Plain Abdominal Film Research Articles

Perforated Meckel’s Diverticulum: A Case Report

Meckel’s diverticulum is a true diverticulum that consists of all layers of bowel normally found in a normal small bowel wall. The three most common presentations in children are intestinal bleeding (30–56%), intestinal obstruction (14–42%), and diverticular inflammation (6–14%). Complications result in more severe symptoms, such as acute abdomen and signs of peritonitis. These presentations are not specific to Meckel’s diverticulum and can be found in many other conditions, making the diagnosis difficult. A five-year-old child came to the emergency department with complaint of acute abdominal pain, especially in the right lower quadrant. The pain was accompanied by vomiting. On physical examination, patient was febrile and signs of peritonitis were found. Abdominal plain film revealed the probability of focal inflammation in the right lower region of the abdomen, with partial intestinal obstruction. Ultrasonography showed a presence of a mass in right iliac region with the size of 24x20x23 mm, with normal appendix. During exploratory laparotomy, a necrotic and perforated Meckel’s diverticulum was found, with associated purulent matter. Diverticulectomy with segmental resection of ileum followed by end-to-end anastomosis were done. Diagnosis of Meckel’s diverticulum requires a high index of suspicion, especially in the pediatric population. It is important for clinicians to be aware of unusual presentations of Meckel’s diverticulum.

Dynamic plain abdominal film provides simple and effective diagnosis of delayed shunt insufficiency caused by abdominal adhesions after VP shunt

BackgroundMany complications may occur after placement of the ventriculoperitoneal shunt (VP shunt) for hydrocephalus, and delayed shunt insufficiency (DSI) is among the most common. It is often caused by abdominal adhesions, which increases the difficulty of diagnosis. This study aimed to explore the clinical value of dynamic plain abdominal radiography (DPAR) as a simple diagnostic method for patients with DSI due to terminal adhesion of the peritoneal shunt after VP surgery.MethodsA total of 30 patients with high suspicion of DSI due to abdominal adhesions after VP surgery were included. DPAR was used for prospective assessment. The interval between the first and second PAR was 4–6 h before surgery. If two plain abdominal radiography at different times indicated that the end of the shunt tube in the abdominal segment was fixed, it was diagnosed as DSI due to adhesion of the shunt tube at the abdominal end. The peritoneal end of the shunt tube was surgically repositioned. Postoperative DPAR was repeated to evaluate the distance of the shunt outlet within the abdominal segment.ResultsAll cases showed clinical symptoms or imaging findings of shunt insufficiency. The diagnostic accuracy of DPAR was 96.67% (29/30). The end of the shunt tube in the abdominal segment of the preoperative group was fixed with abdominal plain film twice with a mean difference of 1.74 ± 1.18 cm. The mean postoperative change in the position of the end of the shunt tube in the abdominal section was 9.36 ± 2.64 cm, showing a significant difference compared with the preoperative group (P < 0.001). The mean postoperative EVANs index (0.37 ± 0.08) was significantly lower than the preoperative (0.42 ± 0.08) (P = 0.007), Glasgow coma scale score (12.8 ± 2.69) was higher than the mean preoperative score (11.36 ± 2.43) (P = 0.013).ConclusionDPAR is a simple and effective method for the diagnosis of shunt insufficiency caused by delayed abdominal end adhesion after VP shunt.

Prospective assessment of entrance skin dose and targets for radiation reduction during abdominal plain films in pediatric urology patients

