogenous density and the smooth surface of the tumors in computed tomography and respectively enteroclysis and the presentation of the tumor vascularisation in the angiography and Colour Doppler sonography in both patients a leiomyoma of the small bowel was diagnosed. Postoperatively this diagnosis was histologically confirmed. The CT-findings of the patient with leiomyosarcoma were not suspicious of a malignant tumor. Conclusion: Radiologically it is not possible to determine the dignity of smooth muscle cell tumors safely. That is the reason why the diagnosis has to be achieved operatively. But the histopathological diagnosis based on the mitotic rate may be difficult. Therefore the after care has to be carried out thoroughly. (orig.) [de

  7. Small Bowel Perforation due to Gossypiboma Caused Acute Abdomen

    Directory of Open Access Journals (Sweden)

    Tahsin Colak

    2013-01-01

    Full Text Available Gossypiboma, an infrequent surgical complication, is a mass lesion due to a retained surgical sponge surrounded by foreign body reaction. In this case report, we describe gossypiboma in the abdominal cavity which was detected 14 months after the hysterectomy due to acute abdominal pain. Gossypiboma was diagnosed by computed tomography (CT. The CT findings were a rounded mass with a dense central part and an enhancing wall. In explorative laparotomy, small bowel loops were seen to be perforated due to inflammation of long standing gossypiboma. Jejunal resection with end-to-end anastomosis was performed. The patient was discharged whithout complication. This case was presented to point to retained foreign body (RFB complications and we believed that the possibility of a retained foreign body should be considered in the differential diagnosis of who had previous surgery and complained of pain, infection, or palpable mass.

  8. Computed tomography to detect body packing: an unusual cause of small bowel obstruction

    International Nuclear Information System (INIS)

    Brown, J.A.; Phang, T.; Enns, R.; Butchart, M.K.; Filipenko, J.D.; Mason, A.C.; Cooperberg, P.I.

    2002-01-01

    Concealment of illicit drugs within the alimentary tract is now an established method used by both smugglers and traffickers to evade detection by authorities. Those who ingest wrapped packets of drugs to transport them across international borders are known as 'body packers,' whereas those who ingest packages of drugs upon an unexpected encounter with law enforcement agents are known as 'body stuffers' or 'quick swallowers. Although most of these individuals require no medical care, acute drug toxicity (from inadvertent leaking of contents or rupture of the drug packet) and bowel obstruction are recognized hazards of drug packet ingestion. The detection of these packets is a challenge to custom officials and police interested in preventing the import and trafficking of illegal drugs, as well as to physicians who have to treat individuals who have ingested them. We report a case of a 38-year-old intravenous drug abuser who presented with an acute small bowel obstruction secondary to an impacted intraluminal heroin balloon in the mid jejunum. The value of computed tomography (CT) in the patient's diagnostic evaluation is highlighted. (author)

  9. Small bowel obstruction in percutaneous fixation of traumatic pelvic fractures

    Directory of Open Access Journals (Sweden)

    Roberto Bini

    2013-01-01

    Full Text Available The use of external fixation for the initial treatment of unstable, complex pelvic injuries with hemodynamic instability remains an effective treatment for multiply injured patients. Bowel entrapment within a pelvic fracture is a rarely reported, potentially fatal complication. Here, we report a polytrauma patient with pelvic fractures who developed an intestinal obstruction after an external fixation. At an explorative laparotomy, we found an ileum segment trapped in the sacral fracture. Reported cases of bowel entrapment in pelvic fractures, especially in sacral fractures, are exceedingly rare. The diagnosis is often delayed due to difficulty distinguishing entrapment from the more common adynamic ileus. In conclusion, clinicians and radiologists should be aware of this potentially lethal complication of pelvic fractures treatment. To exclude bowel entrapment, patients with persistent ileus or sepsis should undergo early investigations.

  10. Colonic carcinoma with multiple small bowel perforations mimicking intestinal obstruction

    Directory of Open Access Journals (Sweden)

    Khanna Rahul

    2006-09-01

    Full Text Available Abstract Background Carcinoma of the colon may present with perforation proximal to the site of malignancy. Caecum is the commonest site of perforation if the ileocecal valve is patent and the jejunal and ileal perforations are very rare. Case presentation A 35 year male presented with intestinal obstruction. Emergency laparotomy revealed carcinoma of the transverse colon with multiple pinpoint perforations along antimesenteric border of ileum, which were wrapped with omentum, and no peritoneal contamination was present. Extended right hemicolectomy with jejunocolic anastomosis was done. Patient made uneventful recovery in postoperative period and was treated with adjuvant chemotherapy. Conclusion Patients with colonic carcinoma and incompetent ileocecal valve may present with intestinal perforation. Increased intraluminal pressure and closed loop obstruction may lead to ischemia and perforation of the small bowel.

  11. Small Bowel Adenocarcinoma Complicating Coeliac Disease: A Report of Three Cases and the Literature Review

    Directory of Open Access Journals (Sweden)

    Hafida Benhammane

    2012-01-01

    Full Text Available Coeliac disease is associated with an increased risk of malignancy, not only of intestinal lymphoma but also of small intestinal adenocarcinoma which is 82 times more common in patients with celiac disease than in the normal population. We report three additional cases of a small bowel adenocarcinoma in the setting of coeliac disease in order to underline the epidemiological features, clinicopathological findings, and therapeutic approaches of this entity based on a review of the literature. The three patients underwent a surgical treatment followed by adjuvant chemotherapy based on capecitabine/oxaliplatin regimen, and they have well recovered.

  12. Mucosal pathobiology and molecular signature of epithelial barrier dysfunction in the small intestine in irritable bowel syndrome.

    Science.gov (United States)

    González-Castro, Ana M; Martínez, Cristina; Salvo-Romero, Eloísa; Fortea, Marina; Pardo-Camacho, Cristina; Pérez-Berezo, Teresa; Alonso-Cotoner, Carmen; Santos, Javier; Vicario, María

    2017-01-01

    Irritable bowel syndrome (IBS) is one of the most prevalent gastrointestinal disorders in developed countries. Its etiology remains unknown; however, a common finding, regardless of IBS subtype, is the presence of altered intestinal barrier. In fact, signaling and location of cell-to-cell adhesion proteins, in connection with increased immune activity, seem abnormal in the intestinal epithelium of IBS patients. Despite that most research is performed on distal segments of the intestine, altered permeability has been reported in both, the small and the large bowel of all IBS subtypes. The small intestine carries out digestion and nutrient absorption and is also the site where the majority of immune responses to luminal antigens takes place. In fact, the upper intestine is more exposed to environmental antigens than the colon and is also a site of symptom generation. Recent studies have revealed small intestinal structural alterations of the epithelial barrier and mucosal immune activation in association with intestinal dysfunction, suggesting the commitment of the intestine as a whole in the pathogenesis of IBS. This review summarizes the most recent findings on mucosal barrier alterations and its relationship to symptoms arising from the small intestine in IBS, including epithelial structural abnormalities, mucosal immune activation, and microbial dysbiosis, further supporting the hypothesis of an organic origin of IBS. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  13. GLP-1 and GLP-2 act in concert to inhibit fasted, but not fed, small bowel motility in the rat

    DEFF Research Database (Denmark)

    Bozkurt, Ayhan; Näslund, Erik; Holst, Jens Juul

    2002-01-01

    Small bowel motility was studied in rats at increasing (1-20 pmol/kg/min) intravenous doses of either glucagon-like peptide-1 (GLP-1) or glucagon-like peptide-2 (GLP-2) alone, or in combination in the fasted and fed state. There was a dose-dependent inhibitory action of GLP-1 on the migrating myo...... demonstrates an additive effect of peripheral administration of GLP-1 and GLP-2 on fasted small bowel motility. In the fed state, GLP-1 and GLP-2 seem to display counter-balancing effects on motility of the small intestine....... myoelectric complex (MMC), where the dose of 5 pmol/kg/min induced an increased MMC cycle length. No effect was seen with GLP-2 alone, but the combination of GLP-1 and GLP-2 induced a more pronounced inhibitory effect, with significant increase of the MMC cycle length from a dose of 2 pmol/kg/min. During fed...

  14. Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer: Investigating dose-volume relationships and role for inverse planning

    International Nuclear Information System (INIS)

    Tho, Lye Mun; Glegg, Martin; Paterson, Jennifer; Yap, Christina; MacLeod, Alice; McCabe, Marie; McDonald, Alexander C.

    2006-01-01

    Purpose: The relationship between volume of irradiated small bowel (VSB) and acute toxicity in rectal cancer radiotherapy is poorly quantified, particularly in patients receiving concurrent preoperative chemoradiotherapy. Using treatment planning data, we studied a series of such patients. Methods and Materials: Details of 41 patients with locally advanced rectal cancer were reviewed. All received 45 Gy in 25 fractions over 5 weeks, 3-4 fields three-dimensional conformal radiotherapy with daily 5-fluorouracil and folinic acid during Weeks 1 and 5. Toxicity was assessed prospectively in a weekly clinic. Using computed tomography planning software, the VSB was determined at 5 Gy dose intervals (V 5 , V 1 , etc.). Eight patients with maximal VSB had dosimetry and radiobiological modeling outcomes compared between inverse and conformal three-dimensional planning. Results: VSB correlated strongly with diarrheal severity at every dose level (p 5 and V 15 . Conclusions: A strong dose-volume relationship exists between VSB and acute diarrhea at all dose levels during preoperative chemoradiotherapy. Our constructed model may be useful in predicting toxicity, and this has been derived without the confounding influence of surgical excision on bowel function. Inverse planning can reduce calculated dose to small bowel and late NTCP, and its clinical role warrants further investigation

  15. Small intestinal bacterial overgrowth in irritable bowel syndrome: are there any predictors?

    Directory of Open Access Journals (Sweden)

    McCallum Richard W

    2010-02-01

    Full Text Available Abstract Background Small intestinal bacterial overgrowth (SIBO is a condition in which excessive levels of bacteria, mainly the colonic-type species are present in the small intestine. Recent data suggest that SIBO may contribute to the pathophysiology of Irritable bowel syndrome (IBS. The purpose of this study was to identify potential predictors of SIBO in patients with IBS. Methods Adults with IBS based on Rome II criteria who had predominance of bloating and flatulence underwent a glucose breath test (GBT to determine the presence of SIBO. Breath samples were obtained at baseline and at 30, 45, 60, 75 and 90 minutes after ingestion of 50 g of glucose dissolved in 150 mL of water. Results of the glucose breath test, which measures hydrogen and methane levels in the breath, were considered positive for SIBO if 1 the hydrogen or methane peak was >20 ppm when the baseline was Results Ninety-eight patients were identified who underwent a GBT (mean age, 49 y; 78% female. Thirty-five patients (36% had a positive GBT result suggestive of SIBO. A positive GBT result was more likely in patients >55 years of age (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.4-9.0 and in females (OR, 4.0; 95% CI, 1.1-14.5. Hydrogen was detected more frequently in patients with diarrhea-predominant IBS (OR, 8; 95% CI, 1.4-45, and methane was the main gas detected in patients with constipation-predominant IBS (OR, 8; 95% CI, 1.3-44. There was no significant correlation between the presence of SIBO and the predominant bowel pattern or concurrent use of tegaserod, proton pump inhibitors, or opiate analgesics. Conclusions Small intestinal bacterial overgrowth was present in a sizeable percentage of patients with IBS with predominance of bloating and flatulence. Older age and female sex were predictors of SIBO in patients with IBS. Identification of possible predictors of SIBO in patients with IBS could aid in the development of successful treatment plans.

  16. The capsule endoscopy "suspected blood indicator" (SBI) for detection of active small bowel bleeding: no active bleeding in case of negative SBI.

    Science.gov (United States)

    Tal, Andrea Oliver; Filmann, Natalie; Makhlin, Konstantin; Hausmann, Johannes; Friedrich-Rust, Mireen; Herrmann, Eva; Zeuzem, Stefan; Albert, Jörg G

    2014-09-01

    Capsule endoscopy (CE) is the gold standard to diagnose small bowel bleeding. The "suspected blood indicator" (SBI) offers an automated detection of active small bowel bleeding but validity of this technique is unknown. The objective was to analyze specificity and sensitivity of the SBI using the second small bowel capsule generation for the detection of active bleeding. This is a retrospective analysis of all patients (199) who attended our clinic for CE from June 2008 through March 2013. The second-generation PillCam SB 2 capsule was used for detection of (1) luminal blood content and (2) potentially responsible small bowel lesions. The findings of an independent investigator were correlated to SBI findings and a number of SBI markings were analyzed by a receiver operating characteristic (ROC). In 157/199 cases, no sign of active bleeding or altered blood was detected. One hundred and thirty-seven of these 157 cases provided at least one SBI marking and a mean of 18.4 positive SBI markings per record were found. In 20 cases, neither SBI nor the human investigator detected abnormalities. Thirteen patients showed investigator-detected minor bleeding with mean SBI findings of 36 positive screenshots per record. When major bleeding was diagnosed by the investigator (n = 29), SBI detected a mean of 46.6 SBI-positive markings. SBI turned positive in 179 patients, whereas the investigator detected active bleeding in 42 cases. All patients with active bleeding were detected by SBI (sensitivity 100%, specificity 13%). ROC analysis revealed 51.0 SBI markings being the optimal cutoff for active versus no bleeding (sensitivity 79.1%, specificity 90.4%, misclassification of 15.3%). The new SBI software is a reliable tool to exclude active bleeding and/or major lesions but analysis of the CE video by a trained investigator is still important for the detection of lesions responsible for past bleeding.

  17. Computed tomography to detect body packing: an unusual cause of small bowel obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Brown, J.A. [St. Paul' s Hospital, Dept. of Radiology, Vancouver, British Columbia (Canada); Phang, T. [St. Paul' s Hospital, Dept. of Surgery, Vancouver, British Columbia (Canada); Enns, R. [St. Paul' s Hospital, Div. of Gastroenterology, Dept. of Internal Medicine, Vancouver, British Columbia (Canada); Butchart, M.K. [St. Paul' s Hospital, Dept. of Radiology, Vancouver, British Columbia (Canada); Filipenko, J.D. [St. Paul' s Hospital, Dept. of Pathology, Vancouver, British Columbia (Canada); Mason, A.C.; Cooperberg, P.I. [St. Paul' s Hospital, Dept. of Radiology, Vancouver, British Columbia (Canada)

    2002-04-01

    Concealment of illicit drugs within the alimentary tract is now an established method used by both smugglers and traffickers to evade detection by authorities. Those who ingest wrapped packets of drugs to transport them across international borders are known as 'body packers,' whereas those who ingest packages of drugs upon an unexpected encounter with law enforcement agents are known as 'body stuffers' or 'quick swallowers. Although most of these individuals require no medical care, acute drug toxicity (from inadvertent leaking of contents or rupture of the drug packet) and bowel obstruction are recognized hazards of drug packet ingestion. The detection of these packets is a challenge to custom officials and police interested in preventing the import and trafficking of illegal drugs, as well as to physicians who have to treat individuals who have ingested them. We report a case of a 38-year-old intravenous drug abuser who presented with an acute small bowel obstruction secondary to an impacted intraluminal heroin balloon in the mid jejunum. The value of computed tomography (CT) in the patient's diagnostic evaluation is highlighted. (author)

  18. Emergency department patients with small bowel obstruction: What is the anticipated clinical course?

    Institute of Scientific and Technical Information of China (English)

    Sarah E Frasure; Amy Hildreth; Sukhjit Takhar; Michael B Stone

    2016-01-01

    BACKGROUND:Emergency physicians(EPs)often care for patients with acute small bowel obstruction.While some patients require exploratory laparotomy,others are managed successfully with supportive care.We aimed to determine features that predict the need for operative management in emergency department(ED)patients with small bowel obstruction(SBO).METHODS:We performed a retrospective chart review of 370 consecutive patients admitted to a large urban academic teaching hospital with a diagnosis of SBO over a two-year period.We evaluated demographic characters(prior SBO,prior abdominal surgery,active malignancy)and clinical findings(leukocytosis and lactic acid)to determine features associated with the need for urgent operative intervention.RESULTS:Patients with a prior SBO were less likely to undergo operative intervention[20.3%(42/207)]compared to those without a prior SBO[35.2%(57/162)].Abnormal bloodwork was not associated with need for operative intervention.68%of patients with CT scan findings of both an SBO and a hernia,however,were operatively managed.CONCLUSIONS:Patients with a history of SBO were less likely to require operative intervention at any point during their hospitalization.Abnormal bloodwork was not associated with operative intervention.The CT finding of a hernia,however,predicted the need for operative intervention,while other findings(ascites,duodenal thickening)did not.Further research would be helpful to construct a prediction rule,which could help community EPs determine which patients may benefit from expedited transfer for operative management,and which patients could be safely managed conservatively as an initial treatment strategy.

  19. Usefulness of intestinal fatty acid-binding protein in predicting strangulated small bowel obstruction.

    Directory of Open Access Journals (Sweden)

    Hirotada Kittaka

    Full Text Available BACKGROUND: The level of intestinal fatty acid-binding protein (I-FABP is considered to be useful diagnostic markers of small bowel ischemia. The purpose of this retrospective study was to investigate whether the serum I-FABP level is a predictive marker of strangulation in patients with small bowel obstruction (SBO. METHODS: A total of 37 patients diagnosed with SBO were included in this study. The serum I-FABP levels were retrospectively compared between the patients with strangulation and those with simple obstruction, and cut-off values for the diagnosis of strangulation were calculated using a receiver operating characteristic curve. In addition, the sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV were calculated. RESULTS: Twenty-one patients were diagnosed with strangulated SBO. The serum I-FABP levels were significantly higher in the patients with strangulation compared with those observed in the patients with simple obstruction (18.5 vs. 1.6 ng/ml p<0.001. Using a cut-off value of 6.5 ng/ml, the sensitivity, specificity, PPV and NPV were 71.4%, 93.8%, 93.8% and 71.4%, respectively. An I-FABP level greater than 6.5 ng/ml was found to be the only independent significant factor for a higher likelihood of strangulated SBO (P =  0.02; odds ratio: 19.826; 95% confidence interval: 2.1560 - 488.300. CONCLUSIONS: The I-FABP level is a useful marker for discriminating between strangulated SBO and simple SBO in patients with SBO.

