Abdominal X-ray Research Articles

EGS SO21 - The undifferentiated general surgical take over 10 years: Emergency imaging

Abstract Background The undifferentiated emergency general surgical take in July 2013 and July 2023, at a District General Hospital, was reviewed with the aim of understanding increasing pressures on the surgical and radiology departments, and subsequently identifying areas in which we could adapt to facilitate these demands. Method Patients were identified retrospectively if they had been cared for by the emergency general surgical team in July 2013 or July 2023. Further information was collected from electronic notes, with a focus on admission and initial imaging modalities. Patients were excluded if information was not available electronically. Results Of the 395 patients in July 2013, and 594 in July 2023, 55% and 61% respectively had imaging studies within 7 days of admission. 11% (n=44/395) of patients in 2013 had abdominal X-ray without further imaging, compared to 6% (n=33/594) in 2023. Computed Tomography (CT) use increased by 35%, whilst ultrasound scanning (USS) increased only by 11%. Time from admission to scans of all types has reduced from 0.79 days (+/-0.16, p=0.02) in 2013 to 0.60 (+/-0.1, p=0.02) days in 2023. Conclusion Overall volume of imaging has increased slightly, although the proportion of patients being scanned is largely unchanged, with subtle variation in preferred imaging modalities. CT is marginally more common, whilst USS remains mostly unchanged. The use of abdominal x-ray without subsequent imaging has decreased, demonstrating its reducing use in clinical judgement and reliance on alternative imaging techniques. Time from admission to scan of all kinds has reduced, despite increasing demands on radiology departments.

EGS SO25 - Ingestion of Sharp Foreign Bodies- Emerging Trends in a Large UK NHS Trust

Abstract Background Foreign body (FB) ingestion is a common medical problem. The type of object ingested depends on age, sex, socio-economic factors, geographical area, and nutritional habits. Accidental ingestion of hijab pins as a phenomenon has not been widely reported in the UK previously. Method Retrospective cohort study on all patients presenting with foreign body ingestion from July 2010 to January 2024. Patient medical records were reviewed, and data collected including mode of presentation, demographics, FB type and mode of ingestion (accidental/deliberate), admission details, radiology, management (conservative, endoscopic, surgery), morbidity and mortality and readmission rate. Data was recorded and analyzed using Microsoft Excel. Results 94 patients presented with FB ingestion of whom 39 ingested hijab pins. Median age was 19 (11-50) years. Median time from ingestion to presentation was 5 hours (0.5-120). All patients had abdominal Xray. The most common hijab pin location on presentation was in the stomach; n=27 (69%). Data on management was available in 38 patients, of whom 29 (76%) were managed conservatively, 6 (15%) had endoscopy and 3 (8%) had flexible nasal endoscopy (FNE). The reintervention rate was 3% with one patient managed conservatively subsequently having endoscopy. No complications, readmissions or mortality was observed. One OGD was therapeutic Conclusion We report increase in the incidence of FB ingestion with a significant proportion involving hijab pins. Young girls hold pins between their lips while styling their hijabs which can result in accidental ingestion. Although we report low morbidity and readmission rates, there is a 22% intervention rate. We believe there may be a causal link between increased accidental ingestion and popularity of social media content on elaborate hijab styling, some with millions of views each. There is a need to increase awareness on dangers of holding pins in the mouth whilst styling hijabs and alternate options such as hijab magnets

Testicular enlargement, abdominal pain and vomiting in 3‐month‐old, male, entire Airedale terrier

AbstractNon‐neoplastic scrotal testicular torsions in juvenile dogs have been rarely reported. This case report describes a scenario in which a patient presented with abdominal pain, vomiting and unilateral testicular enlargement. The primary veterinarian performed abdominal radiographs that were suspicious for a hernia. The patient was referred to a specialty hospital for further diagnostics and treatment. Upon referral, an abdominal ultrasound revealed a suspected non‐neoplastic scrotal testicular torsion. The patient underwent hemicastration to remove the affected testis and recovered uneventfully.