Abdominal radiographs are frequently used for evaluation of bowel and bladder dysfunction in pediatric urology. However, the dose of radiation delivered with each study is estimated from machine settings as opposed to measurement of the true entrance skin dose. In addition, the correlation of radiographic constipation with patient symptoms has been questioned. To evaluate the practices for obtaining abdominal radiographs and the true entrance skin dose of radiation for each examination in order to identify targets for radiation reduction. Pediatric urology patients were prospectively enrolled from June 2022 through June 2023. Dosimeters were attached to the navel to collect entrance skin doses from single view abdominal x-ray. Estimated doses were compared to measured entrance skin dose as well as patient characteristics. Exam parameters were evaluated to identify targets for radiation reduction. A total of 75 patients were recruited for this study with a median age of 10.0 years (IQR 6-14). Most evaluations were done to assess for bowel and bladder dysfunction (68 exams, 91%). The protocol for exams was not standardized resulting in 27% of patients undergoing a medium or high dose strength and 55% undergoing 1 or more image. The median estimated dose was 0.63mGy (IQR 0.3-1.2mGy). The median measured dose was 0.77mGy (IQR 0.31-2.01mGy) which was significantly different than the estimations (p<0.001). The estimated dose, measured dose and estimate error were all found to be positively correlated with patient characteristics including age and body mass index (See Figure). Increasing age and body mass index also showed a higher likelihood of increased dose strength and image acquisition. The measured entrance skin dose of radiation is significantly higher than prior estimates. The measured dose but also the estimate error increased with patient age and size which is likely related to higher settings used for image acquisition as patients age. Standardized protocols using low dose settings and limiting image acquisition to the pelvis may reduce radiation exposure in children with bowel and bladder dysfunction while providing adequate diagnostic data. Radiation dose for abdominal radiographs is higher than previously estimated. Older and larger children received higher doses which may be mediated by increased dose strength and image acquisition. Standardization of protocols could lower radiation exposure.

The Role of Anesthetic Techniques and Drugs in Laparotomy Cases of Postoperative Ileus

Background: Ileus occurs when there is a non-mechanical decrease or stoppage of the flow of intestinal contents. The cause of ileus has yet to be clearly defined. Various factors influence the risk for an ileus, each affecting a small part of the complex neuroimmune system. The patient will present with bloating and abdominal distension. Plain abdominal films and computed tomography (CT) scans of the abdomen are usually the first diagnostic imaging obtained. The most important principle for treating ileus is treating the underlying cause. Treating the infection, electrolyte abnormalities, and decreasing opiate use can all potentially decrease the durability of an ileus. Anesthesia procedures must be performed to treat patients preoperatively, during surgery, and postoperatively. Enhanced recovery protocols, regional anesthesia, opioid-sparing analgesics, and laparoscopy have all improved the number of postoperative ileus cases.Case Presentation: The following is a 67-year-old male patient who presents with abdominal pain with a scale of 4 out of 10, diagnosed with ileus, which was planned for laparotomy surgery by general anesthesia with supine position.Conclusion:We conclude that anesthetic procedures are critical in ileus patients in performing laparotomy operations, both in selecting anesthetic techniques, anesthetic drugs, and supporting scores (Aldrete score). Before induction, anesthesiologists must carefully assess preoperative and monitor postoperative

Reducing inappropriate plain abdominal film requests from the emergency department in accordance with The Royal College of Radiologists (RCR) iRefer guidelines

Reducing inappropriate plain abdominal film requests from the emergency department in accordance with The Royal College of Radiologists (RCR) iRefer guidelines

Application of metal stent implantation with endoscope and X-ray fluoroscopy combined laparoscopic surgery in the treatment of acute left hemicolon cancer obstruction