  20. Consensus guidelines for the use of bowel preparation prior to colonic diagnostic procedures: colonoscopy and small bowel video capsule endoscopy

    NARCIS (Netherlands)

    Mathus-Vliegen, Elisabeth; Pellisé, Maria; Heresbach, Denis; Fischbach, Wolfgang; Dixon, Tricia; Belsey, Jonathan; Parente, Fabrizio; Rio-Tinto, Ricardo; Brown, Alistair; Toth, Ervin; Crosta, Cristiano; Layer, Peter; Epstein, Owen; Boustiere, Christian

    2013-01-01

    Adequate bowel preparation prior to colonic diagnostic procedures is essential to ensure adequate visualisation. This consensus aims to provide guidance as to the appropriate use of bowel preparation for a range of defined clinical circumstances. A consensus group from across Europe was convened and

  1. Migration of eroded laparoscopic adjustable gastric band causing small bowel obstruction and perforation.

    Science.gov (United States)

    Abeysekera, Ashvini; Lee, Jerry; Ghosh, Simon; Hacking, Craig

    2017-05-12

    We present an unusual and rare complication caused by gastric band erosion into the stomach after band placement 15 years ago. The complication was only picked up after the band had subsequently migrated from the stomach at the site of erosion, to the distal ileum causing acute small bowel obstruction and focal perforation requiring emergency laparotomy.Abdominal pain in patients with gastric band should always be treated as serious until proven otherwise. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Enhancement pattern of small hepatic hemangioma: findings on multiphase spiral CT and dynamic MRI

    International Nuclear Information System (INIS)

    Choi, Byung In; Lee, Seung Koo; Kim, Myeong Jin; Chung, Jae Joon; Yoo, Hyung Sik; Lee, Jong Tae

    1999-01-01

    To compare the enhancement characteristics of small hemangiomas seen on multiphase spiral CT and dynamic MR imaging. Thirteen patients with 20 hepatic hemangiomas less than 25mm in diameter underwent both multiphase spiral CT and dynamic MR imaging. All lesions were assigned to one of three classified into 3 categories according to the enhancement pattern seen on multiphase spiral CT : typical delayed pooling, atypical early enhancement, or continuous low attenuation. The enhancement patterns seen on spiral CT and on dynamic MRI were correlated. On CT scans, ten lesions (50%) showed delayed pooling. Six (30%) showed early arterial enhancement and four (20%) showed continuous low attenuation. On delayed-phase MRI, all lesions showed delayed high signal intensity compared to adjacent liver parenchyma. Four of six lesions with early enhancement on CT showed peripheral globular enhancement on early arterial-phase MRI. On multiphase spiral CT scans, small hemangiomas can show variable atypical enhancement features. In this situation, contrast-enhanced dynamic MRI is helpful for the diagnosis of hemangiomas

  3. Evaluation of bowel distension and bowel wall visualization according to patient positions during administration of oral contrast media for CT enterography.

    Science.gov (United States)

    Lee, Seul Bi; Kim, Seung Ho; Son, Jung Hee; Baik, Ji Yeon

    2017-12-01

    To compare small bowel distension and bowel wall visualization among three different patients' positions (supine, sitting and right decubitus) during administration of oral contrast media in preparation for CT enterography (CTE). A total of 150 consecutive patients (104 males and 46 females; mean age 34.6 years, range 15-78 years) who were scheduled to undergo CTE were recruited. Patients were randomly allocated into the three position groups during oral contrast media administration, and there were 50 patients in each group. Two blinded radiologists independently scored the luminal distension and visualization of the bowel wall using a continuous 5-point scale (1: worst and 5: best) at the jejunum and ileum. The Mann-Whitney U test was used to evaluate differences between any two groups among the three positions for bowel distension and wall visualization. For ileal distension, the supine and sitting positions performed better than the right decubitus position [for reader 1, mean: 3.4/3.2/2.9 (hereafter, supine/sitting/right decubitus in order), p = 0.002/0.033; for reader 2, 3.3/3.0/2.6, p 0.05, respectively). For bowel wall visualization, the supine and sitting positions were superior to the right decubitus position for the ileum when scored by one reader (4.0/3.8/3.4, p = 0.001/0.015). Supine and sitting positions during the administration of oral contrast media provided better ileal distension than the right decubitus position in obtaining CTE. Advances in knowledge: The performance of CTE largely depends on adequate luminal distension and wall visualization. As the terminal ileum is the predominant site of small bowel pathology for inflammatory bowel disease, the supine or sitting position would be preferable for patients who are suspected of having small bowel pathology.

  4. Small-bowel absorption of D-tagatose and related effects on carbohydrate digestibility: an ileostomy study.

    Science.gov (United States)

    Normén, L; Laerke, H N; Jensen, B B; Langkilde, A M; Andersson, H

    2001-01-01

    The ketohexose D-tagatose is a new sweetener with a low energy content. This low energy content may be due to either low absorption of the D-tagatose or decreased absorption of other nutrients. The aims of this study were to measure the excretion of D-tagatose from the human small bowel, to calculate the apparent absorption of D-tagatose, and to study the effects of D-tagatose on the small-bowel excretion of other carbohydrates. A controlled diet was served for 2 periods of 2 d during 3 consecutive weeks to 6 ileostomy subjects. In one of the periods, 15 g D-tagatose was added to the diet daily. Duplicate portions of the diet and ileostomy effluents were freeze-dried and analyzed to calculate the apparent net absorption of D-tagatose and carbohydrates. Median D-tagatose excretion was 19% (range: 12-31%), which corresponded to a calculated apparent absorption of 81% (69-88%). Of the total amount of D-tagatose excreted [2.8 g (1.7-4.4 g)], 60% (8-88%) was excreted within 3 h. Between 3 and 5 h, 32% (11-82%) was excreted. Excretion of wet matter increased by 41% (24-52%) with D-tagatose ingestion. Sucrose and D-glucose excretion increased to a small extent, whereas no significant changes were found in the excretion of dry matter, energy, starch, or D-fructose. The apparent absorption of 15 g D-tagatose/d was 81%. D-Tagatose had only a minor influence on the apparent absorption of other nutrients.

  5. Small bowel entrapment and ureteropelvic junction disruption associated with L3 Chance fracture-dislocation

    Science.gov (United States)

    Pesenti, Sebastien; Blondel, Benjamin; Faure, Alice; Peltier, Emilie; Launay, Franck; Jouve, Jean-Luc

    2016-01-01

    Paediatric Chance fracture are rare lesions but often associated with abdominal injuries. We herein present the case of a seven years old patient who sustained an entrapment of small bowel and an ureteropelvic disruption associated with a Chance fracture and spine dislocation following a traffic accident. Initial X-rays and computed tomographic (CT) scan showed a Chance fracture with dislocation of L3 vertebra, with an incarceration of a small bowel loop in the spinal canal and a complete section of the left lumbar ureter. Paraplegia was noticed on the initial neurological examination. A posterior L2-L4 osteosynthesis was performed firstly. In a second time she underwent a sus umbilical laparotomy to release the incarcerated jejunum loop in the spinal canal. An end-to-end anastomosis was performed on a JJ probe to suture the left injured ureter. One month after the traumatism, she started to complain of severe headaches related to a leakage of cerebrospinalis fluid. Three months after the traumatism there was a clear regression of the leakage. One year after the trauma, an anterior intervertebral fusion was done. At final follow-up, no neurologic recovery was noticed. In case of Chance fracture, all physicians should think about abdominal injuries even if the patient is asymptomatic. Initial abdominal CT scan and magnetic resonance imaging provide in such case crucial info for management of the spine and the associated lesions. PMID:27672641

  6. Recurrent intestinal volvulus in midgut malrotation causing acute bowel obstruction: A case report.

    Science.gov (United States)

    Sheikh, Fayed; Balarajah, Vickna; Ayantunde, Abraham Abiodun

    2013-03-27

    Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd's procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality.

  7. Primary small bowel adenocarcinoma: current view on clinical features, risk and prognostic factors, treatment and outcome.

    Science.gov (United States)

    Lech, Gustaw; Korcz, Wojciech; Kowalczyk, Emilia; Słotwiński, Robert; Słodkowski, Maciej

    2017-11-01

    Small bowel adenocarcinoma (SBA) is a rare but increasing cause of gastrointestinal malignancy, being both a diagnostic and therapeutic challenge. The goal of treatment is margin negative resection of a lesion and local lymphadenectomy, followed by modern adjuvant chemotherapy combinations in selected cases. Improved outcomes in patients with SBA are encouraging, but elucidation of mechanisms of carcinogenesis and risk factors as well as improved treatment for this malignancy is very needed.

  8. The Different Volume Effects of Small-Bowel Toxicity During Pelvic Irradiation Between Gynecologic Patients With and Without Abdominal Surgery: A Prospective Study With Computed Tomography-Based Dosimetry

    International Nuclear Information System (INIS)

    Huang, E.-Y.; Sung, C.-C.; Ko, S.-F.; Wang, C.-J.; Yang, Kuender D.

    2007-01-01

    Purpose: To evaluate the effect of abdominal surgery on the volume effects of small-bowel toxicity during whole-pelvic irradiation in patients with gynecologic malignancies. Methods and Materials: From May 2003 through November 2006, 80 gynecologic patients without (Group I) or with (Group II) prior abdominal surgery were analyzed. We used a computed tomography (CT) planning system to measure the small-bowel volume and dosimetry. We acquired the range of small-bowel volume in 10% (V10) to 100% (V100) of dose, at 10% intervals. The onset and grade of diarrhea during whole-pelvic irradiation were recorded as small-bowel toxicity up to 39.6 Gy in 22 fractions. Results: The volume effect of Grade 2-3 diarrhea existed from V10 to V100 in Group I patients and from V60 to V100 in Group II patients on univariate analyses. The V40 of Group I and the V100 of Group II achieved most statistical significance. The mean V40 was 281 ± 27 cm 3 and 489 ± 34 cm 3 (p 3 and 132 ± 19 cm 3 (p = 0.003). Multivariate analyses revealed that V40 (p = 0.001) and V100 (p = 0.027) were independent factors for the development of Grade 2-3 diarrhea in Groups I and II, respectively. Conclusions: Gynecologic patients without and with abdominal surgery have different volume effects on small-bowel toxicity during whole-pelvic irradiation. Low-dose volume can be used as a predictive index of Grade 2 or greater diarrhea in patients without abdominal surgery. Full-dose volume is more important than low-dose volume for Grade 2 or greater diarrhea in patients with abdominal surgery

  9. Clinico-Pathological Profile and Management of Acute Mechanical Small Bowel Obstruction: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Tahir Saleem Khan

    2013-06-01

    Conclusion: Abdominal pain and distention of the abdomen are the most common symptoms and physical findings in patients presenting with acute mechanical small bowel obstruction (SBO. Worm (ascaridial obstruction is the most common cause of obstruction followed by postoperative adhesions. Although all patients were managed conservatively to start with, the operative rate in our series remained very high because it is very difficult to distinguish simple from strangulation obstruction on clinical, biochemical and/or radiological grounds with certainty. [Arch Clin Exp Surg 2013; 2(3.000: 154-160

  10. Primary intestinal lymphangiectasia successfully treated by segmental resections of small bowel.

    Science.gov (United States)

    Kim, Na Rae; Lee, Suk-Koo; Suh, Yeon-Lim

    2009-10-01

    Primary intestinal lymphangiectasia is a rare cause of protein-losing enteropathy and usually presents with intermittent diarrhea or malnutrition. Diagnosis depends largely on its pathologic condition demonstrating greatly dilated lymphatics mainly in the lamina propria of the mucosa. We report a case of primary intestinal lymphangiectasia, of the diffuse type, presenting with abdominal pain and voluminous diarrhea in a previously healthy 8-year-old boy. He had periumbilical pain for 3 months before presentation. He was managed by segmental bowel resections and end-to-end anastomoses. The histopathologic condition of the resected small intestine showed lymphatic dilation limited mainly to the subserosa and mesentery but was not prominent in the mucosa. Abdominal pain and diarrhea subsided postoperatively. The present case is the fourth report describing a response to operative resection.

  11. Comparative study of diffusion weighted imaging and dynamic contrast enhanced MRI for the detection of small breast cancers

    International Nuclear Information System (INIS)

    Tang Jianhua; Yan Fuhua; Zhou Meiling; Ye Fang; Xu Pengju

    2008-01-01

    Objective: To compare the sensitivity of diffusion weighted imaging (DWI) with dynamic contrast enhanced (DCE) MRI for the detection of small breast cancers and to evaluate the clinical value of DWI. Methods: Forty-eight patients with benign (n=25) and malignant (n=45) small breast lesions (≤2 cm) proved by pathology underwent DWI and DCE MRI. The DCE MRI was performed using FLASH sequence and the time-signal intensity curve was drawn. The DWI was performed using GRAPPA- EPI sequence with different b values (800, 1000 s/mm 2 ) and the ADC values of lesions were measured. The sensitivity and specificity of DWI for the detection of small breast cancers were compared with DCE MRI. Results: Forty of 45 small breast cancers and 19 of 25 small benign breast lesions were correctly diagnosed using DCE MRI. The sensitivity and positive predictive value of TIC were 88.9% (40/45) and 87.0% (40/46). With b values of 800 s/mm 2 and 1000 s/mm 2 , the average ADC values of small breast cancers were (1.153±0.192) x 10 -3 and (1.079±0.186) x 10 -3 mm 2 /s, while those of benign ones were (1.473±0.252) x 10 -3 and (1.419 ± 0.255) x 10 -3 mm 2 /s, respectively. There was no significant difference for the ADC values with different b values in the same group (P>0.05), while there was a significant difference between the malignant and the benign lesions (P 2 . Both the sensitivity and positive predictive value of diagnosis were 86.7% (39/45). The abilities of DWI and DCE MRI for the diagnosis of small breast cancers were the same. The sensitivity (93.3%) and positive predictive value (91.3%) were improved with the combination of DCE MRI and DWI. Conclusion: DWI has a high sensitivity for the detection of small breast cancers, the ADC value can provide valuable information in the differential diagnosis. (authors)

  12. Revisiting a dogma: similar survival of patients with small bowel and gastric GIST. A population-based propensity score SEER analysis.

    Science.gov (United States)

    Guller, Ulrich; Tarantino, Ignazio; Cerny, Thomas; Ulrich, Alexis; Schmied, Bruno M; Warschkow, Rene

    2017-01-01

    The objective of the present analysis was to assess whether small bowel gastrointestinal stromal tumor (GIST) is associated with worse cancer-specific survival (CSS) and overall survival (OS) compared with gastric GIST on a population-based level. Data on patients aged 18 years or older with histologically proven GIST was extracted from the SEER database from 1998 to 2011. OS and CSS for small bowel GIST were compared with OS and CSS for gastric GIST by application of adjusted and unadjusted Cox regression analyses and propensity score analyses. GIST were located in the stomach (n = 3011, 59 %), duodenum (n = 313, 6 %), jejunum/ileum (n = 1288, 25 %), colon (n = 139, 3 %), rectum (n = 172, 3 %), and extraviscerally (n = 173, 3 %). OS and CSS of patients with GIST in the duodenum [OS, HR 0.95, 95 % confidence interval (CI) 0.76-1.19; CSS, HR 0.99, 95 % CI 0.76-1.29] and in the jejunum/ileum (OS, HR 0.97, 95 % CI 0.85-1.10; CSS, HR = 0.95, 95 % CI 0.81-1.10) were similar to those of patients with gastric GIST in multivariate analyses. Conversely, OS and CSS of patients with GIST in the colon (OS, HR 1.40; 95 % CI 1.07-1.83; CSS, HR 1.89, 95 % CI 1.41-2.54) and in an extravisceral location (OS, HR 1.42, 95 % CI 1.14-1.77; CSS, HR = 1.43, 95 % CI 1.11-1.84) were significantly worse than those of patients with gastric GIST. Contrary to common belief, OS and CSS of patients with small bowel GIST are not statistically different from those of patients with gastric GIST when adjustment is made for confounding variables on a population-based level. The prognosis of patients with nongastric GIST is worse because of a colonic and extravisceral GIST location. These findings have implications regarding adjuvant treatment of GIST patients. Hence, the dogma that small bowel GIST patients have worse prognosis than gastric GIST patients and therefore should receive adjuvant treatment to a greater extent must be revisited.

  13. Heterotaxy syndromes and abnormal bowel rotation

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley [Stanford University, Lucile Packard Children' s Hospital, Department of Radiology, Stanford, CA (United States); Koppolu, Raji; Sylvester, Karl [Lucile Packard Children' s Hospital at Stanford, Department of Surgery, Stanford, CA (United States); Murphy, Daniel [Lucile Packard Children' s Hospital at Stanford, Department of Cardiology, Stanford, CA (United States)

    2014-05-15

    Bowel rotation abnormalities in heterotaxy are common. As more children survive cardiac surgery, the management of gastrointestinal abnormalities has become controversial. To evaluate imaging of malrotation in heterotaxy with surgical correlation and provide an algorithm for management. Imaging reports of heterotaxic children with upper gastrointestinal (UGI) and/or small bowel follow-through (SBFT) were reviewed. Subsequently, fluoroscopic images were re-reviewed in conjunction with CT/MR studies. The original reports and re-reviewed images were compared and correlated with surgical findings. Nineteen of 34 children with heterotaxy underwent UGI, 13/19 also had SBFT. In 15/19 reports, bowel rotation was called abnormal: 11 malrotation, 4 non-rotation, no cases of volvulus. Re-review, including CT (10/19) and MR (2/19), designated 17/19 (90%) as abnormal, 10 malrotation (abnormal bowel arrangement, narrow or uncertain length of mesentery) and 7 non-rotation (small bowel and colon on opposite sides plus low cecum with probable broad mesentery). The most useful CT/MR findings were absence of retroperitoneal duodenum in most abnormal cases and location of bowel, especially cecum. Abnormal orientation of mesenteric vessels suggested malrotation but was not universal. Nine children had elective bowel surgery; non-rotation was found in 4/9 and malrotation was found in 5/9, with discrepancies (non-rotation at surgery, malrotation on imaging) with 4 original interpretations and 1 re-review. We recommend routine, early UGI and SBFT studies once other, urgent clinical concerns have been stabilized, with elective laparoscopic surgery in abnormal or equivocal cases. Cross-sectional imaging, usually obtained for other reasons, can contribute diagnostically. Attempting to assess mesenteric width is important in differentiating non-rotation from malrotation and more accurately identifies appropriate surgical candidates. (orig.)