Diagnosis and treatment of magnetic foreign bodies in the gastrointestinal tract: the experience of four centers

BACKGROUND: Magnetic foreign bodies in the gastrointestinal tract is a relatively rare problem in urgent pediatric surgery. Meanwhile, among cases with foreign bodies, they are the most difficult both in terms of timely diagnostics and timely treatment. There are no generally accepted therapeutic and diagnostic standards, and traditional algorithms of patient management are focused on the dynamic observation and are not correct. More so, algorithms described in the foreign literature contradict each other. The rate of surgical interventions and the risk of complications are high. Surgical tactics has many "white spots". All these issues remain open for discussion. AIM: To analyze the experience of four medical centers in the diagnostics and treatment of patients with magnetic foreign bodies in the gastrointestinal tract. METHODS: A retrospective analysis of diagnostic and treatment techniques applied in patients with magnetic foreign bodies in their gastrointestinal tract from four pediatric surgical hospitals in 2010–2023 was made. In the study there were patients with neodymium magnetic balls from the constructor (38 patients, 50%), neodymium magnets of other shapes and for other purposes (30 patients, 39.5%), ferrite magnets (6 patients, 7.9%), unknown types of magnets (2 patients, 2.6%). RESULTS: Patients’ average age was (4±3.65) years. The fact of foreign body swallowing was revealed in anamnesis of 46 (60.5%) patients. Mental illnesses were diagnosed in 4 children — 5.3%, which is higher than the average incidence in pediatric population. Clinical symptoms were registered in 4 (11.8%) children with a single magnet foreign body and in 33 (78.6%) children with multiple ones. The basic diagnostic technique was an overview radiography of the abdominal cavity (70 cases, 92%), which allowed to identify both a foreign body and complications (signs of intestinal obstruction, free gas in the abdominal cavity). Esophagogastroduodenoscopy was performed in 50 cases (65.8%), out of which one foreign body was detected in 34 (68%) cases, and in 28 patients, foreign bodies were removed. Other diagnostic methods (ultrasound, spiral computed tomography) were used much less frequently. Among curative techniques, open surgeries prevailed — 32 cases (42%). Laparoscopy was used in few cases. CONCLUSION: The timely diagnostics of magnetic foreign bodies in gastrointestinal tract often depends on anamnesis findings, and if there is no such, diagnostics most often is delayed and is made only intraoperatively. Among the diagnostic techniques, it is difficult to identify a universal one that can be recommended as the "gold standard"; however, the most widely used and well-informative is abdominal X-ray and esophagogastroduodenoscopy. As to surgical tactics, the role of laparoscopic interventions is relatively low. Most often, endoscopy or "open" surgery are performed.

Streamlining the Non-operative Management of Adhesive Small Bowel Obstruction: A Closed-Loop Audit Evaluating the Introduction of a Standardised Gastrografin Protocol in a District General Hospital.

Introduction Adhesive small bowel obstruction (ASBO) is a common cause of admissions to general surgery services. Water-soluble contrast (WSC), such as Gastrografin® (GGF), can be utilised in the conservative management of patients with ASBO, with predictive and possible therapeutic value. We audited the non-operative management of ASBO in the general surgery department of East and North Hertfordshire NHS Trust, a district general hospital. Following the introduction of a hospital-wide protocol standardising the use of GGF in patients with ASBO, a re-audit was conducted to assess its impact. Methods A retrospective audit of ASBO patients who received GGF was conducted in two cycles: before and after the implementation of the protocol. Data were collected between February and June 2022 for group 1 (pre-protocol) and between August and November 2023 for group 2 (post-protocol). Results Forty-eight patients were included in the analysis across both groups: 31 in group 1 (pre-protocol) and 17 in group 2 (post-protocol). The success rate of this non-operative trial with GGF increased from 77%(24/31) in group 1 to 88% (15/17) in group 2. The median duration of conservative management was two days in both groups. The median time from CT scan to GGF administration decreased from 24 hours in group 1 to 19 hours 22 minutes in group 2, and the interval between GGF administration and first abdominal radiograph decreased from 9 hours in group 1 to 6 hours 25 minutes in group 2. Conclusion Our closed-loop audit suggests that by streamlining the non-operative management pathway of adhesive small bowel obstruction, our standardised protocol is safe and possibly improves efficiency within a district general hospital setting.

Fire dragon cupping in treating a parturient woman with gastrointestinal dysfunction after cesarean section: A case report.