BackgroundThis study aimed to conduct a case–control study of endoscopic and fluoroscopic metal stent placement combined with laparoscopic surgery versus conventional open Hartmann’s procedure in treating acute left-sided colon cancer obstruction. Additionally, the study aims to discuss the application value of endoscopic and X-ray-guided metal stent placement combined with laparoscopic surgery in the treatment of acute left-sided colon cancer obstruction.MethodsFrom June 2011 to December 2019, 23 patients with acute left-sided colon cancer obstruction who underwent metal stent implantation combined with laparoscopic surgery under endoscopy and X-ray fluoroscopy in Wenzhou Central Hospital were collected, and 20 patients with acute left-sided colon cancer obstruction who underwent traditional emergency open Hartmann’s surgery during the same period were selected as a control group. All patients were diagnosed with left colon obstruction by plain abdominal film and/or CT before the operation and colon adenocarcinoma by colonoscopic biopsy and/or postoperative pathology. The operation time, intraoperative blood loss, postoperative anal exhaust time, the success rate of one-stage anastomosis, postoperative hospital stay, and postoperative complications were compared between the two groups.ResultsThis study showed a significant difference in the therapeutic effect between the two groups. Compared with the traditional Hartmann’s operation group, the success rate of one-stage anastomosis in endoscopic and X-ray-guided metal stent placement combined with the laparoscopic operation group was significantly higher than that in the Hartmann’s operation group (P < 0.05). The overall incidence of postoperative complications and hospital stay were significantly lower in the observation group than in the Hartmann’s group (P < 0.05). Further subgroup analysis of the overall postoperative complication rate of the two groups showed that the traditional Hartmann’s operation group was more likely to have an incomplete intestinal obstruction (P < 0.05). This study also showed no significant differences between the two groups in operation time, intraoperative blood loss, number of harvested lymph nodes, and postoperative anal exhaust time (all P > 0.05). This study also found no significant differences between the two groups in overall survival rates or recurrence-free survival rates (all P > 0.05).ConclusionsThe comparison of the therapeutic effects of the two groups verified the feasibility of endoscopy combined with X-ray fluoroscopy metal stent placement in combination with laparoscopic surgery in the treatment of acute left-sided colon cancer obstruction. Compared with the traditional emergency open Hartmann’s procedure, metal stent implantation under endoscopy and X-ray fluoroscopy combined with laparoscopic surgery is more minimally invasive, safe, and effective. It avoids the traditional second or even third surgical trauma to effectively improve the quality of life of patients, so that patients can recover quickly after surgery.

Extracorporeal shock wave lithotripsy for lower calyx stones: predicting treatment success

IntroductionThe use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is associated with a high rate of residual fragments. Our aim is to analyse the effectiveness and complications of ESWL for lower calyx stones. MethodsRetrospective review of patients with lower renal calyx stones treated with ESWL between January-2014 and December-2020. Measurement of infundibular length, infundibular width and infundibulopelvic angle in lower renal pole to determine favourable anatomy. ESWL failure: fragments >3 mm detected in plain abdominal film, CT scan and/or renal ultrasound 3 months after treatment.Complications after ESWL, auxiliary procedures along with risk factors associated with perirenal haematoma were analysed. SPSS statistical software was used. Results512 patients with lower calyx stones were treated with ESWL. 80.3% of patients had a favourable anatomy. Overall stone-free rate was 70.5%. Regarding main complications after ESWL, stainstrasse was described in 5 patients and urinary tract infection in 3 patients. 10 perirenal haematomas (2%) were reported. Statistical association was found between antiplatelet treatment and the risk of perirenal haematoma (p = 0.004). Logistic binary regression proved the association between unfavourable anatomy of the lower renal pole (p = 0.000), size of the stone (p = 0.001), number of shock waves (p = 0.003), energy applied (p = 0.038) and the need for additional treatment after ESWL. ConclusionsESWL can still be considered as the initial treatment option for lower renal pole stones. The size of the stone, an unfavourable anatomy of the lower renal calyx, number of shock waves and energy applied can help predict the need for additional treatment.

Litotricia extracorpórea por ondas de choque (LEOCh) Para litiasis de grupo calicial inferior: ¿cómo predecir el éxito del tratamiento?

IntroductionThe use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is associated with a high rate of residual fragments. Our aim is to analyse the effectiveness and complications of ESWL for lower calyx stones. MethodsRetrospective review of patients with lower renal calyx stones treated with ESWL between January-2014 and December-2020. Measurement of infundibular length, infundibular width and infundibulopelvic angle in lower renal pole to determine favourable anatomy. ESWL failure: fragments >3mm detected in plain abdominal film, CT scan and/or renal ultrasound 3 months after treatment.Complications after ESWL, auxiliary procedures along with risk factors associated with perirenal haematoma were analysed. SPSS statistical software was used. Results512 patients with lower calyx stones were treated with ESWL. 80.3% of patients had a favourable anatomy. Overall stone-free rate was 70.5%. Regarding main complications after ESWL, stainstrasse was described in 5 patients and urinary tract infection in 3 patients. 10 perirenal haematomas (2%) were reported. Statistical association was found between antiplatelet treatment and the risk of perirenal haematoma (p=0.004). Logistic binary regression proved the association between unfavourable anatomy of the lower renal pole (p=0.000), size of the stone (p=0.001), number of shock waves (p=0.003), energy applied (p=0.038) and the need for additional treatment after ESWL. ConclusionsESWL can still be considered as the initial treatment option for lower renal pole stones. The size of the stone, an unfavourable anatomy of the lower renal calyx, number of shock waves and energy applied can help predict the need for additional treatment.