  14. Heterotaxy syndromes and abnormal bowel rotation

    International Nuclear Information System (INIS)

    Newman, Beverley; Koppolu, Raji; Sylvester, Karl; Murphy, Daniel

    2014-01-01

    Bowel rotation abnormalities in heterotaxy are common. As more children survive cardiac surgery, the management of gastrointestinal abnormalities has become controversial. To evaluate imaging of malrotation in heterotaxy with surgical correlation and provide an algorithm for management. Imaging reports of heterotaxic children with upper gastrointestinal (UGI) and/or small bowel follow-through (SBFT) were reviewed. Subsequently, fluoroscopic images were re-reviewed in conjunction with CT/MR studies. The original reports and re-reviewed images were compared and correlated with surgical findings. Nineteen of 34 children with heterotaxy underwent UGI, 13/19 also had SBFT. In 15/19 reports, bowel rotation was called abnormal: 11 malrotation, 4 non-rotation, no cases of volvulus. Re-review, including CT (10/19) and MR (2/19), designated 17/19 (90%) as abnormal, 10 malrotation (abnormal bowel arrangement, narrow or uncertain length of mesentery) and 7 non-rotation (small bowel and colon on opposite sides plus low cecum with probable broad mesentery). The most useful CT/MR findings were absence of retroperitoneal duodenum in most abnormal cases and location of bowel, especially cecum. Abnormal orientation of mesenteric vessels suggested malrotation but was not universal. Nine children had elective bowel surgery; non-rotation was found in 4/9 and malrotation was found in 5/9, with discrepancies (non-rotation at surgery, malrotation on imaging) with 4 original interpretations and 1 re-review. We recommend routine, early UGI and SBFT studies once other, urgent clinical concerns have been stabilized, with elective laparoscopic surgery in abnormal or equivocal cases. Cross-sectional imaging, usually obtained for other reasons, can contribute diagnostically. Attempting to assess mesenteric width is important in differentiating non-rotation from malrotation and more accurately identifies appropriate surgical candidates. (orig.)

  15. Prenatal MRI evaluation of limb-body wall complex

    Energy Technology Data Exchange (ETDEWEB)

    Aguirre-Pascual, Elisa [Perelman School of Medicine at the University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Hospital Universitario Doce de Octubre, Department of Radiology, Madrid (Spain); Epelman, Monica [Perelman School of Medicine at the University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Nemours Children' s Hospital, Department of Medical Imaging, Orlando, FL (United States); Johnson, Ann M.; Chauvin, Nancy A.; Coleman, Beverly G.; Victoria, Teresa [Perelman School of Medicine at the University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States)

    2014-11-15

    The sonographic (US) features of limb-body wall complex have been well documented; however the literature regarding the findings on MRI in limb-body wall complex is scant. To characterize the prenatal MRI features of limb-body wall complex. We performed a retrospective review of all MRI scans of fetuses diagnosed with limb-body wall complex at our institution from 2001 to 2011. Fetuses without correlating US scans or follow-up information were excluded. Three pediatric radiologists blinded to the specific US findings reviewed the prenatal MRIs. Images were evaluated for the organ location and attachment, the body part affected, characterization of the body wall defect, and spinal, limb and umbilical cord abnormalities. Ten subjects met inclusion criteria. MRI was able to detect and characterize the body part affected and associated abnormalities. All fetuses had ventral wall defects, a small thorax and herniated liver and bowel. The kidneys were extracorporeal in three cases. The extruded organs were attached to the placenta or the uterine wall in all cases. Abnormal spinal curvatures of various degrees of severity were present in all cases. Eight cases had a short, uncoiled cord. Limb anomalies were present in 6 of the 10 cases. We illustrate the common fetal MRI findings of limb-body wall complex. The prenatal diagnosis of limb-body wall complex and the differentiation of this defect from treatable abdominal wall defects are crucial to providing appropriate guidance for patient counseling and management. (orig.)

  16. Management of perforated essure with migration into small and large bowel mesentery.

    Science.gov (United States)

    Braginsky, Lena; George, Sean T; Locher, Stephen R

    2015-01-01

    The Essure permanent birth control system (Conceptus Inc, San Carlos, CA) is currently the only Food and Drug Administration-approved hysteroscopic sterilization method and has been widely accepted as a safe and effective procedure. We present a rare case of tubal perforation, coil fragmentation, and distal migration into small and large bowel mesentery 8 days after the insertion of the Essure device. We describe the successful management of this complication using laparoscopy and intraoperative fluoroscopy. Providers using Essure must be aware of the possibility of fragmentation of the Essure coils. Intraoperative imaging, ideally fluoroscopy, should be strongly considered in the management of Essure migration to ensure localization and full retrieval of Essure material. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  17. Small bowel obstruction subsequent to Essure microinsert sterilization: a case report.

    Science.gov (United States)

    Belotte, Jimmy; Shavell, Valerie I; Awonuga, Awoniyi O; Diamond, Michael P; Berman, Jay M; Yancy, Amanda F

    2011-07-01

    To report a case of small bowel obstruction (SBO) subsequent to Essure microinsert sterilization. Case report. University teaching hospital. A 38-year-old woman, gravida 1, para 1, with a history of pelvic pain, vaginal spotting, nausea, vomiting, and constipation 1 month after Essure hysteroscopic sterilization. Radiologic investigation, including a computed tomography scan of the abdomen and pelvis, followed by operative laparoscopy. Alleviation of the SBO. Radiologic investigation suggested a distal SBO, with the left Essure microinsert noted in the left lower pelvis. These findings, including an inflamed appendix, were confirmed at operative laparoscopy. Lysis of adhesions, removal of the Essure microinsert, appendectomy, and left salpingectomy were performed. This case is reported to increase awareness that SBO is a potential complication of Essure microinsert placement. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  18. Microscopic polyangiitis: Atypical presentation with extensive small bowel necrosis, diffuse alveolar hemorrhage, and renal failure

    Directory of Open Access Journals (Sweden)

    Justin M. Segraves, M.D.

    2017-01-01

    Full Text Available Microscopic polyangiitis is an uncommon systemic vasculitis of varying severity that is associated with myeloperoxidase (MPO and perinuclear antineutrophil cytoplasmic (p-ANCA antibodies. The most commonly affected organs are the lungs and kidneys. We report on a very unusual case of microscopic polyangiitis presenting with severe mesenteric ischemia in addition to diffuse alveolar hemorrhage and acute renal failure. The patient was initially diagnosed with acute pancreatitis at an outside facility given his severe abdominal pain and elevated pancreatic enzymes. Further investigations after transfer to our facility determined that the patient was actually suffering from a severe exacerbation of previously diagnosed microscopic polyangiitis. He quickly developed diffuse alveolar hemorrhage (DAH necessitating intubation and acute kidney injury (AKI requiring dialysis. He subsequently developed mesenteric ischemia and bowel necrosis resulting in emergent laparotomy and extensive small bowel resection. Physicians need to be aware that microscopic polyangiitis can very rarely present with severe involvement of the abdominal viscera and mesenteric vessels. Severe disease necessitates the use of high dose IV steroids, rituximab or cyclophosphamide, and plasma exchange (PLEX.

  19. Microscopic polyangiitis: Atypical presentation with extensive small bowel necrosis, diffuse alveolar hemorrhage, and renal failure.

    Science.gov (United States)

    Segraves, Justin M; Iyer, Vivek N

    2017-01-01

    Microscopic polyangiitis is an uncommon systemic vasculitis of varying severity that is associated with myeloperoxidase (MPO) and perinuclear antineutrophil cytoplasmic (p-ANCA) antibodies. The most commonly affected organs are the lungs and kidneys. We report on a very unusual case of microscopic polyangiitis presenting with severe mesenteric ischemia in addition to diffuse alveolar hemorrhage and acute renal failure. The patient was initially diagnosed with acute pancreatitis at an outside facility given his severe abdominal pain and elevated pancreatic enzymes. Further investigations after transfer to our facility determined that the patient was actually suffering from a severe exacerbation of previously diagnosed microscopic polyangiitis. He quickly developed diffuse alveolar hemorrhage (DAH) necessitating intubation and acute kidney injury (AKI) requiring dialysis. He subsequently developed mesenteric ischemia and bowel necrosis resulting in emergent laparotomy and extensive small bowel resection. Physicians need to be aware that microscopic polyangiitis can very rarely present with severe involvement of the abdominal viscera and mesenteric vessels. Severe disease necessitates the use of high dose IV steroids, rituximab or cyclophosphamide, and plasma exchange (PLEX).

  20. Tc-99m sucralfate scanning for inflammatory bowel disease

    International Nuclear Information System (INIS)

    Lieberman, L.M.; Becker, S.; Mekhmandarov, S.; Steinmetz, A.

    1987-01-01

    The authors investigated 14 patients with idiopathic inflammatory bowel disease (IBD) by administering Tc-99m sucralfate (TcS) orally and imaging the abdomen 4 and 24 hours after dose. All patients had either barium radiographic studies or colonoscopy before the scan. The scan identified seven of nine patients who had radiologically demonstrated small-bowel lesions and four of five patients with colonic disease. The authors' preliminary experience suggests that TcS maybe a useful procedure to document location and extent of active disease. It provides information about both small and large bowel in one procedure, is noninvasive, easy to perform, and has low radiation absorbed dose

  1. Abnormal accumulation of intestinal fluid following ingestion of an unabsorbable carbohydrate in patients with irritable bowel syndrome: an MRI study.

    Science.gov (United States)

    Undseth, R; Berstad, A; Kløw, N-E; Arnljot, K; Moi, K S; Valeur, J

    2014-12-01

    Postprandial discomfort following intake of poorly absorbable, but fermentable carbohydrates is a common complaint in patients with irritable bowel syndrome (IBS). We used lactulose as a model substance for this group of symptom triggering carbohydrates, aiming to visualize the intestinal response in IBS patients compared to healthy controls. Patients with IBS according to Rome III criteria (n = 52) and healthy controls (n = 16) underwent a lactulose challenge test. By using magnetic resonance imaging, we measured small bowel water content (SBWC), and distension (diameter) of the distal ileum and the colon, both in fasting state and 1 h after ingestion of 10 g lactulose. We recorded symptoms after lactulose ingestion. Lactulose provoked significantly more symptoms in IBS patients than in healthy controls (p intestine or impaired function of the ileocecal segment. © 2014 John Wiley & Sons Ltd.

  2. Rational Use of Antibiotics in the Treatment of Functional Bowel Disorders

    Directory of Open Access Journals (Sweden)

    Roberta Fasulo

    2010-07-01

    Full Text Available Functional gastrointestinal symptoms such us bloating, fullness, flatulence, diarrhea, and constipation due to irritable bowel syndrome (IBS were recently attributed to small bowel bacterial overgrowth, a condition depending on the presence of an increased number of bacteria in the small bowel. However, the methodology used to describe this association may be harshly criticized, since it has already been shown to be quite inaccurate. As a result an inappropriate use of antibiotics was consequently generated. In fact, antibiotics could be effective in the treatment of functional complaints, but only in a limited subgroup of patients, characterized by an increase of fermentation at colonic level. In this review, we have examined the papers suggesting a pathophysiological link between IBS and small bowel bacterial overgrowth, underlining its inappropriateness, and put forth our personal view on the rationale for antibiotic use in IBS.

  3. Intensity modulated radiation therapy (IMRT: differences in target volumes and improvement in clinically relevant doses to small bowel in rectal carcinoma

    Directory of Open Access Journals (Sweden)

    Delclos Marc E

    2011-06-01

    Full Text Available Abstract Background A strong dose-volume relationship exists between the amount of small bowel receiving low- to intermediate-doses of radiation and the rates of acute, severe gastrointestinal toxicity, principally diarrhea. There is considerable interest in the application of highly conformal treatment approaches, such as intensity-modulated radiation therapy (IMRT, to reduce dose to adjacent organs-at-risk in the treatment of carcinoma of the rectum. Therefore, we performed a comprehensive dosimetric evaluation of IMRT compared to 3-dimensional conformal radiation therapy (3DCRT in standard, preoperative treatment for rectal cancer. Methods Using RTOG consensus anorectal contouring guidelines, treatment volumes were generated for ten patients treated preoperatively at our institution for rectal carcinoma, with IMRT plans compared to plans derived from classic anatomic landmarks, as well as 3DCRT plans treating the RTOG consensus volume. The patients were all T3, were node-negative (N = 1 or node-positive (N = 9, and were planned to a total dose of 45-Gy. Pairwise comparisons were made between IMRT and 3DCRT plans with respect to dose-volume histogram parameters. Results IMRT plans had superior PTV coverage, dose homogeneity, and conformality in treatment of the gross disease and at-risk nodal volume, in comparison to 3DCRT. Additionally, in comparison to the 3DCRT plans, IMRT achieved a concomitant reduction in doses to the bowel (small bowel mean dose: 18.6-Gy IMRT versus 25.2-Gy 3DCRT; p = 0.005, bladder (V40Gy: 56.8% IMRT versus 75.4% 3DCRT; p = 0.005, pelvic bones (V40Gy: 47.0% IMRT versus 56.9% 3DCRT; p = 0.005, and femoral heads (V40Gy: 3.4% IMRT versus 9.1% 3DCRT; p = 0.005, with an improvement in absolute volumes of small bowel receiving dose levels known to induce clinically-relevant acute toxicity (small bowel V15Gy: 138-cc IMRT versus 157-cc 3DCRT; p = 0.005. We found that the IMRT treatment volumes were typically larger than that

  4. A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report

    Directory of Open Access Journals (Sweden)

    Patel Pranav H

    2012-03-01

    Full Text Available Abstract Introduction Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. Case presentation We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication. Conclusions Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.

  5. PREVALENCE OF SMALL INTESTINAL BACTERIAL OVERGROWTH IN IRRITABLE BOWEL SYNDROME

    Directory of Open Access Journals (Sweden)

    Premaletha Narayanan

    2017-12-01

    Full Text Available BACKGROUND Irritable Bowel Syndrome (IBS is a common functional disorder and the pathophysiology of IBS is poorly understood. The aim of the study is to assess the prevalence of SIBO in patients with IBS using Lactulose Hydrogen Breath Test (LHBT. Diagnosis of IBS was made according to the Rome III Criteria and Lactulose Hydrogen Breath Test (LHBT was done. MATERIALS AND METHODS The current hypothesis suggests that altered gastrointestinal motility, disturbance of visceral hypersensitivity and infection may contribute to the symptoms. Gut microbiota and intestinal pathogens are likely to influence the pathogenesis of IBS. Small Intestinal Bacterial Overgrowth (SIBO is defined as an abnormally high bacterial count (≥105 colony-forming units/mL in the proximal small intestine. RESULTS Out of the 120 patients, 9 were LHBT positive (7.5% compared to none in controls (p <0.01. IBS patients with LHBT positivity was correlated well with the increased frequency of stools. There was no correlation noted with LHBT positivity and abdominal pain or flatulence or bloating compared to IBS patients who were LHBT negative. CONCLUSION These findings may suggest that patients with chronic diarrhoea including IBS should be tested for SIBO. Our study also showed that LHBT positivity is associated with increased frequency of stools and diarrhoea. If SIBO is found in patients with chronic diarrhoea, specific treatment with antibiotics may benefit them.

  6. Massive retroperitoneal ganglioneuroma presenting with small bowel obstruction 18 years following initial diagnosis.

    LENUS (Irish Health Repository)

    Cronin, E M P

    2012-02-03

    BACKGROUND: Ganglioneuroma is a rare tumour of neural crest origin, which arises from maturation of a neuroblastoma. While previously considered to be non-functioning, they are now known to be frequently endocrinologically active. AIMS AND METHODS: We report a case of a massive retroperitoneal ganglioneuroma presenting with small bowel obstruction in an adult, 18 years after initial diagnosis. Urinary dopamine levels were elevated, but other catecholamines were within normal limits. This is the first report in the English-language literature of a retroperitoneal ganglioneuroma presenting with or causing intestinal obstruction. We also review the metabolic, radiological, and histological features of these tumours. Relevant publications were identified from a Medline search using the MeSH headings \\'ganglioneuroma\\

  7. Detection of small-bowel tumours with CT enteroclysis using carbon dioxide and virtual enteroscopy. A preliminary study

    International Nuclear Information System (INIS)

    Dohan, Anthony; Boudiaf, Mourad; Dautry, Raphael; Dray, Xavier; Samaha, Elia; Cellier, Christophe; Camus, Marine; Eveno, Clarisse; Soyer, Philippe

    2018-01-01

    The aim of this prospective study was to evaluate the feasibility, tolerance and performance of virtual enteroscopy (VE) using carbon dioxide for small-bowel distension in patients with suspected small-bowel tumours (SBTs). After IRB approval, 17 patients with suspected SBTs were prospectively included. Radiation dose was compared to 34 matched patients (2 for 1) for age, gender and body weight, who had undergone CT-enteroclysis with neutral contrast (CTE). Performance of VE was evaluated through comparison with the current standard of reference, including surgery and/or enteroscopy and/or follow-up. Tolerance was excellent in 16/17 patients (94%). The radiation dose was lower for VE than for CTE (533 ± 282 vs. 974 ± 505 mGy.cm; p = 0.002). With VE, a total of 25 polyps >5 mm in size were depicted in 12/17 patients. On a per-lesion analysis, sensitivity and positive predictive value of VE were 92.0% and 92.0%, respectively. On a per-segment analysis VE had a sensitivity and specificity of 95.0% and 87.0%, respectively. Our preliminary study suggests that VE is a feasible and well-tolerated technique with high sensitivity and specificity for the diagnosis of SBT. (orig.)

  8. Detection of small-bowel tumours with CT enteroclysis using carbon dioxide and virtual enteroscopy. A preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Dohan, Anthony [Hopital Lariboisiere - Assistance Publique-Hopitaux de Paris, Department of Body and Interventional Imaging, Paris (France); Universite Sorbonne Paris Cite, Paris Diderot, INSERM UMR 965, Paris (France); Boudiaf, Mourad; Dautry, Raphael [Hopital Lariboisiere - Assistance Publique-Hopitaux de Paris, Department of Body and Interventional Imaging, Paris (France); Dray, Xavier [Department of Digestive Diseases, Hopital Saint-Antoine, Assistance Publique-Hopitaux de Paris, Paris (France); Sorbonne Universite, Paris (France); Samaha, Elia [European Georges Pompidou Hospital, Assistance Publique-Hopitaux de Paris, Gastroenterology and Endoscopy Unit, Paris (France); Cellier, Christophe [European Georges Pompidou Hospital, Assistance Publique-Hopitaux de Paris, Gastroenterology and Endoscopy Unit, Paris (France); Universite Sorbonne Paris Cite, Paris Descartes, Paris (France); Camus, Marine [Universite Sorbonne Paris Cite, Paris Descartes, Paris (France); Hopital Cochin - Assistance Publique-Hopitaux de Paris, Department of Gastroenterology, Paris (France); Eveno, Clarisse [Universite Sorbonne Paris Cite, Paris Diderot, INSERM UMR 965, Paris (France); Hopital Lariboisiere - Assistance Publique-Hopitaux de Paris, Department of Surgical Oncologic and Digestive Unit, Paris (France); Soyer, Philippe [Universite Sorbonne Paris Cite, Paris Diderot, INSERM UMR 965, Paris (France); Hopital Cochin - Assistance Publique-Hopitaux de Paris, Department of Body and Interventional Imaging, Paris (France)

    2018-01-15

    The aim of this prospective study was to evaluate the feasibility, tolerance and performance of virtual enteroscopy (VE) using carbon dioxide for small-bowel distension in patients with suspected small-bowel tumours (SBTs). After IRB approval, 17 patients with suspected SBTs were prospectively included. Radiation dose was compared to 34 matched patients (2 for 1) for age, gender and body weight, who had undergone CT-enteroclysis with neutral contrast (CTE). Performance of VE was evaluated through comparison with the current standard of reference, including surgery and/or enteroscopy and/or follow-up. Tolerance was excellent in 16/17 patients (94%). The radiation dose was lower for VE than for CTE (533 ± 282 vs. 974 ± 505 mGy.cm; p = 0.002). With VE, a total of 25 polyps >5 mm in size were depicted in 12/17 patients. On a per-lesion analysis, sensitivity and positive predictive value of VE were 92.0% and 92.0%, respectively. On a per-segment analysis VE had a sensitivity and specificity of 95.0% and 87.0%, respectively. Our preliminary study suggests that VE is a feasible and well-tolerated technique with high sensitivity and specificity for the diagnosis of SBT. (orig.)