The postoperative gastrointestinal dysfunction after cesarean section is commonly presented as uncomfortable symptoms such as abdominal pain and distension. As a novel traditional Chinese medicine characteristic therapy, the fire dragon cupping can effectively enhance intestinal peristalsis and improve the gastrointestinal discomforts by using the manipulation and moxibustion heat to stimulate acupuncture points. The purpose of this report is to provide a new approach and new ideas for rapid rehabilitation of gastrointestinal dysfunction after cesarean section. A parturient woman, 39 years old, pregnancy 4, delivery 2, underwent lower uterine segment cesarean section under intrathecal anesthesia due to scarred uterus. On the 3rd day after cesarean section, the anus still did not exhaust and defecate, so this parturient woman complained of obvious abdominal pain, abdominal distension, nausea, and vomiting. The measured abdominal circumference was 96 cm, and the bowel sounds weakened on auscultation; the plain abdominal radiograph indicated a small amount of pneumomediastinum, thus the incomplete intestinal obstruction was considered. The parturient woman was treated with fire dragon cupping treatment in her back and abdomen once a day, each time about 30 to 40 minutes, 3 consecutive days of treatment. On the 4th day after cesarean section, the parturient woman naturally had anal exhaust and defecated watery stools twice, without complaint of abdominal pain distension. Under the guidance of the concept of rapid rehabilitation nursing in obstetrics, according to the principle of making gradual and orderly progress, risk management of gastrointestinal dysfunction after cesarean section is carried out in the early stage, the fire dragon cupping and individualized rehabilitation scheme are implemented, and the parturient women with gastrointestinal dysfunction after cesarean section are actively treated.

EFFECTIVE DOSE ANALYSIS IN ABDOMEN AP EXAMINATION PATIENTS WITH CALDOSE_X VERSION 5.0

This study evaluates radiation dose exposure during diagnostic radiology procedures using X-rays and their potential risks, including cancer, to optimize radiation safety through the CALDose_X software that calculates the absorbed organ dose, effective dose, and cancer risk, according to the lowest possible achievable (ALARA) principle. This study used a quantitative experimental design to evaluate the impact of filter thickness variations on Entrance Surface Air Kerma (ESAK) and effective dose by analyzing data from 54 patients undergoing AP Abdominal X-ray examinations. The results showed that the effective dose to the abdominal organs varied with exposure factors and Focus to Detector Distance (FDD), where the colon wall had the highest sensitivity with doses ranging from 0.030 mSv to 0.126 mSv, followed by the stomach and pancreas. Increasing kV, mAs, and FDD increased the effective dose, emphasizing the importance of careful dose management. This study concluded that exposure factors and FDD affect the effective dose received by the abdominal organs, with recommendations to monitor patient doses, revise national diagnostic reference levels, and establish standard protocols with health authorities. Keywords: CALDose_X, X-ray Exposure Factor, patient dose, ESAK, Effective Dose, Abdomen AP.

068. Revealing the Hidden Giant: When Giant Appendicitis Mimics A Mesenteric Cyst in Recurrent Sigmoid Volvulus – A Case Report

Background: Giant appendicitis is an exceptionally rare condition that can mimic other intra-abdominal pathologies, including mesenteric cysts, due to its unusual size and presentation. Distinguishing between these entities is chalenging due to its resemblances. Case: A 56-year-old woman with a history of chronic constipation who was admitted to the emergency department with abdominal distension and inability to defecate. Abdominal examination revealed a distended abdomen with visible bowel contour and an abdominal X-ray showed coffee bean appearance, suggestive of sigmoid volvulus. An exploratory laparotomy revealed twisting of the sigmoid colon. After reducing the volvulus and confirming viability of the sigmoid, a loop sigmoidostomy was performed to prevent recurrent volvulus. Intraoperatively, a mass resembling a mesenteric cyst was identified, which was subsequently confirmed to be a case of giant appendicitis. Conclusion: Considering giant appendicitis in the differential diagnosis of abdominal masses resembling mesenteric cysts is important, particularly in patients with chronic constipation and recurrent volvulus, to ensure timely and appropriate surgical management.

Diagnosing Necrotizing Enterocolitis via Fine-Grained Visual Classification.