Symptoms: Abdominal Pain, Diaphoresis, Fever, Nausea, and Constipation

Symptoms: Abdominal Pain, Diaphoresis, Fever, Nausea, and Constipation

Is there a role for Abdominal Plain Films in Patients Suspected of Having Renal Colic?

Is there a role for Abdominal Plain Films in Patients Suspected of Having Renal Colic?

Survey of Diagnostic and Management Practices in Small Bowel Obstruction: Individual and Generational Variation Despite Practice Guidelines.

Background: Small bowel obstruction (SBO) is a common disorder managed by surgeons. Despite extensive publications and management guidelines, there is no universally accepted approach to its diagnosis and management. We conducted a survey of acute care surgeons to elucidate their SBO practice patterns.Methods: A self-report survey of SBO diagnosis and management practices was designed and distributed by email to AAST surgeons who cared for adult SBO patients. Responses were analyzed with descriptive statistics and Chi-square test of independence at α = .05.Results: There were 201 useable surveys: 53% ≥ 50years, 77% male, 77% at level I trauma centers. Only 35.8% reported formal hospital SBO management guidelines. Computed tomography (CT) scan was the only diagnostic exam listed as "essential" by the majority of respondents (82.6%). Following NG decompression, 153 (76.1%) would "always/frequently" administer a water-soluble contrast challenge (GC). There were notable age differences in approach. Compared to those ≥50years, younger surgeons were less likely to deem plain abdominal films as "essential" (16.0% vs 40.2%; P < .01) but more likely to require CT scan (88.3% vs 77.6%; P = .045) for diagnosis and to "always/frequently" administer GC (84.0% vs 69.2%; P < .01). Younger surgeons used laparoscopy "frequently" more often than older surgeons (34.0% vs 21.5%, P = .05).Discussion: There is significant variation in diagnosis and management of SBO among respondents in this convenience sample, despite existing PMGs. Novel age differences in responses were observed, which prompts further evaluation. Additional research is needed to determine whether variation in practice patterns is widespread and affects outcomes.

Cocaine-Filled Capsule Detected after Firearm Injury: A Case Report

Emergency departments are facing increasing drug-related health problems with difficult medicolegal and social consequences. A 25-year-old male with no past medical history arrived at our emergency department. He was brought to the emergency room of our hospital by the security forces, as he suffered a gunshot wound while traveling to a place. The cocaine-filled capsule was seen on plain abdominal film. The plain abdominal film is the most commonly used radiological tool to detect 2-8 cm drug-filled packages within the gastrointestinal tract of body packers. In a study that analyzed the role of drugs in firearm deaths in New York between 1990 and 1998, more than half of firearm deaths had positive drug toxicology. Physicians working in the emergency unit should be prepared for secondary diagnoses. In addition, different examination and imaging findings should be kept in mind in suspicious cases.

Ileoileal intussusception due to Meckel's diverticulum in a pre-term neonate

Presented is a case of ileoileal intussusception in a pre-term male born at 24 weeks gestation caused by a Meckel's diverticulum, which likely occurred in utero. Neonatal intussusception accounts for less than 1.3% of all intussusception cases and is exceedingly rare in premature infants [2]. Around 90% of pediatric intussusceptions involve the ileum telescoping into the cecum or ascending colon (ileocolic), however, ileoileal intussusception due to Meckel's diverticulum is less common [6]. The diagnosis of intussusception in the neonatal period requires a high index of suspicion and does not have any specific radiological findings or signs, in contrast to older children. Misdiagnosis leads to delay in treatment, which leads to intestinal perforation and necrosis [3]. Radiologic studies to help differentiate intussusception from other disease entities, including necrotizing enterocolitis (NEC). These studies include ultrasound, plain abdominal films, and air or contrast enema. Treatment of neonatal intussusception is primarily operative versus necrotizing enterocolitis(NEC) in which medical treatment can be considered initially. This case presentation reports an exceedingly rare cause of intestinal obstruction in a neonate and reminds clinicians to expand the differential diagnosis when consulted by the NICU.