  9. Infantile Short Bowel Syndrome: short and long term evaluation

    NARCIS (Netherlands)

    J.F. Olieman (Joanne)

    2009-01-01

    textabstractInfantile short bowel syndrome is a condition which is characterized by malabsorption of nutrients, as a result of congenital intestinal shortening or massive small bowel resection. Survival rates have improved over the years, but morbidity remains high and clinical management of these

  10. 14C-lactose breath tests during pelvic radiotherapy: the effect of the amount of small bowel irradiated

    International Nuclear Information System (INIS)

    Weiss, R.G.; Stryker, J.A.

    1982-01-01

    Thirty patients who were undergoing pelvic radiotherapy had 14 C-lactose breath tests performed in the first and fifth weeks of treatment. In Group I (21 patients), a significant portion of the small intestine was irradiated, and in Group II (9 patients), only a small portion of the small intestine was irradiated. In Group I, the average reductions in the excretion of ingested 14 C between the first- and fifth-week tests were 41.5% at 1/2 hour postingestion (p 0.05). The data suggest that lactose malabsorption is a factor in the etiology of the nausea, vomiting, and diarrhea experienced by patients who are undergoing pelvic radiotherapy, and that the amount of bowel included in the treatment volume significantly influences the degree of malabsorption

  11. Small bowel obstruction in the virgin abdomen: time to challenge surgical dogma with evidence.

    Science.gov (United States)

    Ng, Yvonne Ying-Ru; Ngu, James Chi-Yong; Wong, Andrew Siang-Yih

    2018-01-01

    Although adhesions account for more than 70% of small bowel obstruction (SBO), they are thought to be less likely aetiologies in patients without previous abdominal surgery. Expedient surgery has historically been advocated as prudent management in these patients. Emerging evidence appears to challenge such a dogmatic approach. A retrospective analysis was performed in all SBO patients with a virgin abdomen admitted between January 2012 and August 2014. Patients with obstruction secondary to abdominal wall hernias were excluded. Patient demographics, clinical presentation, management strategy and pathology involved were reviewed. A total of 72 patients were included in the study. The majority of patients were males (66.7%), with a median age of 58 years (range: 23-101). Abdominal pain (97%) and vomiting (86%) were the most common presentations while abdominal distention (60%) and constipation (25%) were reported less frequently. Adhesions accounted for the underlying cause in 44 (62%) patients. Other aetiologies included gallstone ileus (n = 5), phytobezoar (n = 5), intussusception (n = 4), internal herniation (n = 4), newly diagnosed small bowel tumour (n = 3), mesenteric volvulus (n = 3), stricture (n = 3) and Meckel's diverticulum (n = 1). Twenty-nine (40%) patients were successfully managed conservatively while the remaining 43 (60%) underwent surgery. The intraoperative findings were in concordance with the preoperative computed tomography scan in 76% of cases. Adhesions remain prevalent despite the absence of previous abdominal surgery. Non-operative management is feasible for SBO in a virgin abdomen. Computed tomography scan can be a useful adjunct in discerning patients who may be treated non-operatively by elucidating the underlying cause of obstruction. © 2016 Royal Australasian College of Surgeons.

  12. Towards a less costly but accurate test of gastric emptying and small bowel transit

    Energy Technology Data Exchange (ETDEWEB)

    Camilleri, M.; Zinsmeister, A.R.; Greydanus, M.P.; Brown, M.L.; Proano, M. (Mayo Clinic and Foundation, Rochester, MN (USA))

    1991-05-01

    Our aim is to develop a less costly but accurate test of stomach emptying and small bowel transit by utilizing selected scintigraphic observations 1-6 hr after ingestion of a radiolabeled solid meal. These selected data were compared with more detailed analyses that require multiple scans and labor-intensive technical support. A logistic discriminant analysis was used to estimate the sensitivity and specificity of selected summaries of scintigraphic transit measurements. We studied 14 patients with motility disorders (eight neuropathic and six myopathic, confirmed by standard gastrointestinal manometry) and 37 healthy subjects. The patient group had abnormal gastric emptying (GE) and small bowel transit time (SBTT). The proportion of radiolabel retained in the stomach from 2 to 4 hr (GE 2 hr, GE 3 hr, GE 4 hr), as well as the proportion filling the colon at 4 and 6 hr (CF 4 hr, CF 6 hr) were individually able to differentiate health from disease (P less than 0.05 for each). From the logistic discriminant model, an estimated sensitivity of 93% resulted in similar specificities for detailed and selected transit parameters for gastric emptying (range: 62-70%). Similarly, combining selected observations, such as GE 4 hr with CF 6 hr, had a specificity of 76%, which was similar to the specificity of combinations of more detailed analyses. Based on the present studies and future confirmation in a larger number of patients, including those with less severe motility disorders, the 2-, 4-, and 6-hr scans with quantitation of proportions of counts in stomach and colon should provide a useful, relatively inexpensive strategy to identify and monitor motility disorders in clinical and epidemiologic studies.

  13. Transabdominal ultrasonography of the small bowel after oral administration of a non-absorbable anechoic solution: Comparison with barium enteroclysis

    Energy Technology Data Exchange (ETDEWEB)

    Cittadini, Giuseppe; Giasotto, Veronica; Garlaschi, Giacomo; De Cicco, Enzo; Gallo, Alessandra; Cittadini, Giorgio

    2001-03-01

    AIM: The aim of this study was to determine if oral administration of a non-absorbable anechoic solution conveys any benefit during abdominal ultrasound (US), with special reference to its accuracy. MATERIALS AND METHODS: Fifty-three adult out-patients scheduled for small bowel barium enema (SBE) were included. The day before SBE all patients underwent abdominal US before and after oral administration of an isotonic non-absorbable electrolyte solution containing polyethylene glycol (PEG-ELS). Sensitivity and specificity were evaluated using SBE as a gold standard. RESULTS: After ingestion of PEG-ELS satisfactory distension of the intestinal lumen was obtained (11-25 mm) with sequential visualization of jejunoileal loops in 30.9 {+-} 17.3 min. In 15 out of 53 cases both US and SBE showed bowel changes characteristic of Crohn's disease. In three out of 53 cases both US and SBE showed neoplasms. In one out of 53 cases US was negative, SBE positive for local nodularity and ulcerations typical of Crohn's disease. In one out of 53 cases US was negative, SBE positive for macronodularity consistent with coeliac disease. In five out of 53 cases US was negative, while SBE was positive for mininodularity expressive of lymphoid hyperplasia. In 28 out of 53 cases both examinations were negative. CONCLUSION: PEG-ELS administration allows a thorough US investigation of the small bowel, with fair sensitivity (72%) and excellent specificity (100%). False negative findings are mainly due to lymphoid hyperplasia, a feature of uncertain significance in adults. Cittadini G. et al.(2001)

  14. The effect of cis-diammine dichloro platinum(II) on radiation injury in the rat bowel

    International Nuclear Information System (INIS)

    Lee, Kyung Ja; Rhee, Chung Sik

    1995-01-01

    This experimental study was performed for evaluate the effects of cis-diamminedichloroplatinum(II) (cis-DDP) on the radiation injury of rat bowel by histopathologic changes. Rats were exposed to entire abdomen by a single doses of X-ray(6-10 Gy) without or with cis-DDP(2.5mg/kg). Rats were divided into 3 groups such as radiation alone, cis-DDP alone and combined group. In combined group, cis-DDP was given 30 minutes before or immediately after irradiation. Cis-DDP induced the inflammatory cell infiltrations with focal necrosis of the mucosa in the small bowel and no abnormal change in the large bowel. In radiation alone group, mucosal necrosis, submucosal fibrosis and muscular necrosis were prominent changes in small bowel and submucosal fibrosis in the large bowel. The submucosal fibrosis in the small bowel was appeared in 10 Gy of radiation alone group and 8 Gy of cis-DDP infusion after radiation and 6 Gy of cis-DDP infusion before radiation of combined group. In the large bowel, submucosal fibrosis was noted in 8 Gy of radiation alone group 8 Gy of cis-DDP infusion after radiation and 6 Gy of cis-DDP infusion before radiation of combined group. In the small bowel, the enhancement ratio was 1.67 in a group of cis-DDP infusion before radiation and 1.25 in group of cis-DDP infusion after radiation as the end point was the submucosal fibrosis. In the large bowel, the enhancement ratio was 1.33 in a group of cis-DDP infusion before radiation and 1.0 in a group of cis-DDP infusion after radiation as the end point was the submucosal fibrosis. This study suggested that cis-DDP enhance the radiation effect in the small and large bowel especially when cis-DDP was infused before radiation

  15. The influence of food restriction on the small bowel: Does intensive short‑term food restriction lead to weight loss?

    Czech Academy of Sciences Publication Activity Database

    Makovický, Peter; Tůmová, E.; Volek, Z.; Makovický, P.; Arnone, J.M.; Švecová, Ivana; Samasca, G.

    2017-01-01

    Roč. 118, č. 6 (2017), s. 361-365 ISSN 0006-9248 R&D Projects: GA MŠk(CZ) LM2015040; GA MŠk(CZ) ED1.1.00/02.0109 Institutional support: RVO:68378050 Keywords : experimental medicine * food restriction * rabbit * slimming * small bowel weight loss Subject RIV: EB - Genetics ; Molecular Biology OBOR OECD: Pathology Impact factor: 0.667, year: 2016

  16. Adhesions small bowel obstruction in emergency setting: conservative or operative treatment?

    Science.gov (United States)

    Assenza, M; De Gruttola, I; Rossi, D; Castaldi, S; Falaschi, F; Giuliano, G

    2016-01-01

    Adhesions small bowel obstructions (aSBO) are among the leading causes of emergency operative intervention. About the 80% of aSBO cases resolve without a surgical treatment. It's important to identify which patients could undergo a conservative treatment to prevent an useless surgery The aim of this study is to determine findings that can indicate whether patients with aSBO should undergo a conservative or a surgical treatment. 313 patients with diagnosis of submission of aSBO were restudied. Patients were divided into two groups based on the different type of treatment received, 225 patients who underwent surgical treatment within 24 hours after admission, 88 patients which underwent conservative treatment successfully. For each patient, clinical, hematochemical and radiological findings have been analysed. The treatment of aSBO should be, at the beginning, conservative except that cases that presents clinical and/or CT-scan findings predictive for a surgical treatment (free peritoneal fluid, mesenterial edema, transitional point) or a peritonitis (pneumatosis intestinalis, pneumoperitoneum).

  17. Proteomic analysis of the intestinal adaptation response reveals altered expression of fatty acid binding proteins following massive small bowel resection.

    Science.gov (United States)

    Stephens, Andrew N; Pereira-Fantini, Prue M; Wilson, Guineva; Taylor, Russell G; Rainczuk, Adam; Meehan, Katie L; Sourial, Magdy; Fuller, Peter J; Stanton, Peter G; Robertson, David M; Bines, Julie E

    2010-03-05

    Intestinal adaptation in response to the loss of the small intestine is essential to restore enteral autonomy in patients who have undergone massive small bowel resection (MSBR). In a proportion of patients, intestinal function is not restored, resulting in chronic intestinal failure (IF). Early referral of such patients for transplant provides the best prognosis; however, the molecular mechanisms underlying intestinal adaptation remain elusive and there is currently no convenient marker to predict whether patients will develop IF. We have investigated the adaptation response in a well-characterized porcine model of intestinal adaptation. 2D DIGE analysis of ileal epithelium from piglets recovering from massive small bowel resection (MSBR) identified over 60 proteins that changed specifically in MSBR animals relative to nonoperational or sham-operated controls. Three fatty acid binding proteins (L-FABP, FABP-6, and I-FABP) showed changes in MSBR animals. The expression changes and localization of each FABP were validated by immunoblotting and immunohistochemical analysis. FABP expression changes in MSBR animals occurred concurrently with altered triglyceride and bile acid metabolism as well as weight gain. The observed FABP expression changes in the ileal epithelium occur as part of the intestinal adaptation response and could provide a clinically useful marker to evaluate adaptation following MSBR.

  18. Clinical Efficacy of Various Diagnostic Tests for Small Bowel Tumors and Clinical Features of Tumors Missed by Capsule Endoscopy

    Directory of Open Access Journals (Sweden)

    Jung Wan Han

    2015-01-01

    Full Text Available Background. We aimed to evaluate the efficacy of various diagnostic tools such as computerized tomography (CT, small bowel follow-through (SBFT, and capsule endoscopy (CE in diagnosing small bowel tumors (SBTs. Additionally, we aimed to evaluate the clinical features of SBTs missed by CE. Methods. We retrospectively studied 79 patients with histologically proven SBT. Clinical data were analyzed with particular attention to the efficacy of CT, SBFT, and CE in detecting SBT preoperatively. We also analyzed the clinical features of SBTs missed by CE. Results. The most common symptoms of SBT were bleeding (43% and abdominal pain (13.9%. Diagnostic yields were as follows: CT detected 55.8% of proven SBTs; SBFT, 46.1%; and CE, 83.3%. The sensitivity for detecting SBTs was 40.4% for CT, 43.9% for SBFT, and 79.6% for CE. Two patients with nondiagnostic but suspicious findings on CE and seven patients with negative findings on CE were eventually found to have SBT. These nine patients were eventually diagnosed with gastrointestinal stromal tumor (4, small polyps (3, inflammatory fibroid polyp (1, and adenocarcinoma (1. These tumors were located in the proximal jejunum (5, middle jejunum (1, distal jejunum (1, and proximal ileum (1. Conclusion. CE is more efficacious than CT or SBFT for detecting SBTs. However, significant tumors may go undetected with CE, particularly when located in the proximal jejunum.

  19. Chlamydia trachomatis antigens in enteroendocrine cells and macrophages of the small bowel in patients with severe irritable bowel syndrome

    Directory of Open Access Journals (Sweden)

    Sandström Gunnar

    2010-02-01

    Full Text Available Abstract Background Inflammation and immune activation have repeatedly been suggested as pathogentic factors in irritable bowel syndrome (IBS. The driving force for immune activation in IBS remains unknown. The aim of our study was to find out if the obligate intracellular pathogen Chlamydia could be involved in the pathogenesis of IBS. Methods We studied 65 patients (61 females with IBS and 42 (29 females healthy controls in which IBS had been excluded. Full thickness biopsies from the jejunum and mucosa biopsies from the duodenum and the jejunum were stained with a monoclonal antibody to Chlamydia lipopolysaccharide (LPS and species-specific monoclonal antibodies to C. trachomatis and C. pneumoniae. We used polyclonal antibodies to chromogranin A, CD68, CD11c, and CD117 to identify enteroendocrine cells, macrophages, dendritic, and mast cells, respectively. Results Chlamydia LPS was present in 89% of patients with IBS, but in only 14% of healthy controls (p C. trachomatis major outer membrane protein (MOMP. Staining for C. pneumoniae was negative in both patients and controls. Chlamydia LPS was detected in enteroendocrine cells of the mucosa in 90% of positive biopsies and in subepithelial macrophages in 69% of biopsies. Biopsies taken at different time points in 19 patients revealed persistence of Chlamydia LPS up to 11 years. The odds ratio for the association of Chlamydia LPS with presence of IBS (43.1; 95% CI: 13.2-140.7 is much higher than any previously described pathogenetic marker in IBS. Conclusions We found C. trachomatis antigens in enteroendocrine cells and macrophages in the small bowel mucosa of patients with IBS. Further studies are required to clarify if the presence of such antigens has a role in the pathogenesis of IBS.

  20. Systemic amyloidosis due to unknown multiple myeloma in small bowel pseudo-obstruction: case report

    Directory of Open Access Journals (Sweden)

    Giuseppe Caparrotti

    2016-03-01

    Full Text Available Amyloidosis is a pathologic diagnosis characterized by extracellular deposition of insoluble protein fibrils in various organs and tissues. There are two main forms of amyloidosis, primary amyloidosis, and secondary amyloidosis. Gastrointestinal involvement is common in both amyloidosis forms. We describe the case of a 78-year-old woman taken to the operating room for small bowel obstruction, found to have pseudo-obstruction and enteritis. Exploratory laparotomy revealed gastric mass and histological examen showed extensive amyloid deposition consistent with amyloidosis. Hematological evaluation revealed unknown multiple myeloma. This case report and literature data suggest to perform a hematological examination in patients with amyloidosis diagnosis to exclude a multiple myeloma or other plasma cell disorders

  1. Surgical therapy for injuries of bowels by radiation

    International Nuclear Information System (INIS)

    Yamada, Akiyoshi; Sasaki, Hiroaki; Oomori, Naofumi; Hamano, Kyoichi; Kobayashi, Seiichiro

    1980-01-01

    A group of patients with damage of the GI tract by therapeutic irradiation for intra-abdominal neoplasma such as the carcinoma of uterus and rectum has been presented. With regard to the location of radiation damage, 32 cases of them are limited in the recto-sigmoid colon, 3 cases in the small bowel and 4 cases in both bowels. Among 19 cases who underwent an operation, radiation damage was found in the colon of 12 cases. Colostomy was made in all cases and in 2 cases colon resection was also performed. If radiation damage is noticed only in the rectum, colostomy is good indicated except for the cases in which a massive bleeding is seen. As to small bowel damages, if the symptoms of patient do not respond to the conservative treatment, operative intervention is necessary. At operation, the surgeon should be aware of the risks involved in performing adhesiolysis. (author)

  2. Experimental high-frequency ultrasound can detect graft rejection after small bowel transplantation.

    Science.gov (United States)

    Yang, R; Liu, Q; Wu, E X; Pescovitz, M D; Collins, M H; Kopecky, K K; Grosfeld, J L

    1994-02-01

    Early diagnosis of graft rejection after small bowel transplantation (SBT) can allow prompt institution of vigorous immunosuppressive therapy, with resultant reversal of the rejection process. The current method for graft monitoring is random mucosal biopsy from a stomal site or through an endoscope. However, because early rejection often has a patchy distribution, it could be missed by random biopsy. We hypothesized that the pathological process of rejection would alter acoustic impedance of the tissue and thus change the ultrasonic patterns of the graft intestinal wall. If this hypothesis is correct, then high-frequency endoscopic ultrasound (US) could be used to monitor the entire transplanted bowel and guide the biopsy, with improved yields. This hypothesis was tested in a rat orthotopic SBT model. Sixty-two intestinal specimens (9 isografts, 12 allografts treated with cyclosporine A [CsA], 22 untreated allografts, and 19 intestines from normal rats) were collected for in vitro transluminal US imaging (30 MHz) and histopathologic study. The echo pattern of normal rat intestinal wall consisted of five echo layers that correlated spatially with the histological layers: the innermost hyperechoic layer 1, plus hypoechoic layer 2, corresponded to the mucosa; hyperechoic layer 3, the submucosa; anechoic layer 4, the muscularis propria; and hyperechoic layer 5, the serosa. The isografts and CsA-treated allografts were identical histologically and ultrasonically to normal intestine. However, the echo patterns of the untreated allografts had progressive loss of architectural stratification, with worsening rejection. The change began with patchy indistinctness and disruption of hyperechoic layers 1, 3 and 5, and progressed to total obliteration of the layers, with the intestinal wall becoming a nonstratified hypoechoic structure.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Radiologic examination

    International Nuclear Information System (INIS)

    Thoeni, R.F.