Necrotizing Enterocolitis (NEC) is a devastating condition affecting prematurely born neonates. Reviewing Abdominal X-rays (AXRs) is a key step in NEC diagnosis, staging and treatment decision-making, but poses significant challenges due to the subtle, difficult-to-identify radiological signs of the disease. In this paper, we propose AIDNEC - AI Diagnosis of NECrotizing enterocolitis, a deep learning method to automatically detect and stratify the severity (surgical or medical) of NEC from no pathology in AXRs. The model is trainable end-to-end and integrates a Detection Transformer and Graph Convolution modules for localizing discriminative areas in AXRs, used to formulate subtle local embeddings. These are then combined with global image features to perform Fine-Grained Visual Classification (FGVC). We evaluate AIDNEC on our GOSH NEC dataset of 1153 images from 334 patients, achieving 79.7% accuracy in classifying NEC against No Pathology. AIDNEC outperforms the backbone by 2.6%, FGVC models by 2.5% and CheXNet by 4.2%, with statistically significant (two-tailed p 0.05) improvements, while providing meaningful discriminative regions to support the classification decision. Additional validation in the publicly available Chest X-ray14 dataset yields comparable performance to state-of-the-art methods, illustrating AIDNEC's robustness in a different X-ray classification task.

Novel scoring system for predicting stone-free rate after flexible ureteroscopy lithotripsy.

This study aims to investigate the factors affecting the stone-free rate (SFR) of flexible ureteroscopy and laser lithotripsy (fURSL) for renal stones and establish predictive models by identifying their prognostic factors. We retrospectively examined 252 patients with renal stones who were treated with fURSL between July 2020 and April 2022. We analyzed the relationship between the patient's clinical data (sex, age, and body mass index), stone status (side, size, location, stone/transverse process pixel ratio [STPR], and the CT value of stone [SCTV]), and SFR to determine the relevant factors and analyze their influence. Additionally, a nomogram was constructed based on these prediction results. A total of 252 patients were enrolled based on the inclusion and exclusion criteria. They were reviewed 7, 30, and 90 days postoperatively, with 46, 23, and 10 patients failing to discharge stones, respectively. Univariate Cox proportional hazard regression results revealed that the SFR was correlated with stone location, diameter (D1, diameter of stone measured by computed tomography [CT]; D2, diameter of stone measured by kidney-ureter-bladder abdominal radiography), SCTV, STPR, and operation time. Multivariate Cox proportional hazard regression was used to develop 2 predictive models for the SFR. The influencing factors of model 1 included D1, location, and SCTV, whereas those of model 2 were D2, location, and STPR. The results are shown in the nomogram. Receiver operating characteristic curves showed no significant difference between models 1 and 2 (P = .498), indicating that the nomogram was highly predictive. After 1000 resamples and internal self-validation, the C-indices of models 1 and 2 were 0.924 and 0.895, respectively, showing that the stone clearance predicted by the nomogram matched the actual situation. Stone location, size, and density (SCTV and STPR) were significant predictors of SFR after fURSL. The scoring system based on these factors may be used to guide optimal treatment strategy selection.

A Rare Case Report Of Sigmoid Volvulus – An Important Differential To Consider In Acute Abdomen

Background: Sigmoid volvulus an uncommon source of bowel obstruction in middle-aged individuals.. This perilous condition pervades globally, with a pronounced predilection for elderly population burdened by concurrent health ailments. While both genders can fall victim, males (1) are more frequently affected. Case Report: A middle aged gentleman presented to emergency center reporting pain abdomen, vomiting , obstipation. On palpation generalized tenderness , guarding present, X – ray abdomen showed classic coffee bean (volvulus) immediately underwent emergency laparotomy - found sigmoid colon was distended and gangrenous. Sigmoidectomy with Hartmann’s performed. Conclusion: This case underscores the criticality of swift action in addressing this life-threatening ailment. Its evaluation should be of utmost importance among the potential diagnoses for individuals reporting with abdominal distention and pain, vomiting,obstipation. An abdominal X-ray (3) both erect and supine positions provides excellent diagnostic results