S101 Colosplenic Fistula in Inflammatory Bowel Disease: A Scoping Review

Background: A colosplenic fistula is an extremely rare complication of Crohn’s disease (CD) first described in a 1985 case report that remains relatively poorly understood due to its infrequent incidence. With only a few colosplenic fistulas reported worldwide, the diagnosis and management of patients with colosplenic fistula is vague. Hence, we described a review of patients with colosplenic fistula due to inflammatory bowel disease (IBD) to summarize colosplenic fistula etiology, clinical features, diagnosis, management, and prognosis to help clinicians gain a better understanding of this unusual complication and provide an aid if it were to be encountered. Methods: We conducted a systematic search of articles published from 1946 to June 2022 in Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, and Wiley Cochrane Library to identify patients with colosplenic fistulas. Studies with etiology of IBD were included. Results: The search strategy retrieved 141 references and a total of 4 studies reporting 4 patients with colosplenic fistula in the setting of IBD were analyzed. Most patients (75%) were male, with a median age of 33 years. All 4 (100%) patients had prior diagnosis of CD, with a median time of 12.5 years since diagnosis. Two patients had extraintestinal manifestations of IBD (uveitis, erythema nodosum, ankylosing spondylitis). Three patients were on long-term sulfasalazine and 2 (50%) were on corticosteroids. Etiology: Our review revealed that patients with CD formed a fistula tract from their colon to the adjacent spleen due to chronic, transmural inflammation and ulceration. Active inflammation was observed in the adjacent colon on pathology or endoscopy. Clinical features: Most patients presented with complaints of recurring fever, leukocytosis, and left upper quadrant pain or discomfort. Diagnosis: The most widely-used and effective diagnostic imaging was the computed tomography (CT) scan. CT with intravenous (IV) contrast helped identify splenic lesions and colonic thickening, while enteral contrast was useful to identify fistula tract. Chest X-rays, plain abdominal films, and colonoscopy were not essential in diagnosing a colosplenic fistula. Use of magnetic resonance imaging (MRI) was not reported in any case. Management: Most patients were promptly treated with IV fluid and broad-spectrum antibiotics. Only one patient was started on IV steroids. Most patients underwent surgical intervention of colosplenic fistulas with splenectomy and segmental resection of the affected col1on. One case offered temporary diverting loop ileostomy with plans for future splenectomy and colectomy. Prognosis: Symptoms resolved with surgical intervention. No postoperative complications or mortalities were reported. Conclusion(s): Our review revealed that patients with Crohn’s disease can form a fistula tract from their diseased colon to the adjacent spleen due to transmural inflammation. Diagnosis can be achieved with a CT scan with enteral and/or intravenous contrast. Most colosplenic fistulas can be successfully treated with laparotomy, splenectomy, and resection of the affected colon with low rate of postoperative complications. Our pooled analysis of available colosplenic fistula cases may serve as an aid for diagnosis and management of this rare entity.