    1989-01-01

    The radiographic examination of the upper and lower gastrointestinal tract has been changed drastically by the introduction of endoscopic procedures that are now widely available. However, the diagnostic approach to the small bowel remains largely unchanged. Ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) are occasionally employed but are not primary imaging modalities for small bowel disease. Even though small bowel endoscopes are available, they are infrequently used, and no scientific paper on their employment has been published. Barium studies are still the mainstay for evaluating patients with suspected small bowel abnormalities. This paper discusses the anatomy and physiology of the small bowel and lists the various types of barium and pharmacologic aids used for examining it. The different radiographic methods for examining the small bowel with barium, including SBFT, dedicated SBFT, enteroclysis, peroral pneumocolon (PPC), and retrograde small bowel examination, are described and put into perspective. To some degree such an undertaking must be a personal opinion, but certain conclusions can be made based on the available literature and practical experience. This analysis is based on the assumption that all the various barium techniques are performed with equal expertise by the individual radiologist, thus excluding bias from unfamiliarity with certain aspects of a procedure, such as intubation or skilled compression during fluoroscopy. Also, the use of water-soluble contrast material, CT, and MRI for evaluating suspected small bowel abnormalities is outlined

  4. Small intestinal bacterial overgrowth as an uncommon cause of false positive lactose hydrogen breath test among patients with diarrhea-predominant irritable bowel syndrome in Asia.

    Science.gov (United States)

    Wang, Yilin; Xiong, Lishou; Gong, Xiaorong; Li, Weimin; Zhang, Xiangsong; Chen, Minhu

    2015-06-01

    It has been reported that small intestinal bacterial overgrowth (SIBO) may lead to false positive diagnoses of lactose malabsorption (LM) in irritable bowel syndrome patients. The aim of this study was to determine the influence of SIBO on lactose hydrogen breath test (HBT) results in these patients. Diarrhea-predominant irritable bowel syndrome patients with abnormal lactose HBTs ingested a test meal containing (99m) Tc and lactose. The location of the test meal and the breath levels of hydrogen were recorded simultaneously by scintigraphic scanning and lactose HBT, respectively. The increase in hydrogen concentration was not considered to be caused by SIBO if ≥ 10% of (99m) Tc accumulated in the cecal region at the time or before of abnormal lactose HBT. LM was present in 84% (31/37) of irritable bowel syndrome patients. Twenty of these patients agreed to measurement of oro-cecal transit time. Only three patients (15%) with abnormal lactose HBT might have had SIBO. The median oro-cecal transit time between LM and lactose intolerance patients were 75 min and 45 min, respectively (Z=2.545, P=0.011). Most of irritable bowel syndrome patients with an abnormal lactose HBT had LM. SIBO had little impact on the interpretation of lactose HBTs. The patients with lactose intolerance had faster small intestinal transit than LM patients. © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  5. Duodenal localization is a negative predictor of survival after small bowel adenocarcinoma resection: A population-based, propensity score-matched analysis.

    Science.gov (United States)

    Wilhelm, Alexander; Galata, Christian; Beutner, Ulrich; Schmied, Bruno M; Warschkow, Rene; Steffen, Thomas; Brunner, Walter; Post, Stefan; Marti, Lukas

    2018-03-01

    This study assessed the influence of tumor localization of small bowel adenocarcinoma on survival after surgical resection. Patients with resected small bowel adenocarcinoma, ACJJ stage I-III, were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2013. The impact of tumor localization on overall and cancer-specific survival was assessed using Cox proportional hazard regression models with and without risk-adjustment and propensity score methods. Adenocarcinoma was localized to the duodenum in 549 of 1025 patients (53.6%). There was no time trend for duodenal localization (P = 0.514). The 5-year cancer-specific survival rate was 48.2% (95%CI: 43.3-53.7%) for patients with duodenal carcinoma and 66.6% (95%CI: 61.6-72.1%) for patients with cancer located in the jejunum or ileum. Duodenal localization was associated with worse overall and cancer-specific survival in univariable (HR = 1.73; HR = 1.81, respectively; both P matrimonial status were positive, independent prognostic factors. Duodenal localization is an independent risk factor for poor survival after resection of adenocarcinoma. © 2017 Wiley Periodicals, Inc.

  6. Comparison between air CT and MRI in the detection of small acoustic neurinomas

    Energy Technology Data Exchange (ETDEWEB)

    Kamei, Tetsuya; Nakashima, Aiko; Seto, Hikaru; Kakishita, Masao

    1989-02-01

    Air CT proved useful in yielding images of acoustic tumors as an air filling defect in 11 (24%) of 46 patients. Six of the 11 tumors were small ones of less than 1 cm in diameter. Air CT was also able to exclude an intracanalicular tumor in 29 patients (63%). MRI was performed for comparison in eight patients (nine tumors) already diagnosed by air CT as having an acoustic tumor. MRI detected eight (89%) of nine tumors. A false negative result on MRI was obtained only in one intracanalicular tumor (4.3 mm in size). This was considered to be attributable to limitations of spatial resolution including the wide slice thickness. A protocol for radiological investigation and management of patients whose clinical symptoms and/or audiovestibular examination are highly indicative of acoustic tumor is proposed and discussed. (author).

  7. Comparison between air CT and MRI in the detection of small acoustic neurinomas

    International Nuclear Information System (INIS)

    Kamei, Tetsuya; Nakashima, Aiko; Seto, Hikaru; Kakishita, Masao

    1989-01-01

    Air CT proved useful in yielding images of acoustic tumors as an air filling defect in 11 (24%) of 46 patients. Six of the 11 tumors were small ones of less than 1 cm in diameter. Air CT was also able to exclude an intracanalicular tumor in 29 patients (63%). MRI was performed for comparison in eight patients (nine tumors) already diagnosed by air CT as having an acoustic tumor. MRI detected eight (89%) of nine tumors. A false negative result on MRI was obtained only in one intracanalicular tumor (4.3 mm in size). This was considered to be attributable to limitations of spatial resolution including the wide slice thickness. A protocol for radiological investigation and management of patients whose clinical symptoms and/or audiovestibular examination are highly indicative of acoustic tumor is proposed and discussed. (author)

  8. Wireless capsule endoscopy and proximal small bowel lesions in Crohn’s disease

    Science.gov (United States)

    Petruzziello, Carmelina; Onali, Sara; Calabrese, Emma; Zorzi, Francesca; Ascolani, Marta; Condino, Giovanna; Lolli, Elisabetta; Naccarato, Paola; Pallone, Francesco; Biancone, Livia

    2010-01-01

    AIM: To investigate the prevalence of proximal small bowel (SB) lesions detected by wireless capsule endoscopy (WCE) in Crohn’s disease (CD). METHODS: WCE was performed in 64 patients: 32 with CD of the distal ileum, and 32 controls with iron-deficiency anemia (IDA) or diarrhea. WCE was performed using the Given SB-WCE, followed by small intestine contrast ultrasonography (SICUS). Findings compatible with CD by using WCE included erosions, aphthoid or deep ulcers, and strictures/stenosis. RESULTS: WCE detected proximal SB lesions in 16/32 (50%) patients (14 aphthoid ulcers, 2 deep ulcers, one stricture), which appeared not to be related to clinical parameters [epigastric pain, age, smoking, non-steroidal anti-inflammatory drugs (NSAIDs), IDA]. Among patients with proximal SB lesions, 6 (37%) were smokers, 3 (19%) NSAID users, 3 (19%) had epigastric pain and 4 (25%) had IDA. SICUS detected proximal SB lesions in 3/32 patients (19%) also showing lesions with WCE. No correlations were observed between proximal SB lesions assessed by WCE or by SICUS (χ2 = 1.5, P = 0.2). CONCLUSION: The use of WCE allows the detection of previously unknown upper SB lesions in a high proportion of patients with a previous diagnosis of CD involving the distal ileum. PMID:20614486

  9. MRI findings of small cell neuroendocrime carcinoma of the uterine cervix: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Won, You Sun; Yi, Boem Ha; Lee, Hae Kyung; Lee, Min Hee; Choi, Seo Youn; Kwak, Jeong Ja [Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon (Korea, Republic of)

    2015-10-15

    Small cell neuroendocrine carcinoma of the uterine cervix is a rare primary neoplasm, accounting for less than 5% of all uterine cervical cancers. The tumor is known to have an aggressive behavior and poor prognosis. In this article, we present the MRI findings of 5 cases of pathologically-proven small cell neuroendocrine carcinoma of the uterine cervix, including diffusion-weighted images.

  10. MR imaging of the small bowel with increasing concentrations of an oral osmotic agent

    Energy Technology Data Exchange (ETDEWEB)

    Borthne, Arne S. [Ullevaal University Hospital, Department of Radiology, Oslo (Norway); Ullevaal University Hospital, Department of Pediatric Radiology, Oslo (Norway); Abdelnoor, Michael [Ullevaal University Hospital, Unit of Epidemiology and Biostatistics, Centre of Clinical Research, Oslo (Norway); Hellund, Johan C.; Geitung, Jonn T.; Kloew, Nils-E. [Ullevaal University Hospital, Department of Radiology, Oslo (Norway); Storaas, Trygve; Gjesdal, Kjell I. [Ullevaal University Hospital, Department of Medical Physics, Oslo (Norway)

    2005-04-01

    The aim of this study was to assess the quality of MR imaging and level of adverse effects with increasing concentrations of gastrografin. This is a prospective study with 24 healthy volunteers which were randomised into four groups receiving 50%, 25%, 10% and 0% gastrografin. The endpoint was bowel image quality based on distension, signal homogeneity and wall delineation evaluated by three independent radiologists, and the maximum bowel diameter at three different levels. The subjects also scored any adverse events on a 1-5 scale. The interradiologist agreement was relatively good, with kappa values varying between 0.81 and 0.41. Improved bowel distension and image quality were achieved with increasing concentrations. But significant dose-response effects were found between increasing osmolalities and the bowel diameters and also versus the score of adverse events. The most frequent adverse reactions were diarrhea, nausea and lack of palatability. There is a gradient relationship between increasing osmolality of gastrografin and improved image quality and the score of adverse effects. The optimum concentration of gastrografin is dependent of the tolerance of the adverse events. (orig.)

  11. MR imaging of the small bowel with increasing concentrations of an oral osmotic agent

    International Nuclear Information System (INIS)

    Borthne, Arne S.; Abdelnoor, Michael; Hellund, Johan C.; Geitung, Jonn T.; Kloew, Nils-E.; Storaas, Trygve; Gjesdal, Kjell I.

    2005-01-01

    The aim of this study was to assess the quality of MR imaging and level of adverse effects with increasing concentrations of gastrografin. This is a prospective study with 24 healthy volunteers which were randomised into four groups receiving 50%, 25%, 10% and 0% gastrografin. The endpoint was bowel image quality based on distension, signal homogeneity and wall delineation evaluated by three independent radiologists, and the maximum bowel diameter at three different levels. The subjects also scored any adverse events on a 1-5 scale. The interradiologist agreement was relatively good, with kappa values varying between 0.81 and 0.41. Improved bowel distension and image quality were achieved with increasing concentrations. But significant dose-response effects were found between increasing osmolalities and the bowel diameters and also versus the score of adverse events. The most frequent adverse reactions were diarrhea, nausea and lack of palatability. There is a gradient relationship between increasing osmolality of gastrografin and improved image quality and the score of adverse effects. The optimum concentration of gastrografin is dependent of the tolerance of the adverse events. (orig.)

  12. Effects of Hypericum perforatum extract on rat irritable bowel syndrome

    Science.gov (United States)

    Mozaffari, Shilan; Esmaily, Hadi; Rahimi, Roja; Baeeri, Maryam; Sanei, Yara; Asadi-Shahmirzadi, Azar; Salehi-Surmaghi, Mohammad-Hossein; Abdollahi, Mohammad

    2011-01-01

    Context: In irritable bowel syndrome (IBS), disturbance of bowel motility is associated with infiltration of inflammatory mediators and cytokines into the intestine, such as neutrophils, myeloperoxidase (MPO), tumor necrosis factor alfa (TNF-α), and lipid peroxide. Aims: Regarding promising anti-inflammatory and anti-oxidative effects of Hypericum perforatum (HP) extract, besides its anti-depressant effect, this study was designed to evaluate the effects of HP in an experimental model of IBS. Settings and Design: IBS was induced by a 5-day restraint stress in rats. The HP extract was administered by gavage in doses of 150, 300, and 450 mg/kg for 26 days. Fluoxetine and loperamide were used as positive controls. Gastric emptying and small bowel and colon transit, besides the levels of TNF-α, MPO, lipid peroxidation, and antioxidant power, were determined in colon homogenates. Statistical Analysis Used: Data were analyzed by one-way ANOVA followed by Tukey's post hoc test for multiple comparisons. Results: A significant reduction in small bowel and colonic transit (450 mg/kg), TNF-α, MPO, and lipid peroxidation and an increase in antioxidant power in all HP-treated groups (150, 300, and 450 mg/kg) were seen as compared with the control group. Gastric emptying did not alter significantly when compared with the control group. Treatment with loperamide (10 mg/kg) significantly inhibited gastric emptying and small bowel and colonic transit, while flouxetine (10 mg/kg) decreased gastric emptying, TNF-α, MPO, and lipid peroxidation and increased the antioxidant power of the samples in comparison with the control group. Conclusions: HP diminished the recruitment of inflammatory cells and TNF-α following restraint stress not in a dose-dependent manner, possibly via inhibition of MPO activity and increasing colon antioxidant power, without any difference with fluoxetine. The HP extract inhibits small bowel and colonic transit acceleration like loperamide but has minimal

  13. Effects of intestinal muscular wrapping on remnant intestinal motility after massive small bowel resection in conscious canines.

    Science.gov (United States)

    Uchiyama, M; Iwafuchi, M; Yagi, M; Iinuma, Y; Kanada, S; Ohtaki, M; Yamazaki, S; Homma, S

    2000-04-01

    We searched the effect of the muscular valve on the management of short bowel syndrome. The motility of the remnant intestine with a special muscular valve after 80% massive distal small bowel resection (MSBR) was evaluated in conscious dogs. The valve (muscular ring) was made by the autointestinal muscle layer holding vascular pedicle. Interdigestive and postprandial bowel motility using bipolar electrodes and/or contractile strain gauge force transducers 2-4 weeks after the surgery, and data of this group (Group I) were compared to the motility in dogs after MSBR without valve construction (Group II) and in controls (Control). Results; Fasting duodenal migrating myoelectric (or motor) complexes (MMCs) in Group I occurred at longer intervals than in Control and almost similarly to those in Group II. MMCs arising from the duodenum were often interrupted before the jejunum above the valve and the anastomosis. The velocity of duodenal MMC propagation was slowed in every intestinal segment including that from the duodenum to the proximal jejunum, and to the jejunum above the anastomosis. Transit time in MSBR group (I and II) from the duodenum to the terminal ileum was extremely shorter than in Control, but there were no differences between in Groups I and II. The duration of the postprandial period without duodenal MMCs in Group I was significantly prolonged than in Control, but was shorter than that in Group II. The muscular valve was frequently activated, and the jejunum covered with the valve was contracted frequently which synchronized with the valve activity. It seemed the valve worked as sphincter. However, intestinal obstruction was not occurred through the jejunum covered by the valve. In conclusion, changes in gut motility after MSBR with the valve construction compensate for the shortened intestine and maintain the bowel content earlier postoperatively in comparison with the MSBR alone, and also contribute to the adaptive increase in the remnant intestinal

  14. Effect of IGF-rich colostrum on bowel adaptation in neonatal piglets with short bowel syndrome

    NARCIS (Netherlands)

    Heemskerk, V. H.; van Heurn, L. W. E.; Farla, P.; Buurman, W. A.; Piersma, F.; ter Riet, G.; Heineman, E.

    2002-01-01

    BACKGROUND: Insulin-like growth factor 1 (IGF-1), a polypeptide growth factor with mitogenic effects on intestinal epithelial crypt cells occurs naturally in high concentrations in colostrum. The hypothesis for this study was that colostrum rich in IGF-1 could promote small bowel adaptation in

  15. Optimal use of polyethylene glycol for preparation of small bowel video capsule endoscopy: a network meta-analysis.

    Science.gov (United States)

    Wu, Shan; Gao, Yun-Jie; Ge, Zhi-Zheng

    2017-06-01

    Standardized strategy of bowel preparation before video capsule endoscopy (VCE) remains controversial. This study aimed to assess the ideal dose of PEG, based on small bowel visualization quality (SBVQ), diagnostic yield (DY), and complete rate (CR) of VCE using a network meta-analysis (NMA) of randomized controlled trials (RCTs). This NMA included RCTs comparing any of the following bowel preparation interventions for VCE: fasting overnight ("Fast"), 1 liter PEG ("PEG 1L"), 2-liter PEG ("PEG 2L"), or 4-liter PEG ("PEG 4L"). The authors searched papers in PubMed, Cochrane Library, and Embase as of June 2016. The cumulative ranking (SUCRA) probabilities to rank different doses of PEG and Fast were used. The search engine provided 102 studies. Nine RCTs including 982 patients were incorporated into this analysis. All studies showed low risk of bias of blinding. SUCRA provided an initial ranking among these strategies, in which PEG 2 L showed the best score in SBVQ (PEG 2 L, 89.4%; PEG 1 L, 62.5%; PEG 4 L, 44.0%; Fast, 4.1%) and DY (PEG 2 L, 74.6%; PEG 1 L 28.1%; PEG 4 L 65.9%; Fast 31.4%) of VCE. No significant difference was shown in the analysis of CR. This study recommends PEG 2 L as the ideal dose, which may improve the SBVQ of VCE and, therefore, diagnostic accuracy. Multi-center randomized controlled trials are required to verify these findings.