Intussusception in children with celiac disease

ABSTRACT Celiac disease (CD) is a chronic illness. Blood testing for tissue transglutaminase antibodies is the initial screening test for the diagnosis of CD, and upper gastrointestinal endoscopy and duodenal/jejunal biopsy are used to confirm CD. Intussusception (IS) is the process in which a proximal segment of the bowel invaginates through the lumen of a distal segment. The association between pediatric IS and CD has been described but is still not widely recognized. Herein, we report a case of IS as the first manifestation of CD in a child. A 3-year-old girl presented to the emergency department with a 1-week history of marked abdominal distention and lethargy, but there was no history of fever, bleeding per rectum, or jaundice. A second-degree relative had a family history of CD. Clinical examination: The patient was a lethargic child with pale conjunctiva and bilateral lower limb edema. She was a febrile and had a normal hemodynamic status. The adipose tissue was diminished throughout the patient’s body; her weight was 8 kg (<5% weight percentile for girls), and her height was 81 cm (<5% height percentile for girls). Laboratory results included the following: Hb of 9 g/dL, serum ferritin of 10 ng/mL (30–400 ng/mL), normal liver function test results except for hypoalbuminemia at 21 g/L (35–52 g/L), and low blood cholesterol of 0.94 g/L (1.54–2.01 g/L). The patient’s blood sugar level was 98 mg/dL, and her renal function test results were normal, with negative septic screening. Abdominal radiography revealed several air–fluid levels, suggestive of an obstruction in the small bowel. Abdominal ultrasonography revealed typical features confirming the diagnosis of IS. Abdominal computed tomography demonstrated an enteroenteric IS with no other signs of organic causes, such as lymphoma or other tumors. Based on the high index of suspicion of CD, a workup confirmed the diagnosis. A gluten-free diet [A1] was started during the hospital course, and the patient improved dramatically regarding her symptoms and was discharged home. In conclusion, this case highlights the association between IS and CD. Intussusception is an emergency condition and usually idiopathic. However, in atypical or recurrent typical presentations underlying causes, we should do proper investigations to initiate appropriate management. [A1]Abbreviations are generally avoided for terms that are not repeated in the text. In this case, this abbreviation is not used elsewhere in the Abstract. Hence, I have deleted the abbreviation. Categories: Pediatrics, Gastroenterology.

048. Roux-En-Y Duodenojejunostomy as Surgical Treatment for Congenital Duodenal Obstruction: A Case Report

Background: Congenital duodenal obstruction is an anatomical abnormality in newborn. Various intrinsic and extrinsic etiologies can cause duodenal obstruction. The surgical treatment that commonly performed on duodenal obstruction in neonates is duodenoduodenostomy. However, several etiologies conditions such as preduodenal portal vein (PDPV) and pancreatic annulare cause duodenoduodenostomy is nearly impossible to be performed, so an alternative treatment is necessary. Case: This case describes female neonate with congenital duodenal obstruction which had been suspected since in pregnancy due to polyhydramnios, an OGT was installed with greenish yellow residue after the baby was born. Based on abdominal x-ray examination, a double bubble appearance was seen. The patient then underwent surgery when he was 5 days old. Intraoperatively, there was PDPV and pancreas annulare covering the 3rd-4th part of duodenum, so it was decided to perform Roux-en-y duodenojejunostomy. Conclusion: In patients with congenital duodenal obstruction with special etiology and anatomy such as PDPV and pancreatic annulare, it is possible to perform a roux-en-y duodenojejunostomy. Even though this operation is rarely performed on neonate and more common in adult patients, it can be an alternative in cases of congenital duodenal obstruction.

Thrombosis in Hemodialysis Tunnelled Central Venous Catheters: From Pathogenesis to Therapeutic Strategies

Central venous catheter-related thrombosis is a frequent non-infectious complication, typically associated with catheter dysfunction and hemodialysis inadequacy. Central venous catheters (CVCs) are categorized into non-tunnelled and tunnelled types, wherein the choice depends on patient's clinical conditions and the diagnostic and therapeutic workup. Tunnelled CVCs (tCVCs) are sought whenever an arteriovenous fistula is unfeasible or as primary access in patients with poor prognosis. Dysfunction is defined as the inability to maintain adequate blood flow within the prescribed dialytic session. Amongst non-infectious complications causing tCVC malfunctioning, thrombosis is the most frequent, and it is further classified into intrinsic (being endoluminal, pericatheter or fibrin sleeve-associated thrombosis) and extrinsic forms (including mural and atrial thrombosis). Diagnosis requires imaging tests like chest X-ray or abdominal X-ray, echocardiography, dynamic catheterography and computed tomography. Pharmacological treatment involves use of local thrombolytic agents. In case of extrinsic thrombosis, systemic anticoagulation is mandatory, occasionally requiring tCVC replacement. Prevention of thrombotic complications includes adequate positioning and appropriate use of the tCVC, with anticoagulant/antimicrobial-based locking solutions playing a crucial role in this context. In cases of extrinsic thrombosis, treatment options vary based on thrombus size, ranging from a conservative approach availing of systemic anticoagulation to surgical interventions like thrombectomy or thrombus aspiration, possibly associated with tCVC removal. In conclusion, late dysfunction of tCVCs is primarily due to thrombosis, thus requiring diagnostic imaging and specific drug therapies. Prevention is crucial to minimize complications.