Survey of Diagnostic and Management Practices in Small Bowel Obstruction: Individual and Generational Variation Despite Practice Guidelines

Introduction: Small bowel obstruction (SBO) is among the most common disorders managed by acute care surgeons. Despite extensive publications and an Eastern Association for the Surgery of Trauma (EAST) practice management guideline (PMG), there is no universally accepted approach to the diagnosis and management of SBO. We conducted a survey of trauma surgeons to elucidate their current SBO practice patterns. Methods: A self-report survey of SBO diagnosis and management practices in adults was designed and distributed by email to American Association for the Surgery of Trauma member surgeons who directly cared for SBO patients. Responses were analyzed with descriptive statistics and Chi-Square test of independence at α=.05. Results: There were 201 useable surveys: 53% ≥50 years, 77% male, 77% at Level I trauma centers. Formal hospital SBO management guidelines were reported by only 35.8%. CT scan was the only diagnostic exam listed as “essential” by most respondents (82.6%). After NG decompression, 153 (80.1%) would always/frequently administer gastrografin challenge (GC). There were notable age differences in approach. Surgeons 30-49 years were less likely to deem plain abdominal films as ‘essential’ (16.0% vs 40.2%; p < .001), but more likely to require CT scan (88.3% vs 77.6%; p = .045) for diagnosis, and to always/frequently administer GC (84.0% vs 69.2%; p < .01) compared with those ≥50 years. Conclusion: Among respondents in this convenience sample, there is significant variation in the diagnosis and management of SBO despite a specific EAST PMG. Novel age differences in responses were observed and prompt further evaluation. Additional research is needed to determine whether variation in practice patterns is widespread and affects patient outcomes.

Neonatal Meconium Plug Caused Severe Proximal Small Bowel Dilatation and Made A Misinterpretation of Pneumoperitoneum

&lt;p&gt;There is a high mortality rate for infants with visceral perforations. Clinical imaging of this condition includes free air in the abdomen with abdominal plain radiography or lateral decubitus radiographs. An important disease that is easily ignored in the perinatal period is meconium plug syndrome, which causes functional obstruction in the colon that leads to dilated bowel loops in abdominal plain radiography. We report a female newborn who had a suspected bowel obstruction during prenatal examination because of polyhydramnios. The initial plain abdominal film showed a large volume of air accumulation in the peritoneum. An emergent exploratory laparotomy was performed and it revealed that there was no free a3 ir nor ascites in the peritoneal cavity. The proximal small bowel was severely dilated and a meconium plug at the splenic flexure was found. The image of air in the patient&amp;rsquo;s small bowel and peritoneal cavity in the anterior&amp;ndash;posterior view and image of the left decubitus view of the abdomen were similar in this case to the degree that the clinicians could not differentiate them, leading to an unnecessary exploration laparotomy.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

398 Abdominal X-Rays: Are They Still Relevant? a Review of Outcomes Following Emergency Abdominal Plain Films

Abstract Background Abdominal plain films (AXR) have historically been a routine investigation in Surgical and Emergency Departments (ED), however when considering CT imaging yields significantly more diagnostic information, AXRs are ineffectual in comparison as an aid to decision making. With CT scanning and reporting readily available 24/7, are AXRs still practical? Aim To assess the utilisation and outcomes of emergency abdominal films. Method All emergency AXRs performed across the trust in a 15-day period were identified retrospectively from our electronic database and were compared with outcomes obtained from our electronic record system. Results 248 emergency AXRs were performed, 153 Emergency Department and 95 inpatient (IP) requests. 163 (66%) were reported normal, 85 (34%) as abnormal. Of those reported as normal, 26% had further imaging (30% from ED, 17% from IP). Of those reported abnormal, 49% had no further imaging performed (62% from ED, 37% from IP). The odds ratio of admission between ED patients with a significant AXR and an insignificant AXR was 1.34 (95%CI: 0.68–2.83, p&amp;lt;0.05). Conclusions One quarter of AXRs reported as normal underwent further imaging, but almost half of the AXRs with reported pathologies did not. This suggests that the usefulness of AXRs acutely is limited, as the presence or absence of abnormalities on the AXR was not a reliable predictor of further investigation nor patient outcome. We therefore suggest re-examination of their utilisation.

Clip or Tattooing: A Comparative Study for Preoperative Colon Cancer Endoscopic Localization.