  16. A Simple Evaluation Tool (ET-CET) Indicates Increase of Diagnostic Skills From Small Bowel Capsule Endoscopy Training Courses

    OpenAIRE

    Albert, J.G.; Humbla, O.; McAlindon, M.E.; Davison, C.; Seitz, U.; Fraser, C.; Hagenm?ller, F.; Noetzel, E.; Spada, C.; Riccioni, M.E.; Barnert, J.; Filmann, N.; Keuchel, M.

    2015-01-01

    Abstract Small bowel capsule endoscopy (SBCE) has become a first line diagnostic tool. Several training courses with a similar format have been established in Europe; however, data on learning curve and training in SBCE remain sparse. Between 2008 and 2011, different basic SBCE training courses were organized internationally in UK (n?=?2), Italy (n?=?2), Germany (n?=?2), Finland (n?=?1), and nationally in Germany (n?=?10), applying similar 8-hour curricula with 50% lectures and 50% hands-on t...

  17. Radiation exposure and examination time during enteroclysis and small bowel follow-through

    International Nuclear Information System (INIS)

    Thoeni, R.F.; Gould, R.G.

    1989-01-01

    The authors have investigated radiation exposures and total examination and fluoroscopy times in enterolysis and small-bowel-follow-through (SBFT). Enteroclysis was performed in 25 patients and SBFT in another 25 (17 with UGI/SBFT and 8 with SBFT alone), with 5 TLD dosimeters placed in areas of the back exposed to primary x-rays during fluoroscopy, spot, and overhead radiography. Skin entry exposures, fluoroscopy, and total examination times in enteroclysis were compared to those in SBFTs. Biphasic enteroclyis was performed, with an average of 18 radiographs per study, SBFT with 16, and UGI/SBFT with 23. Indications and pathology for enteroclysis and SBFT were similar. Detailed findings are presented. The authors conclude that total examination time for enteroclysis is two to three times shorter and skin entry exposure is less than two to three times higher than for SBFT. Higher radiation exposure of enteroclysis should be weighted against very short examination times and reported high accuracy in deciding between enteroclysis and SBFT

  18. Bariumexaminations of the small intestine and the colon in inflammatory bowel disease; Konventionelle Duenn- und Dickdarmdiagnostik bei entzuendlichen Darmerkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Antes, G. [Abteilung fuer Radiologie, Klinikum Kempten-Oberallgaeu g, GmbH, Kempten (Germany)

    2003-01-01

    This article gives an overview of the possibilities of conventional radiography in the diagnosis of inflammatory bowel disease of the small intestine and colon.Material and methods For more than 25 years we examine the small bowel employing enteroclysis with barium and methylcellulose and the colon with the usual double-contrast method. In the last 152 months 1560 small bowel enemas were performed. In the last 40 months 410 examinations of the colon were performed. There is a thirty percent decrease in enteroclysis examinations within the past 5 years,however, the rate of examinations with positive results increased from 46 to 57%.The proportion of the inflammatory small intestinal diseases (not only Crohn's disease) remained constant with 18%.Concerning the examinations of the colon for inflammatory disease we confirmed the diagnosis in seven cases.The radiation exposure for the enteroclysis in inflammatory diseases was 7mSv, for colon examinations 14 mSv. Barium examinations, especially of the stomach and colon are decreasing in frequency.Therefore the art of performance and interpretation might get lost.Enteroclysis, however, is still the method of reference for the other imaging methods.The advantages compared to the other imaging methods are the excellent presentation of the details of the mucosal surface and the observation of functional disorders. (orig.) [German] Zielsetzung Diese Uebersichtsarbeit soll die Moeglichkeiten der konventionellen Roentgendiagnostik an Duenndarm und Kolon bei entzuendlichen Darmerkrankungen aufzeigen.Material und Methoden Seit mehr als 25 Jahren untersuchen wir den Duenndarm mit dem Enteroklysma mit Barium und Methylzellulose und das Kolon mit der ueblichen Doppelkontrastmethode. In den letzten 152 Monaten wurden 1560 Duenndarmuntersuchungen durchgefuehrt. In den letzten 40 Monaten erfolgten 410 Kolonuntersuchungen.Ergebnisse Bei den Duenndarmuntersuchungen wurde in den letzten 5 Jahren ein Rueckgang um 30% beobachtet

  19. CLMP is required for intestinal development, and loss-of-function mutations cause congenital short-bowel syndrome

    NARCIS (Netherlands)

    Van Der Werf, Christine S.; Wabbersen, Tara D.; Hsiao, Nai-Hua; Paredes, Joana; Etchevers, Heather C.; Kroisel, Peter M.; Tibboel, Dick; Babarit, Candice; Schreiber, Richard A.; Hoffenberg, Edward J.; Vekemans, Michel; Zeder, Sirkka L.; Ceccherini, Isabella; Lyonnet, Stanislas; Ribeiro, Ana S.; Seruca, Raquel; Meerman, Gerard J. Te; van Ijzendoorn, Sven C. D.; Shepherd, Iain T.; Verheij, Joke B. G. M.; Hofstra, Robert M. W.

    BACKGROUND & AIMS: Short-bowel syndrome usually results from surgical resection of the small intestine for diseases such as intestinal atresias, volvulus, and necrotizing enterocolitis. Patients with congenital short-bowel syndrome (CSBS) are born with a substantial shortening of the small

  20. SPECT data acquisition and image reconstruction in a stationary small animal SPECT/MRI system

    Science.gov (United States)

    Xu, Jingyan; Chen, Si; Yu, Jianhua; Meier, Dirk; Wagenaar, Douglas J.; Patt, Bradley E.; Tsui, Benjamin M. W.

    2010-04-01

    The goal of the study was to investigate data acquisition strategies and image reconstruction methods for a stationary SPECT insert that can operate inside an MRI scanner with a 12 cm bore diameter for simultaneous SPECT/MRI imaging of small animals. The SPECT insert consists of 3 octagonal rings of 8 MR-compatible CZT detectors per ring surrounding a multi-pinhole (MPH) collimator sleeve. Each pinhole is constructed to project the field-of-view (FOV) to one CZT detector. All 24 pinholes are focused to a cylindrical FOV of 25 mm in diameter and 34 mm in length. The data acquisition strategies we evaluated were optional collimator rotations to improve tomographic sampling; and the image reconstruction methods were iterative ML-EM with and without compensation for the geometric response function (GRF) of the MPH collimator. For this purpose, we developed an analytic simulator that calculates the system matrix with the GRF models of the MPH collimator. The simulator was used to generate projection data of a digital rod phantom with pinhole aperture sizes of 1 mm and 2 mm and with different collimator rotation patterns. Iterative ML-EM reconstruction with and without GRF compensation were used to reconstruct the projection data from the central ring of 8 detectors only, and from all 24 detectors. Our results indicated that without GRF compensation and at the default design of 24 projection views, the reconstructed images had significant artifacts. Accurate GRF compensation substantially improved the reconstructed image resolution and reduced image artifacts. With accurate GRF compensation, useful reconstructed images can be obtained using 24 projection views only. This last finding potentially enables dynamic SPECT (and/or MRI) studies in small animals, one of many possible application areas of the SPECT/MRI system. Further research efforts are warranted including experimentally measuring the system matrix for improved geometrical accuracy, incorporating the co

  1. A Single Session of rTMS Enhances Small-Worldness in Writer’s Cramp: Evidence from Simultaneous EEG-fMRI Multi-Modal Brain Graph

    Directory of Open Access Journals (Sweden)

    Rose D. Bharath

    2017-09-01

    Full Text Available Background and Purpose: Repetitive transcranial magnetic stimulation (rTMS induces widespread changes in brain connectivity. As the network topology differences induced by a single session of rTMS are less known we undertook this study to ascertain whether the network alterations had a small-world morphology using multi-modal graph theory analysis of simultaneous EEG-fMRI.Method: Simultaneous EEG-fMRI was acquired in duplicate before (R1 and after (R2 a single session of rTMS in 14 patients with Writer’s Cramp (WC. Whole brain neuronal and hemodynamic network connectivity were explored using the graph theory measures and clustering coefficient, path length and small-world index were calculated for EEG and resting state fMRI (rsfMRI. Multi-modal graph theory analysis was used to evaluate the correlation of EEG and fMRI clustering coefficients.Result: A single session of rTMS was found to increase the clustering coefficient and small-worldness significantly in both EEG and fMRI (p < 0.05. Multi-modal graph theory analysis revealed significant modulations in the fronto-parietal regions immediately after rTMS. The rsfMRI revealed additional modulations in several deep brain regions including cerebellum, insula and medial frontal lobe.Conclusion: Multi-modal graph theory analysis of simultaneous EEG-fMRI can supplement motor physiology methods in understanding the neurobiology of rTMS in vivo. Coinciding evidence from EEG and rsfMRI reports small-world morphology for the acute phase network hyper-connectivity indicating changes ensuing low-frequency rTMS is probably not “noise”.

  2. MRI: Imaging of stomach

    International Nuclear Information System (INIS)

    Lam, W. W. M; Lee, J. S. W.; Ho, G.

    2007-01-01

    Full text: The study is to determine the optimal MRI bowel preparation regime for visualization of the stomach anatomy, Eight healthy volunteers were asked to take water, 75% barium and blueberry juice. The image quality and tolerance of different stomach distension regime were evaluated. Blueberry juice gave the best distension, but the signal intensity was not very homogeneous. Taking into account the image quality, tolerability and adverse effects, it is concluded that water is the most desirable oral contrast for MR stomach imaging

  3. MR of the small bowel with a biphasic oral contrast agent (polyethylene glycol): technical aspects and findings in patients affected by Crohn's disease.

    Science.gov (United States)

    Laghi, Andrea; Paolantonio, Pasquale; Iafrate, Franco; Borrelli, Osvaldo; Dito, Lucia; Tomei, Ernesto; Cucchiara, Salvatore; Passariello, Roberto

    2003-01-01

    To report our experience using MR of the small bowel with polyethylene glycol (PEG) solution as an oral contrast agent in a population of adults and children with known Crohn's disease. 40 patients (29 males; 11 females), 15 adults (age range 24-52 years) and 25 children (age range 5-17 years), with known Crohn's disease, underwent MR of the small bowel using a supeconductive 1.5 T magnet, and polyethylene glycol solution as an oral contrast agent. The fixed amount of contrast agent was 750-1000 ml for adults and 10 ml/kg of body weight for children. The Crohn's Disease Activity Index (CDAI) was available in all patients. Our study protocol included the acquisition of T2-weighted half-Fourier single-shot turbo spin-echo (HASTE) sequences and true fast imaging in the steady-state precession (true-FISP) sequences, followed by the acquisition of "spoiled" 2D gradient echo T1-weighted sequences with fat suppression (FLASH, fast low-angle shot) or alternatively "spoiled" 3D (VIBE, volume interpolated breath-hold examination), acquired 70 seconds after intravenous administration of gadopentetate dimeglumine (Gd-DTPA) (0,1 mmol/kg). A specific MR score was created and calculated for each patient and was compared by means of the Spearman rank with CDAI. In all patients no significant side effects were observed and the MR examination was well tolerated even by paediatric patients. In all cases MR showed a small bowel wall thickening (> 4 mm) in the terminal ileum, with lumen stenosis in 26 patients. In 3 cases pathological segments proximal to the terminal ileum were observed and in another 3 cases caecal involvement was visible. The MR examination was able to show abnormalities of perivisceral fat tissue in 15 patients, mesenteric lymphadenopathy in 1 patient and abdominal abscess in 1 case. The Spearman rank showed a statistically significant correlation between CDAI and the MR score (r = 0.91, P = 0,0001). MR using PEG as an oral contrast agent could be considered a test

  4. Laparoscopic management of a small bowel obstruction secondary to Elipse intragastric balloon migration: A case report

    Directory of Open Access Journals (Sweden)

    Saud Al-Subaie

    Full Text Available Introduction: The Elipse™ intragastric balloon (IGB for weight loss is a swallowable capsule that is filled with 550 mL of fluid and resides in the stomach for four months before being excreted from the gastrointestinal tract. Although initial data showed that use of this device is safe and free from serious complications, we report for the first time the successful management of an Elipse™ IGB-related adverse event. Presentation of case: A 41-year-old woman presented to our emergency department following two days of abdominal pain, vomiting, and constipation. Her medical history included four caesarean sections and insertion of the Elipse™ IGB 16 weeks prior to presentation. The patient was vitally stable at presentation and abdominal examination revealed a mildly distended abdomen. Plain X-ray revealed a small bowel obstruction (SBO, and a double contrast computed tomography scan showed a dilated small bowel with mild free fluid proximal to a transition zone at the distal jejunum. Laparoscopic enterotomy was performed just proximal to the obstruction site, and the balloon was visualized and extracted after it had been incised and emptied. The enterotomy incision was closed with an intracorporeal continuous absorbable suture. The patient’s recovery was uneventful and she was discharged on postoperative day 4. Discussion: We discuss the possible etiologies of SBO following Elipse™ IGB insertion, and present a brief literature review regarding surgical and nonsurgical management options for such cases. Conclusion: Although initial data showed the Elipse™ IGB to be safe, complications can occur and be managed successfully. Keywords: Elipse, Intragastric balloon, Capsule, Obesity, Case report

  5. 14C-lactose breath tests during pelvic radiotherapy: the effect of the amount of small bowel irradiated

    International Nuclear Information System (INIS)

    Weiss, R.G.; Stryker, J.A.

    1982-01-01

    Thirty patients who were undergoing pelvic radiotherapy had 14 C-lactose breath tests performed in the first and fifth weeks of treatment. In Group I (21 patients), a significant portion of the small intestine was irradiated, and in Group II (9 patients), only a small portion of the small intestine was irradiated. In Group I, the average reductions in the excretion of ingested 14 C between the first- and fifth-week tests were 41.5% at 1/2 hour postingestion (p less than 0.05), and 21.8% at 1 hour postingestion (p less than 0.05). In Group II, the percentage reductions were 11.8% and 3.7% at 1/2 and 1 hour, respectively (p greater than 0.05). The data suggest that lactose malabsorption is a factor in the etiology of the nausea, vomiting, and diarrhea experienced by patients who are undergoing pelvic radiotherapy, and that the amount of bowel included in the treatment volume significantly influences the degree of malabsorption

  6. Surgical intervention for complications caused by late radiation damage of the small bowel; a retrospective analysis

    International Nuclear Information System (INIS)

    Halteren, H.K. van; Gortzak, E.; Taal, B.G.; Helmerhorst, Th.J.M.; Aleman, B.M.P.; Hart, A.A.M.; Zoetmulder, F.A.N.

    1993-01-01

    The authors studied the records of 46 patients who had been operated on between 1974 and 1990 in the Netherlands Cancer Institute because of complications due to late radiation damage of the small bowel. The following factors led to an increase in complication-risk: hypalbuminemia. more than one laparotomy prior to irradiation and a short interval (< 12 months) between irradiation and surgical intervention. The following factors related to a poorer survival: incomplete resection of the primary tumor and a short interval (< 12 months) between irradiation and surgical intervention. The type f surgical intervention did not have cumulative prognostic value in relation to complication-risk or survival. (author)

  7. Intra-abdominal fibrosis in a recent cohort of patients with neuroendocrine ('carcinoid') tumours of the small bowel.

    Science.gov (United States)

    Druce, M R; Bharwani, N; Akker, S A; Drake, W M; Rockall, A; Grossman, A B

    2010-03-01

    Fibrosis is a hallmark of neuroendocrine tumours (NETs) arising in the jejunum and ileum and may manifest in the mesentery and elsewhere. It is clinically important and once-established, there are few effective therapies. To examine the frequency, radiological manifestations and clinical significance of intra-abdominal fibrosis in a patient cohort using modern cross-sectional imaging. Current prevalence is compared to historical series and correlation with cardiac fibrosis evaluated. Cross-sectional, retrospective survey of a cohort of patients with mid-gut NETs from a single centre. Review of clinical features, biochemistry and imaging of patients with sporadic mid-gut NET and available imaging between 2002 and 2008. Thirty-one patients were included: 26 (83.9%) had liver metastases and 11 (35.4%) had small-bowel wall thickening; 17 patients (55%) had mesenteric involvement, with a mass, which contained coarse calcification in seven patients and fine calcification in a further two. There was soft-tissue stranding in 13 patients (plus in a further patient with no mass) and 'indrawing' of tissues in 11 patients. Two patients had a 'misty' mesentery and two had early retroperitoneal fibrosis. Mesenteric involvement was unrelated to gender and urinary 5HIAA excretion. Intra-abdominal fibrosis can be detected radiologically in around half of patients with mid-gut NET using contemporary cross-sectional imaging. Although not statistically significant, small-bowel obstruction was seen more frequently in the group with fibrosis. There was no relationship with cardiac fibrosis. Prospective studies are needed to evaluate predictors of fibrosis onset and clinical course and determine optimal methods of prevention and treatment.

  8. Seatbelt injury causing small bowel devascularisation: case series and review of the literature.

    LENUS (Irish Health Repository)

    O'Dowd, Vincent

    2012-01-31

    The use of seatbelts has increased significantly in the last twenty years, leading to a decrease in mortality from road traffic accidents (RTA). However, this increase in seatbelt use has also led to a change in the spectrum of injuries from RTA; abdominal injuries, particularly intestinal injuries have dramatically increased with the routine use of seatbelts. Such intestinal injuries frequently result from improper placement of the "lap belt". We present 3 cases in which passengers wearing a seatbelt sustained significant devascularisation injuries to the small bowel requiring emergency surgical intervention. A high index of suspicion is crucial in such cases to prevent delays in diagnosis that can lead to severe complications and adverse outcomes. It is evident that while advocating seatbelt use, the importance of education in correct seatbelt placement should also be a focus of public health strategies to reduce RTA morbidity and mortality.

  9. Incidence of bloodstream infections in small bowel transplant recipients receiving selective decontamination of the digestive tract: A single-center experience.