Correlation between circulating dephosphorylated uncarboxylated matrix Gla protein and vascular calcification in peritoneal dialysis patients.

To explore the association between serum Dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) and abdominal aortic calcification (AAC) in peritoneal dialysis (PD) patients. A total 128 PD patients and 120 healthy controls were enrolled into the study. Serum dp-ucMGP was measured by enzyme-linked immunosorbent assay. Abdominal lateral plain radiography was used to evaluate the abdominal aortic calcification score (AACS). PD patients were divided into two groups according to the presence or absence of AAC. The relationships between dp-ucMGP levels and AACS were assessed by Spearman analysis and the value of dp-ucMGP in predicting AAC was evaluated by receiver operating characteristic (ROC). Serum dp-ucMGP in PD patients were significantly higher than controls (p < 0.05). And PD patients with AAC had higher serum dp-ucMGP than that of PD patients without AAC (p < 0.05). The serum dp-ucMGP levels was positively associated with AACS (r = 0.794, p < 0.0001) in PD patients. The multivariate logistic regression analyses showed that serum dp-ucMGP was independent factors of AAC in PD patients (OR = 2.555, 95% CI = 1.415-4.609). The area under ROC curve of dp-ucMGP was 0.9227, the corresponding sensitivity was 0.86, and the specificity was 0.92. Serum dp-ucMGP levels were positively associated with the AACS in PD patients. Higher serum dp-ucMGP level is independently associated with AAC in PD patients.

Applying Deep-Learning Algorithm Interpreting Kidney, Ureter, and Bladder (KUB) X-Rays to Detect Colon Cancer.

Early screening is crucial in reducing the mortality of colorectal cancer (CRC). Current screening methods, including fecal occult blood tests (FOBT) and colonoscopy, are primarily limited by low patient compliance and the invasive nature of the procedures. Several advanced imaging techniques such as computed tomography (CT) and histological imaging have been integrated with artificial intelligence (AI) to enhance the detection of CRC. There are still limitations because of the challenges associated with image acquisition and the cost. Kidney, ureter, and bladder (KUB) radiograph which is inexpensive and widely used for abdominal assessments in emergency settings and shows potential for detecting CRC when enhanced using advanced techniques. This study aimed to develop a deep learning model (DLM) to detect CRC using KUB radiographs. This retrospective study was conducted using data from the Tri-Service General Hospital (TSGH) between January 2011 and December 2020, including patients with at least one KUB radiograph. Patients were divided into development (n = 28,055), tuning (n = 11,234), and internal validation (n = 16,875) sets. An additional 15,876 patients were collected from a community hospital as the external validation set. A 121-layer DenseNet convolutional network was trained to classify KUB images for CRC detection. The model performance was evaluated using receiver operating characteristic curves, with sensitivity, specificity, and area under the curve (AUC) as metrics. The AUC, sensitivity, and specificity of the DLM in the internal and external validation sets achieved 0.738, 61.3%, and 74.4%, as well as 0.656, 47.7%, and 72.9%, respectively. The model performed better for high-grade CRC, with AUCs of 0.744 and 0.674 in the internal and external sets, respectively. Stratified analysis showed superior performance in females aged 55-64 with high-grade cancers. AI-positive predictions were associated with a higher long-term risk of all-cause mortality in both validation cohorts. AI-enhanced KUB X-ray analysis can enhance CRC screening coverage and effectiveness, providing a cost-effective alternative to traditional methods. Further prospective studies are necessary to validate these findings and fully integrate this technology into clinical practice.

Radiographic and ultrasonographic findings of seminal vesiculitis with nonmineral stones in a guinea pig: Case report.