Background and AimPreoperative endoscopic markers have been extensively used for the localization of colonic neoplastic lesions in laparoscopic surgery. We conducted this respective cohort study to compare the localization accuracy of two commonly used endoscopic marker strategies (endoscopic clip plus abdominal plain film and endoscopic tattooing).MethodsPatients who received preoperative colonoscopy localization for colonic neoplasia and underwent an elective laparoscopic operation afterward between 2013 and 2020 were included in this retrospective study. The localization accuracy of the two endoscopic strategies was compared, and the predictors of successful endoscopic localization were identified by multivariate regression.ResultsIn total, 195 patients [average age 62.4 ± 9.2 years, 123 male (63.1%)] undergoing preoperative colonoscopy localization and subsequent laparoscopic colectomy for colonic neoplasms were included. Endoscopic localization was finally proven to be successful in 150 (76.9%) patients in the surgery. Compared to the tattooing group, patients who had successful localization for colonic lesions were fewer in the clip group (64 of 101 cases, 63.4% vs. 86 of 94 cases, 91.5%, p < 0.001). The multivariate regression analysis showed that the endoscopic tattooing strategy, endoscopic clip strategy, and lesion location were all predictors for successful localization (all with p < 0.001).ConclusionCompared with endoscopic clip plus abdominal plain film, endoscopic tattooing had higher localization accuracy and less intraoperative colonoscopy counseling; the endoscopic clip strategy, tattooing strategy, and colonic lesion location were all predictors of successful endoscopic localization.

Endoscopic management of intravesical foreign body: A challenging condition.

Background: Unusual genitourinary activity is categorized by the genital deposit of foreign objects. It has been known for centuries and common etiological factors include sexual stimulation. Psychiatric disorders and intoxication may also be associated. Foreign body retrieval and the evaluation of psychosocial factors are involved in management. This study intends to present a 'hair pin' case as a foreign body in the bladder.&#x0D; Methodology: A 25-year-old female presented to the urology outpatient clinic in early pregnancy with a history of manually inserting hairpin into the urinary bladder through her urethra four years back. She lost to follow up during pregnancy and then presented again after C-section. A plain abdominal film of the kidneys, ureters, and bladder (KUB) confirmed the location of the hairpin and large stone around it in the urinary bladder.&#x0D; Results: The patient underwent endoscopic removal of foreign body and stone. At cystoscopy urethra was normal, but in the urinary bladder, there was a hairpin with stone formation at its proximal end, and distal portion of the hairpin was embedded in the bladder neck. The hairpin was pushed back in the bladder to separate from the bladder neck, followed by stone fragmentation using a stone punch. After complete removal of stones, the hairpin was aligned in the line of the urethra and removed with the help of forceps.&#x0D; Conclusion: Depending on the nature of the foreign body and available expertise, methods for removing intravesical foreign bodies are opted. Mostly endoscopic techniques are used for retrieval of intravesical foreign bodies without resorting to open surgery.

Analysis of the Application Value of X-Ray Digital Tomographic Fusion Technique in Urinary System Diseases.

Objective To explore the application value of the X-ray digital tomographic fusion technique in the diagnosis of urinary system diseases. Methods 500 patients with suspected urinary diseases in our hospital were examined by three methods: X-ray digital tomographic fusion imaging (DTS), intravenous pyelography (IVP), and abdominal plain film (KUB), and the image quality before and after tomographic fusion was objectively evaluated. The image quality could be divided into three grades: excellent, good, and poor. Results The image excellent rate of DTS (88%) was higher than that of IVP (27.5%). The sensitivity of DTS in the diagnosis of renal cyst and space occupying of the bladder was higher than that of IVP (P < 0.05). The accuracy rate of DTS in the diagnosis of urinary calculi was 93.33%, higher than 63.3% of KUB (P < 0.001). The accuracy rate of DTS in the diagnosis of ureteral stricture was 90%, higher than 65% of IVP (P=0.03). The accuracy of DTS in the diagnosis of hydronephrosis was higher than that of IVP and KUB (P < 0.05). Conclusion In the examination of urinary system-related diseases, high-definition images can be obtained by timely using sectional fusion technology. Compared with conventional IVP, space occupying lesions such as the bladder and kidney can be displayed more clearly with the help of the tomographic fusion technique, which is helpful to improve the possibility of finding lesions and is of great significance in clinical application.