    Science.gov (United States)

    Galloway, David; Danziger-Isakov, Lara; Goldschmidt, Monique; Hemmelgarn, Trina; Courter, Joshua; Nathan, Jaimie D; Alonso, Maria; Tiao, Greg; Fei, Lin; Kocoshis, Samuel

    2015-11-01

    Pediatric patients undergoing small bowel transplantation are susceptible to postoperative CLABSI. SDD directed against enteric microbes is a strategy for reducing CLABSI. We hypothesized that SDD reduces the frequency of CLABSI, infections outside the bloodstream, and allograft rejection during the first 30 days following transplant. A retrospective chart review of 38 pediatric small bowel transplant recipients at CCHMC from 2003 to 2011 was conducted. SDD antimicrobials were oral colistin, tobramycin, and amphotericin B. The incidence of CLABSI, infections outside the bloodstream, and rejection episodes were compared between study periods. The incidence of CLABSI did not differ between study periods (6.9 CLABSI vs. 4.6 CLABSI per 1000 catheter days; p = 0.727), but gram positives and Candida predominated in the first 30 days. Incidence of bacterial infections outside the bloodstream did not differ (p = 0.227). Rejection occurred more frequently during the first month following transplant (p = 0.302). SDD does not alter the incidence of CLABSI, bacterial infections outside the bloodstream, or allograft rejection in the immediate 30 days post-transplantation. However, SDD does influence CLABSI organism types (favoring gram positives and Candida) and Candidal infections outside the bloodstream. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Does vasoactive intestinal polypeptide mediate the pathophysiology of bowel obstruction?

    Science.gov (United States)

    Basson, M D; Fielding, L P; Bilchik, A J; Zucker, K A; Ballantyne, G H; Sussman, J; Adrian, T E; Modlin, I M

    1989-01-01

    We hypothesized that bioactive peptides might be released into the portal circulation and mediate pathophysiologic alterations accompanying small bowel obstruction. We studied this question in a subacute canine small bowel obstruction model using 50 percent diameter occlusion. Control animals underwent sham laparotomy. Vasoactive intestinal peptide (VIP), peptide YY, and gastrin were measured in portal and systemic plasma by specific radioimmunoassays at 24-hour intervals as the obstruction progressed to completion over 5 days. All peptides in both groups demonstrated portal and peripheral gradients. In control dogs, peptide concentrations did not change postoperatively but VIP increased markedly in obstructed dogs, demonstrating a median portal level of 95 pmol/liter at 96 hours compared with 31.5 pmol/liter in control animals. These portal VIP levels are known to cause hypersecretion and splanchnic vasodilation in experimental models. The release of vasoactive compounds such as VIP may mediate local pathophysiology in human small bowel obstruction. A similar explanation of the systemic effects is consistent with the known cardiopulmonary bioactivity of VIP.

  11. Magnetic resonance imaging of the bowel. Today and tomorrow; Magnetresonanztomografie des Darms. Altbewaehrtes und Innovatives

    Energy Technology Data Exchange (ETDEWEB)

    Kinner, S.; Hahnemann, M.L.; Forsting, M.; Lauenstein, T.C. [Univ. Hospital Essen (Germany). Dept. of Diagnostic and Interventional Radiology and Neuroradiology

    2015-03-15

    Magnetic resonance imaging of the small bowel has been feasible for more than 15 years. This review is meant to give an overview of typical techniques, sequences and indications. Furthermore, newly evaluated promising techniques are presented, which have an impact on the advance of MR imaging of the small and large bowel.

  12. Electrocautery-induced localized colonic injury elicits increased levels of pro-inflammatory cytokines in small bowel and decreases jejunal alanine absorption.

    Science.gov (United States)

    Barada, Kassem; Mourad, Fadi H; Noutsi, Bakiza; Saadé, Nayef E

    2015-01-01

    Colitis is associated with functional abnormalities in proximal non-inflamed gut areas, but animal models to study small bowel dysfunction in colitis have limitations. This study aims to determine small intestinal alanine absorption and cytokine expression in a novel model of colonic ulceration induced by electro-cautery. A descending colon ulcer was induced in rats by a bipolar electro-cautery probe. Ulcer score was determined using Satoh's criteria. Jejunal alanine absorption was measured immediately and at different time intervals post ulcer induction. Levels of interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) protein and m-RNA were determined in mucosal scrapings obtained from the colon, duodenum, jejunum and ileum at various time intervals after colonic ulcer induction. The mean ulcer score was 3 up to 48h, followed by healing by 96h post ulcer induction. Small bowel histology was normal throughout. Jejunal alanine absorption was reduced by 12-34% immediately and up to 72h after cautery and returned to normal at 96h. IL-1 and TNF-α mRNA increased significantly in the colon, duodenum, jejunum and ileum 3h post electro-cautery and returned to normal at 48h, while that of IL-6 increased significantly at 48h post ulcer induction. Similarly, IL-1, IL-6 and TNF-α protein levels increased in the duodenum, jejunum, ileum and colon up to 48h post ulcer induction. Electrically induced localized colonic injury increased production of pro-inflammatory cytokines in non-inflamed segments of the small intestine and was associated with derangements of jejunal absorptive function. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Advances in MRI for colorectal cancer and bowel motility

    NARCIS (Netherlands)

    van der Paardt, M.P.

    2015-01-01

    In the first part of this thesis certain aspects of MRI in the evaluation of colorectal cancer and its precursors, and restaging of rectal cancer were addressed. The current status of MR colonography regarding the different preparation techniques as well as the imaging sequences and colon distension

  14. Comparison of gadolinium-EOB-DTPA-enhanced and diffusion-weighted liver MRI for detection of small hepatic metastases.

    Science.gov (United States)

    Shimada, Kotaro; Isoda, Hiroyoshi; Hirokawa, Yuusuke; Arizono, Shigeki; Shibata, Toshiya; Togashi, Kaori

    2010-11-01

    To compare the accuracy of gadolinium ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI with that of diffusion-weighted MRI (DWI) in the detection of small hepatic metastases (2 cm or smaller). Forty-five patients underwent abdominal MRI at 3 T, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), heavily T2WI (HASTE), DWI with a b-value of 500 s/mm(2) and contrast-enhanced MRI with Gd-EOB-DTPA. Two groups were assigned and compared: group A (T1WI, T2WI, HASTE and contrast-enhanced study with Gd-EOB-DTPA), and group B (T1WI, T2WI, HASTE and DWI). Two observers independently interpreted the images obtained in a random order. For all hepatic metastases, the diagnostic performance using each imaging set was evaluated by receiver-operating characteristic (ROC) curve analysis. A total of 51 hepatic metastases were confirmed. The area under the ROC curve (Az) of group A was larger than that of group B, and the difference in the mean Az values between the two image sets was statistically significant, whereas, there were three metastases that lay near thin vessels or among multiple cysts and were better visualised in group B than in group A. Gd-EOB-DTPA-enhanced MRI showed higher accuracy in the detection of small metastases than DWI.

  15. Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction

    Directory of Open Access Journals (Sweden)

    Zuhal Ozisler

    2015-01-01

    Full Text Available In this study, we aimed to determine gastrointestinal problems associated with neurogenic bowel dysfunction in spinal cord injury patients and to assess the efficacy of bowel program on gastrointestinal problems and the severity of neurogenic bowel dysfunction. Fifty-five spinal cord injury patients were included in this study. A bowel program according to the characteristics of neurogenic bowel dysfunction was performed for each patient. Before and after bowel program, gastrointestinal problems (constipation, difficult intestinal evacuation, incontinence, abdominal pain, abdominal distension, loss of appetite, hemorrhoids, rectal bleeding and gastrointestinal induced autonomic dysreflexia and bowel evacuation methods (digital stimulation, oral medication, suppositories, abdominal massage, Valsalva maneuver and manual evacuation were determined. Neurogenic bowel dysfunction score was used to assess the severity of neurogenic bowel dysfunction. At least one gastrointestinal problem was identified in 44 (80% of the 55 patients before bowel program. Constipation (56%, 31/55 and incontinence (42%, 23/55 were the most common gastrointestinal problems. Digital rectal stimulation was the most common method for bowel evacuation, both before (76%, 42/55 and after (73%, 40/55 bowel program. Oral medication, enema and manual evacuation application rates were significantly decreased and constipation, difficult intestinal evacuation, abdominal distention, and abdominal pain rates were significantly reduced after bowel program. In addition, mean neurogenic bowel dysfunction score was decreased after bowel program. An effective bowel program decreases the severity of neurogenic bowel dysfunction and reduces associated gastrointestinal problems in patients with spinal cord injury.

  16. An unusual white blood cell scan in a child with inflammatory bowel disease: a case report.

    Science.gov (United States)

    Porn, U; Howman-Giles, R; O'Loughlin, E; Uren, R; Chaitow, J

    2000-10-01

    Technetium-99m-labeled leukocyte (WBC) imaging is a valuable screening method for inflammatory bowel disease, especially in children, because of its high rate of sensitivity, low cost, and ease of preparation. A 14-year-old girl is described who had juvenile arthritis and iritis complicated by inflammatory bowel disease. She was examined for recurrent abdominal pain. A Tc-99m stannous colloid WBC scan was performed, and tracer accumulation was seen in the small bowel in the region of the distal ileum on the initial 1-hour image. Delayed imaging at 3 hours also revealed tracer accumulation in the cecum and ascending colon, which was not seen on the early image. A biopsy of the colon during endoscopy showed no evidence of active inflammation in the colon. The small bowel was not seen. Computed tomography revealed changes suggestive of inflammatory bowel disease in the distal ileum. The appearance on the WBC study was most likely a result of inflammatory bowel disease involving the distal ileum, with transit of luminal activity into the large bowel.

  17. Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction.

    Science.gov (United States)

    Musiienko, Anton M; Shakerian, Rose; Gorelik, Alexandra; Thomson, Benjamin N J; Skandarajah, Anita R

    2016-10-01

    The acute surgical unit (ASU) is a recently established model of care in Australasia and worldwide. Limited data are available regarding its effect on the management of small bowel obstruction. We compared the management of small bowel obstruction before and after introduction of ASU at a major tertiary referral centre. We hypothesized that introduction of ASU would correlate with improved patient outcomes. A retrospective review of prospectively maintained databases was performed over two separate 2-year periods, before and after the introduction of ASU. Data collected included demographics, co-morbidity status, use of water-soluble contrast agent and computed tomography. Outcome measures included surgical intervention, time to surgery, hospital length of stay, complications, 30-day readmissions, use of total parenteral nutrition, intensive care unit admissions and overall mortality. Total emergency admissions to the ASU increased from 2640 to 4575 between the two time periods. A total of 481 cases were identified (225 prior and 256 after introduction of ASU). Mortality decreased from 5.8% to 2.0% (P = 0.03), which remained significant after controlling for confounders with multivariate analysis (odds ratio = 0.24, 95% confidence interval 0.08-0.73, P = 0.012). The proportion of surgically managed patients increased (20.9% versus 32.0%, P = 0.003) and more operations were performed within 5 days from presentation (76.6% versus 91.5%, P = 0.02). Fewer patients received water-soluble contrast agent (27.1% versus 18.4%, P = 0.02), but more patients were investigated with a computed tomography (70.7% versus 79.7%, P = 0.02). The ASU model of care resulted in decreased mortality, shorter time to intervention and increased surgical management. Overall complications rate and length of stay did not change. © 2015 Royal Australasian College of Surgeons.

  18. Ultrasound of the Small Bowel in Crohn’s Disease

    Directory of Open Access Journals (Sweden)

    Emma Calabrese

    2012-01-01

    Full Text Available Several radiological and endoscopic techniques are now available for the study of inflammatory bowel diseases. In everyday practice, the choice of the technique to be used depends upon its availability and a careful evaluation of diagnostic accuracy, clinical usefulness, safety, and cost. The recent development of innovative and noninvasive imaging techniques has led to a new and exciting area in the exploration of the gastrointestinal tract, especially in Crohn’s disease patients by using ultrasound with oral or intravenous contrast.

  19. Imaging tools to study pharmacology: functional MRI on small rodents

    Directory of Open Access Journals (Sweden)

    Elisabeth eJonckers

    2015-10-01

    Full Text Available Functional Magnetic Resonance Imaging (fMRI is an excellent tool to study the effect of pharmacological modulations on brain function in a non-invasive and longitudinal manner. We introduce several blood oxygenation level dependent (BOLD fMRI techniques, including resting state (rsfMRI, stimulus-evoked (st-fMRI, and pharmacological MRI (phMRI. Respectively, these techniques permit the assessment of functional connectivity during rest as well as brain activation triggered by sensory stimulation and/or a pharmacological challenge. The first part of this review describes the physiological basis of BOLD fMRI and the hemodynamic response on which the MRI contrast is based. Specific emphasis goes to possible effects of anaesthesia and the animal’s physiological conditions on neural activity and the hemodynamic response. The second part of this review describes applications of the aforementioned techniques in pharmacologically-induced, as well as in traumatic and transgenic disease models and illustrates how multiple fMRI methods can be applied successfully to evaluate different aspects of a specific disorder. For example, fMRI techniques can be used to pinpoint the neural substrate of a disease beyond previously defined hypothesis-driven regions-of-interest (ROIs. In addition, fMRI techniques allow one to dissect how specific modifications (e.g. treatment, lesion etc. modulate the functioning of specific brain areas (st-fMRI, phMRI and how functional connectivity (rsfMRI between several brain regions is affected, both in acute and extended time frames. Furthermore, fMRI techniques can be used to assess/explore the efficacy of novel treatments in depth, both in fundamental research as well as in preclinical settings. In conclusion, by describing several exemplary studies, we aim to highlight the advantages of functional MRI in exploring the acute and long-term effects of pharmacological substances and/or pathology on brain functioning along with

  20. Imaging tools to study pharmacology: functional MRI on small rodents

    OpenAIRE

    Elisabeth eJonckers; Disha eShah; Julie eHamaide; Marleen eVerhoye; Annemie eVan Der Linden

    2015-01-01

    Functional Magnetic Resonance Imaging (fMRI) is an excellent tool to study the effect of pharmacological modulations on brain function in a non-invasive and longitudinal manner. We introduce several blood oxygenation level dependent (BOLD) fMRI techniques, including resting state (rsfMRI), stimulus-evoked (st-fMRI), and pharmacological MRI (phMRI). Respectively, these techniques permit the assessment of functional connectivity during rest as well as brain activation triggered by sensory stimu...

  1. Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes.

    Science.gov (United States)

    Schulmann, Karsten; Hollerbach, Stephan; Kraus, Katja; Willert, Jörg; Vogel, Tilman; Möslein, Gabriela; Pox, Christian; Reiser, Markus; Reinacher-Schick, Anke; Schmiegel, Wolff

    2005-01-01

    At present, surveillance of premalignant small bowel polyps in hereditary polyposis syndromes has a number of limitations. Capsule endoscopy (CE) is a promising new method to endoscopically assess the entire length of the small bowel. We prospectively examined 40 patients with hereditary polyposis syndromes (29 familial adenomatous polyposis (FAP), 11 Peutz-Jeghers syndrome (PJS)). Results were compared with push-enteroscopy (PE) results in FAP and with esophagogastroduodenoscopy, PE, (MR)-enteroclysis, and surgical specimen in PJS patients. A total of 76% of the patients with FAP with duodenal adenomas (n = 21) had additional adenomas in the proximal jejunum that could be detected by CE and PE. Moreover, 24% of these FAP patients had further polyps in the distal jejunum or ileum that could only be detected by CE. In contrast, in FAP patients without duodenal polyps (n = 8), jejunal or ileal polyps occurred rarely (12%). CE detected polyps in 10 of 11 patients with PJS, a rate superior to all other reference procedures employed. Importantly, the findings of CE had immediate impact on further clinical management in all PJS patients. Our results suggest that CE may be of clinical value in selected patients with FAP, whereas in PJS, CE could be used as first line surveillance procedure.

  2. Early small-bowel ischemia: dual-energy CT improves conspicuity compared with conventional CT in a swine model.

    Science.gov (United States)

    Potretzke, Theodora A; Brace, Christopher L; Lubner, Meghan G; Sampson, Lisa A; Willey, Bridgett J; Lee, Fred T

    2015-04-01

    To compare dual-energy computed tomography (CT) with conventional CT for the detection of small-bowel ischemia in an experimental animal model. The study was approved by the animal care and use committee and was performed in accordance with the Guide for Care and Use of Laboratory Animals issued by the National Research Council. Ischemic bowel segments (n = 8) were created in swine (n = 4) by means of surgical occlusion of distal mesenteric arteries and veins. Contrast material-enhanced dual-energy CT and conventional single-energy CT (120 kVp) sequences were performed during the portal venous phase with a single-source fast-switching dual-energy CT scanner. Attenuation values and contrast-to-noise ratios of ischemic and perfused segments on iodine material-density, monospectral dual-energy CT (51 keV, 65 keV, and 70 keV), and conventional 120-kVp CT images were compared. Linear mixed-effects models were used for comparisons. The attenuation difference between ischemic and perfused segments was significantly greater on dual-energy 51-keV CT images than on conventional 120-kVp CT images (mean difference, 91.7 HU vs 47.6 HU; P conventional CT by increasing attenuation differences between ischemic and perfused segments on low-kiloelectron volt and iodine material density images. © RSNA, 2014.

  3. [Myeloid sarcoma of the small bowel with inversion of chromosome 16: a description of 3 clinical cases].

    Science.gov (United States)

    Gavrilina, O A; Bariakh, E A; Parovichnikova, E N; Troitskaia, V V; Zvonkov, E E; Kravchenko, S K; Sinitsyna, M N; Obukhova, T N; Gitis, M K; Savchenko, V G

    2014-01-01

    Myeloid sarcoma (MS) is a rare malignant solid tumor presented with myeloid blast cells showing varying degrees of maturation. MS may have an extramedullary site, precede, or develop simultaneously with the clinical manifestations of acute myeloid leukemia (AML); it may also occur as an AML relapse. Besides AML, MS may be a manifestation of chronic myeloid leukemia or other chronic myeloproliferative diseases. Due to the fact that this disease is rare, the bulk of the literature on MS is presented with single descriptions of retrospective studies and clinical cases. The paper describes 3 cases of MS with inversion of chromosome 16 and small bowel lesion.

  4. Value of MDCT and Clinical and Laboratory Data for Predicting the Need for Surgical Intervention in Suspected Small-Bowel Obstruction.