This case report refers to a 1-year-old Guinea pig showing signs of anorexia and antipain posture. On abdominal radiography, five rounded mineral opaque structures were evident in the mid-caudal abdomen. On ultrasound, a right seminal vesicle with a reduction in diameter was observed, containing less echogenic material than the contralateral one, with five oval structures with a hyperechogenic contour and a central hypoechogenic area, forming acoustic shadowing. The left seminal vesicle presented with the usual characteristics. After bilateral vesiculectomy, the patient recovered well, with no further symptoms. The histopathological result was a suppurative/abscessive inflammatory process with an accumulation of proteinaceous material.

Prevalence of an empty colon in patients with acute and chronic small intestinal mechanical obstruction: A retrospective radiographic study in 100 dogs and cats

Small intestinal mechanical obstruction (SIMO) is a common clinical condition, with radiographic studies typically focusing on the small intestine. However, the colon's appearance in SIMO has not been extensively studied. This retrospective study aimed to determine the prevalence of an empty colon on radiographs of dogs and cats with confirmed SIMO. Pre-surgical abdominal radiographs of 100 patients (68 dogs and 32 cats) with surgically confirmed mechanical ileus and a control group of 30 dogs and 20 cats with non-obstructive gastrointestinal (GI) disease and one without GI disease, respectively, were evaluated. The colon was assessed for content (none/collapsed, gas, faeces) and segmental distribution (ascending, transverse, descending colon) and correlated to the duration of clinical signs (acute, chronic). A colon was classified as empty when ≥2/3 was collapsed and/or gas-filled. The overall prevalence of an empty colon in cases of mechanical ileus was 61% (p=0.028), with 49/68 in dogs (72.1%) and 12/32 in cats (37.5%), p=0.001 between dogs and cats. Clinical signs duration did not influence the prevalence 28/61 (45.9%) acute, 33/61 (54.1%) chronic, p=0.522. However, acute cases had more empty colon segments (2/3 segments: 6/28, 21.4%; 3/3 segments: 22/28, 78.6%) than chronic cases (2/3 segments: 23/33, 69.7%; 3/3 segments: 10/33, 30.3%; p≤0.001). In the control groups, the prevalence of an empty colon was 64% (p=0.048) with and 38%, p=0.048) without GI disease, with no statistical difference between dogs and cats. An empty colon can be a supporting radiographic finding in diagnosing patients with GI disease, including SIMO, in addition to other established characteristic features. Dogs are more likely to have an empty colon in the presence of mechanical ileus.

External abdominal pressure radiography versus survey radiography for the diagnosis of hiatal hernia in brachycephalic dogs

Hiatal hernia (HH) is a common disorder in brachycephalic dogs with upper airway obstruction. The breathing effort results in an exaggerated transdiaphragmatic pressure gradient during inspiration that can displace the gastroesophageal junction causing gastroesophageal reflux. The diagnosis is challenging because the HH usually occurs intermittently and is often missed on survey radiography. In this retrospective study, the application of external abdominal pressure to mimic the transdiaphragmatic pressure gradient during radiographic screening for HH was evaluated in 146 dogs. Hiatal hernia was diagnosed with external abdominal pressure radiographs in 6.8% (10/146 dogs), whereas it was diagnosed via survey radiography in only 2% (3 dogs). In conclusion, the radiographic diagnosis of HH in brachycephalic dogs can be improved by performing external abdominal pressure radiographs.

An apparently healthy female British shorthair cat with a rare complication of colonic stenosis after flank approach ovariohysterectomy

BackgroundColonic stenosis is a rare postoperative complication of ovariohysterectomy in cats, leading to dyschezia and fecal diameter reduction. In cats, while there are reports of colonic stenosis after midline approach ovariohysterectomy, there are no specific reports of flank approach ovariohysterectomy.Case presentationThis report describes a severe case of a one-year-old British shorthair female cat presenting with gastrointestinal signs, including dyschezia and reduced fecal diameter, three weeks after flank approach ovariohysterectomy. Despite abdominal radiography, proctography with barium sulfate, colonoscopy, CT, and hematological analysis, the cause of colonic stenosis remained unclear. During exploratory laparotomy, an annular tissue band was found encircling the descending colon, resulting in severe local stenosis. After excision of the tissue band, the presenting clinical signs of the cat were rapidly improved. This result suggests that colonic stenosis caused by tissue band should be considered when diagnosing postoperative complications in flank approach ovariohysterectomy in cats.ConclusionColon stenosis due to annular tissue band restriction should be considered one of the differentials for postoperative complications in flank approach ovariohysterectomy in cats.