    Science.gov (United States)

    Scrima, Andrew; Lubner, Meghan G; King, Scott; Pankratz, Joshua; Kennedy, Gregory; Pickhardt, Perry J

    2017-04-01

    The purpose of this article is to assess the value of a large panel of clinical and MDCT variables in patients with suspected small-bowel obstruction (SBO) for predicting urgent surgical intervention (data were abstracted from electronic medical record review. Univariate and multivariate analyses were performed. Among all 179 patients with suspected SBO, 56 (31.3%) underwent surgical intervention within 72 hours, 10 (5.6%) had ischemia at surgery, and nine (5.0%) required small-bowel resection. On univariate analysis, multiple CT findings were highly significant (p < 0.01) for predicting the main surgical outcomes, including degree of obstruction, 5-point radiology likelihood scores, and the presence of a transition point, closed loop, and mesenteric congestion. None of the objective clinical or laboratory variables (including serum lactate level) reached this level of significance. At multivariate analysis, forward stepwise logistic regression with 0.05 significance level cutoff included both degree of obstruction (p < 0.001) and closed loop (p < 0.01), with the presence of a transition point showing a trend toward significance (p = 0.081). A number of findings at abdominal MDCT are associated with the need for surgery and other important surgical outcomes in patients with suspected SBO. Overall radiologist impression of need for surgical intervention was a better predictor than any clinical or laboratory parameter.

  5. Whole-bowel transit in patients with the irritable bowel syndrome

    International Nuclear Information System (INIS)

    Hardy, J.G.; Clark, A.G.; Wood, E.; Reynolds, J.R.

    1986-01-01

    The transit of radiolabelled preparations through the stomach, small intestine and colon was monitored in ten patients with the irritable bowel syndrome. Five patients complained of diarrhoea, and five complained of constipation. The preparations comprised a non-disintegrating capsule and a multiparticulate system. Both preparations emptied from the stomach together and at the same rates in both groups of patients. In the patients complaining of constipation, the transit times through the small intestine were the same for both preparations. In the patients complaining of diarrhoea, the capsule passed through the small intestine slightly faster than the particles, but there were no significant differences in the small-intestinal transit rates of the two patient groups. Within the colon, the transit of the capsule was faster than that of the small particles. Although movement through the colon was, on average, faster in the group of patients complaining of diarrhoea, there was considerable intersubject variability, and the differences in transit rates between the two patient groups were not statistically significant. (orig.)

  6. Whole-bowel transit in patients with the irritable bowel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Hardy, J.G.; Clark, A.G.; Wood, E.; Reynolds, J.R.

    1986-02-01

    The transit of radiolabelled preparations through the stomach, small intestine and colon was monitored in ten patients with the irritable bowel syndrome. Five patients complained of diarrhoea, and five complained of constipation. The preparations comprised a non-disintegrating capsule and a multiparticulate system. Both preparations emptied from the stomach together and at the same rates in both groups of patients. In the patients complaining of constipation, the transit times through the small intestine were the same for both preparations. In the patients complaining of diarrhoea, the capsule passed through the small intestine slightly faster than the particles, but there were no significant differences in the small-intestinal transit rates of the two patient groups. Within the colon, the transit of the capsule was faster than that of the small particles. Although movement through the colon was, on average, faster in the group of patients complaining of diarrhoea, there was considerable intersubject variability, and the differences in transit rates between the two patient groups were not statistically significant. (orig.).

  7. Acquired Epidermodysplasia Verruciformis Associated with Human Papilloma Virus Type 14 in a Small Bowel Transplanted Child--A Case Report.

    Science.gov (United States)

    Hirschman, Derek; Tacastacas, Joselin; Rady, Peter L; Tyring, Stephen K; Cooper, Kevin; Honda, Kord

    2016-01-01

    A 3-year-old African American girl taking sirolimus and tacrolimus for a small bowel transplantation presented with hypopigmented macules and papules throughout her trunk. A biopsy diagnosed epidermodysplasia verruciformis (EV) that was found to be associated with human papillomavirus (HPV) type 14 according to polymerase chain reaction analysis. There are few cases of acquired EV in the setting of organ transplantation. Although there is no standardized treatment for acquired EV, prevention and surveillance for transformation to squamous cell carcinoma are primary concerns. © 2015 Wiley Periodicals, Inc.

  8. The Effects of Distention and Obstruction on the Accumulation of Fluid in the Lumen of Small Bowel of Dogs

    Science.gov (United States)

    Mishra, Nand K.; Appert, Hubert E.; Howard, John M.

    1974-01-01

    Fluid accumulation in either the obstructed upper or lower intestinal segments of the dog was found in most animals to be negligible. Distention pressures of 25 cm of water tended to reduce fluid accumulation within the intestinal lumen. These studies suggest that if the dog is comparable to man, the intraluminal accumulation of fluid in the obstructed small bowel of man might be due to alterations in blood supply to the intestine, rather than to obstruction per se, or the accumulated fluid originates proximal to the jejunum. PMID:4419581

  9. Capsule Endoscopy for Ileitis with Potential Involvement of Other Sections of the Small Bowel

    Directory of Open Access Journals (Sweden)

    Hyun Seok Lee

    2016-01-01

    Full Text Available Ileitis is defined as inflammation of the ileum. This condition includes ulcers, aphthous ulcers, erosions, and nodular or erythematous mucosa. Various etiologies are associated with ileitis. Crohn’s disease, ulcerative colitis, medications such as nonsteroidal anti-inflammatory drugs, infectious conditions, neoplasms, infiltrative disorders, vasculitides, spondyloarthritis, endometriosis, and radiation therapy-related conditions involve the ileum. However, the differential diagnosis of terminal ileitis can be difficult in many cases. Video capsule endoscopy (VCE has become a useful tool for the diagnosis of a variety of small bowel lesions. This review describes each of the various conditions associated with ileitis and the diagnostic value of VCE for ileitis, which may help identify and evaluate these conditions in clinical practice. Based on the information provided by VCE, a definitive diagnosis could be made using the patients’ medical history, clinical course, laboratory and ileocolonoscopic findings, radiologic imaging findings, and histologic findings.

  10. Usefulness of bowel sound auscultation: a prospective evaluation.

    Science.gov (United States)

    Felder, Seth; Margel, David; Murrell, Zuri; Fleshner, Phillip

    2014-01-01

    Although the auscultation of bowel sounds is considered an essential component of an adequate physical examination, its clinical value remains largely unstudied and subjective. The aim of this study was to determine whether an accurate diagnosis of normal controls, mechanical small bowel obstruction (SBO), or postoperative ileus (POI) is possible based on bowel sound characteristics. Prospectively collected recordings of bowel sounds from patients with normal gastrointestinal motility, SBO diagnosed by computed tomography and confirmed at surgery, and POI diagnosed by clinical symptoms and a computed tomography without a transition point. Study clinicians were instructed to categorize the patient recording as normal, obstructed, ileus, or not sure. Using an electronic stethoscope, bowel sounds of healthy volunteers (n = 177), patients with SBO (n = 19), and patients with POI (n = 15) were recorded. A total of 10 recordings randomly selected from each category were replayed through speakers, with 15 of the recordings duplicated to surgical and internal medicine clinicians (n = 41) blinded to the clinical scenario. The sensitivity, positive predictive value, and intra-rater variability were determined based on the clinician's ability to properly categorize the bowel sound recording when blinded to additional clinical information. Secondary outcomes were the clinician's perceived level of expertise in interpreting bowel sounds. The overall sensitivity for normal, SBO, and POI recordings was 32%, 22%, and 22%, respectively. The positive predictive value of normal, SBO, and POI recordings was 23%, 28%, and 44%, respectively. Intra-rater reliability of duplicated recordings was 59%, 52%, and 53% for normal, SBO, and POI, respectively. No statistically significant differences were found between the surgical and internal medicine clinicians for sensitivity, positive predictive value, or intra-rater variability. Overall, 44% of clinicians reported that they rarely listened

  11. Prevalence and Risk of Inflammatory Bowel Disease in Patients with Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Jemec, Gregor B.E.; Kimball, Alexa B.

    2017-01-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. In small studies, inflammatory bowel disease has been associated with the increased prevalence of HS, but the data on the concurrence of inflammatory bowel disease in patients with HS are limited. We therefore investigated...

  12. Biodistribution of the radiopharmaceutical sodium pertechnetate (Na99mTcO4) after massive small bowel resection in rats

    International Nuclear Information System (INIS)

    Chacon, Damaso de Araujo; Araujo-Filho, Irami; Villarim-Neto, Arthur; Brandao-Neto, Jose; Medeiros, Aldo Cunha; Rego, Amalia Cinthia Meneses; Azevedo, Italo Medeiros; Bernardo-Filho, Mario

    2007-01-01

    Purpose: To evaluate the biodistribution of sodium pertechnetate (Na 99m TcO 4 ) in organs and tissues, the morphometry of remnant intestinal mucosa and ponderal evolution in rats subjected to massive resection of the small intestine. Methods:Twenty-one Wistar rats were randomly divided into three groups of 7 animals each. The short bowel (SB) group was subjected to massive resection of the small intestine; the control group (C) rats were not operated on, and soft intestinal handling was performed in sham rats. The animals were weighed weekly. On the 30th postoperative day, 0.1 mL of Na 99m TcO 4 , with mean activity of 0.66 MBq was injected intravenously into the orbital plexus. After 30 minutes, the rats were killed with an overdose of anesthetic, and fragments of the liver, spleen, pancreas, stomach, duodenum, small intestine, thyroid, lung, heart, kidney, bladder, muscle, femur and brain were harvested. The biopsies were washed with 0.9% NaCl.,The radioactivity was counted using Gamma Counter Wizard TM 1470, Perkin-Elmer. The percentage of radioactivity per gram of tissue (%ATI/g) was calculated. Biopsies of the remaining jejunum were analysed by HE staining to obtain mucosal thickness. Analysis of variance (ANOVA) and the Tukey test for multiple comparisons were used, considering p 99m TcO 4 in the organs of the groups studied (p>0.05). An increase in the weight of the SB rats was observed after the second postoperative week. The jejunal mucosal thickness of the SB rats was significantly greater than that of C and sham rats (p 99m TcO 4 was not affected by massive intestinal resection, suggesting that short bowel syndrome is not the cause of misleading interpretation, if an examination using this radiopharmaceutical is indicated. (author)

  13. Real-time monitoring of nitric oxide (NO) and pO2 levels under ischemic conditions associated with small bowel ischemia/reperfusion injury using selective electrodes for NO and oxygen molecules.

    Science.gov (United States)

    Watanabe, T; Owada, S; Kobayashi, H; Ishiuchi, A; Nakano, H; Asakuta, T; Shimamura, T; Asano, T; Koizumi, S; Jinnouchi, Y; Katayama, M; Kamibayasi, M; Murakami, E; Otsubo, T

    2007-12-01

    The present study demonstrated the feasibility of monitoring nitric oxide (NO) and pO2 levels under ischemic conditions associated with small bowel ischemia/reperfusion (I/R) injury through the use of selective electrodes for NO and oxygen molecules. NO levels gradually increased during ischemia. When reperfusion was started, the NO level decreased suddenly and returned to pre-ischemia values within 10 minutes. After clamping, pO2 decreased rapidly. When reperfusion was started, pO2 increased suddenly, returning to pre-ischemia values within 10 minutes. We concluded that it is feasible to monitor NO and pO2 levels under ischemic conditions of small bowel I/R injury through the use of electrodes selective for NO and oxygen molecules.

  14. Acute hypertensive encephalopathy with widespread small-vessel disease at MRI in a diabetic patient: pathogenetic hypotheses

    Energy Technology Data Exchange (ETDEWEB)

    Cotton, F. [Centre Hospitalier Lyon Sud, Department of Radiology, Pierre Benite (France); Universite Claude-Bernard Lyon-I, CREATIS, UMR CNRS (France); Universite Claude-Bernard Lyon-I, Laboratoire d' Anatomie, Laennec (France); Kamoun, S.; Rety-Jacob, F.; Tran-Minh, V.A. [Centre Hospitalier Lyon Sud, Department of Radiology, Pierre Benite (France); Nighoghossian, N. [Hopital Neurologique et Neurochirurgical, Department of Neurology, Bron (France); Universite Claude-Bernard Lyon-I, CREATIS, UMR CNRS (France); Hermier, M. [Hopital Neurologique et Neurochirurgical, Department of Neuroradiology and MRI, Bron (France); Universite Claude-Bernard Lyon-I, CREATIS, UMR CNRS (France)

    2005-08-01

    We report unusual magnetic resonance imaging (MRI) findings in a diabetic patient with neglected hypertension and hyperglycemia, presenting with seizures and coma. Outcome was fatal despite intensive care. The MRI findings included bilateral insular and temporo-occipital grey and white matter involvement, and numerous, scattered, lacunar-like lesions involving the peripheral and deep white matter, basal ganglia grey matter, and brainstem. Lesions had a low apparent diffusion coefficient, and some enhanced following contrast injection. Hypertensive encephalopathy with widespread and severe acute small-vessel disease was considered. Pathophysiology is discussed. (orig.)

  15. Acute hypertensive encephalopathy with widespread small-vessel disease at MRI in a diabetic patient: pathogenetic hypotheses

    International Nuclear Information System (INIS)

    Cotton, F.; Kamoun, S.; Rety-Jacob, F.; Tran-Minh, V.A.; Nighoghossian, N.; Hermier, M.

    2005-01-01

    We report unusual magnetic resonance imaging (MRI) findings in a diabetic patient with neglected hypertension and hyperglycemia, presenting with seizures and coma. Outcome was fatal despite intensive care. The MRI findings included bilateral insular and temporo-occipital grey and white matter involvement, and numerous, scattered, lacunar-like lesions involving the peripheral and deep white matter, basal ganglia grey matter, and brainstem. Lesions had a low apparent diffusion coefficient, and some enhanced following contrast injection. Hypertensive encephalopathy with widespread and severe acute small-vessel disease was considered. Pathophysiology is discussed. (orig.)

  16. Bowel morbidity following radiochemotherapy and image-guided adaptive brachytherapy for cervical cancer: Physician- and patient reported outcome from the EMBRACE study

    DEFF Research Database (Denmark)

    Jensen, Nina Boje Kibsgaard; Pötter, Richard; Kirchheiner, Kathrin

    2018-01-01

    BACKGROUND/PURPOSE: This study describes late bowel morbidity prospectively assessed in the multi-institutional EMBRACE study on MRI-guided adaptive brachytherapy in locally advanced cervical cancer (LACC). MATERIALS/METHODS: A total of 1176 patients were analyzed. Physician reported morbidity (C...

  17. Large bowel resection

    Science.gov (United States)

    ... blockage in the intestine due to scar tissue Colon cancer Diverticular disease (disease of the large bowel) Other reasons for bowel resection are: Familial polyposis (polyps are growths on the lining of the colon or rectum) Injuries that damage the large bowel ...

  18. Impact of remote ischemic preconditioning on wound healing in small bowel anastomoses

    Science.gov (United States)

    Holzner, Philipp Anton; Kulemann, Birte; Kuesters, Simon; Timme, Sylvia; Hoeppner, Jens; Hopt, Ulrich Theodor; Marjanovic, Goran

    2011-01-01

    AIM: To investigate the influence of remote ischemic preconditioning (RIPC) on anastomotic integrity. METHODS: Sixty male Wistar rats were randomized to six groups. The control group (n = 10) had an end-to-end ileal anastomosis without RIPC. The preconditioned groups (n = 34) varied in time of ischemia and time of reperfusion. One group received the amino acid L-arginine before constructing the anastomosis (n = 9). On postoperative day 4, the rats were re-laparotomized, and bursting pressure, hydroxyproline concentration, intra-abdominal adhesions, and a histological score concerning the mucosal ischemic injury were collected. The data are given as median (range). RESULTS: On postoperative day 4, median bursting pressure was 124 mmHg (60-146 mmHg) in the control group. The experimental groups did not show a statistically significant difference (P > 0.05). Regarding the hydroxyproline concentration, we did not find any significant variation in the experimental groups. We detected significantly less mucosal injury in the RIPC groups. Furthermore, we assessed more extensive intra-abdominal adhesions in the preconditioned groups than in the control group. CONCLUSION: RIPC directly before performing small bowel anastomosis does not affect anastomotic stability in the early period, as seen in ischemic preconditioning. PMID:21455330

  19. Altered gastric emptying in patients with irritable bowel syndrome

    International Nuclear Information System (INIS)

    Caballero-Plasencia, A.M.; Valenzuela-Barranco, M.; Herrerias-Gutierrez, J.M.; Esteban-Carretero, J.M.

    1999-01-01

    Irritable bowel syndrome is the most frequent functional disorder of the digestive system. Patients with irritable bowel syndrome have motor disorders not only in the colon, but also in other parts of the digestive tract such as the oesophagus and small intestine; however, it is not known whether the stomach is also involved. We used a radiolabelled mixed solid-liquid meal (technetium-99m for the solid component, indium-111 for the liquid component) to study gastric emptying of solids (GES), liquids (GEL) and indigestible solids (GER) in 50 patients diagnosed as having irritable bowel syndrome (30 with predominant constipation and 20 with predominant diarrhoea). GER was measured by counting the number of indigestible solids remaining in the stomach 4 h after they were swallowed. In patients with irritable bowel syndrome, GES and GEL were slower than in control subjects (P<0.05). GER was normal in all patients except for two women. Thirty-two patients (64%) showed delayed GES, 29 (58%) delayed GEL, and 2 (4%) delayed GER. Among patients with irritable bowel syndrome, GES was slower in those with predominant constipation than in those with predominant diarrhoea (P<0.05); GEL and GER were similar in both groups. Gastroparesis was found in a large proportion of patients with irritable bowel syndrome, suggesting the presence of a more generalised motor disorder of the gut. (orig.)

  20. Germ line mutations of mismatch repair genes in hereditary nonpolyposis colorectal cancer patients with small bowel cancer: International Society for Gastrointestinal Hereditary Tumours Collaborative Study

    DEFF Research Database (Denmark)

    Park, Jae-Gahb; Kim, Duck-Woo; Hong, Chang Won

    2006-01-01

    PURPOSE: The aim of study was to determine the clinical characteristics and mutational profiles of the mismatch repair genes in hereditary nonpolyposis colorectal cancer (HNPCC) patients with small bowel cancer (SBC). EXPERIMENTAL DESIGN: A questionnaire was mailed to 55 members of the Internatio......PURPOSE: The aim of study was to determine the clinical characteristics and mutational profiles of the mismatch repair genes in hereditary nonpolyposis colorectal cancer (HNPCC) patients with small bowel cancer (SBC). EXPERIMENTAL DESIGN: A questionnaire was mailed to 55 members...... of the International Society for Gastrointestinal Hereditary Tumours, requesting information regarding patients with HNPCC-associated SBC and germ line mismatch repair gene mutations. RESULTS: The study population consisted of 85 HNPCC patients with identified mismatch repair gene mutations and SBCs. SBC was the first...... HNPCC-associated malignancy in 14 of 41 (34.1%) patients for whom a personal history of HNPCC-associated cancers was available. The study population harbored 69 different germ line mismatch repair gene mutations, including 31 mutations in MLH1, 34 in MSH2, 3 in MSH6, and 1 in PMS2. We compared...