Abdominal X-ray Research Articles

Comparison between Guy’s Stone Score and S.T.O.N.E. Score System in Predicting Stone Free Rate after PCNL

Abstract Background PCNL is the gold standard treatment modality of large and complex kidney stones. We compared the stone free status predicting ability of Guy’s stone score and S.T.O.N.E. score system. Objective To compare to compare between Guy’s stone score and S.T.O.N.E score system in predicting stone free rate after PCNL. Patients and Methods A total number of 40 patients underwent PCNL in the period between December 2021 and May 2022. All cases were evaluated and graded using both Guy score and S.T.O.N.E. score based on preoperative computerized plain ctut. The post operative stone free status was evaluated using post operative plain KUB xray and ctut. Statistical analysis was done to determine relation of the scores with the post-operative stone free status. Also receiver operating characteristics curves (ROC) was drawn and area under the curve was calculated to assess the scores predictability of post-operative stone free status. Results The overall stone free rate of our study was 80%. Mean age of study population was 43 years (±SD10.60). we found that stone free patients had lower mean Guy score (2.00 vs 3.38) and lower mean S.T.O.N.E. score (7.84 vs 9.75). both scores had statistically significant relation with stone free status the P value was 0.001 for Guy score and 0.022 for S.T.O.N.E. score. The post operative stone free status predictability of both scores was assessed by drawing receiver operating characteristics curves (ROC) and the area under the curve was calculated by ROC curve. When comparing area under the curve for both scores we found no great difference between guy score and S.T.O.N.E. score (0.867 – 95% CI 0.735-1.000) vs (0.760– 95% CI 0.569-0.951). Conclusion The study shows that both Guy score and S.T.O.N.E. score systems have similar predicting ability of post PCNL stone free status with strong correlation with post operative stone free status.

Study on the application of self-fixing and self-detachable drainage stent in pancreaticojejunostomy

Objectives: To evaluate the efficacy and safety of the self-fixing and self-detachable drainage stent in pancreaticojejunostomy and to provide supportive data for the follow clinical trials. Methods: This is an experimental research in animals which completed from February 2022 to September 2022. A self-fixing and self-detachable pancreaticojejunostomy drainage stent was designed for Hong's pancreaticojejunostomy technique based on the theory of "fistula healing" in pancreaticojejunostomy. Ten biocompatibility tests were completed in vitro before this study. Twenty-five Bama minipigs were selected and double-ligated in the neck of the pancreas to dilate the distal main pancreatic duct. Twenty-three of them were successfully modelled and divided into three groups by a stratified random method: pancreaticojejunostomy drainage stent group (referred to as stent group) with 11 pigs, pancreatic duct to jejunal mucosa anastomosis group (referred to as manual suture group) with 8 pigs, sham operation group with 4 pigs. The anastomic time,amylase content in postoperative abdominal drainage fluid and the tolerable pressure value of pancreaticojejunostomy were compared between the stent group and the manual suture group. An abdominal X-ray fluoroscopy examination was adopted to detect the detach time of the stent. A postoperative pathological examination was performed to verify the healing time,the type of treatment and the stricture rate of pancreaticojejunostomy. Quantitative data was analyzed by independent sample t-test. The classified data were analyzed by Fisher's exact test. Results: There were no significant differences in the diameter of the pancreatic duct and pancreatic texture,the time of pancreaticojejunostomy,the amylase content in postoperative peritoneal drainage fluid,and the tolerable pressure value of the pancreaticojejunostomy between the stent group and the manual suture group(all P>0.05). Abdominal X-ray fluoroscopy showed that the stents gradually detached and were removed from the body 21 days after operation,and all stents were detached in the follow 3 months after operation. Pancreaticojejunostomy healed 7 days after operation based on fistula formation in the stent group,and 14 days in the manual suture group. The incidence of anastomotic stricture within 35 days after operation was 2/8 in the stent group and 6/8 in the manual suture group (Fisher's exact test: P=0.132). Conclusion: The stent method is safer and simpler than the manual suture method in pancreaticojejunostomy of Bama minipigs, with shorter anastomotic healing time and lower stricture rate.

Unraveling the Enigma of Gossypiboma: A Series of 14 Cases Highlighting the Prevalence, Root Causes, and Outcomes in Resource-Limited Settings.

Gossypiboma or textiloma is the unintentional retention of textile material in a patient's body, often occurring during abdominal surgery and involving surgical sponges. The body may respond to this foreign body with an exudative inflammatory reaction or an aseptic fibrotic reaction, encapsulating the cotton material and forming a mass. This rare but dramatic event can lead to life-threatening complications, and due to legal and ethical concerns, few publications exist. There were no published papers regarding this issue in our nation (Yemen). This study aims to report the retained surgical sponges' cases and their associated factors in a resource-limited setting to improve prevention. A retrospective case series study was conducted at hospitals affiliated with Ibb University, Ibb, Yemen, between March 22, 2018, and May 12, 2024. The study included 14 cases of diagnosed and surgically confirmed retained surgical sponges. Data on demographic characteristics, type of operation, and risk factors were gathered and analyzed. Among 15,120 surgical procedures, there were 14 cases of retained surgical sponges with a prevalence rate of 0.09%. The mean age was 32.5±17.0 years, with 10 (71.4%) females and 4 (28.6%) males. Gynecological surgery was the most common causal procedure (n=7, 50.0%). The most common clinical presenting features were abdominal pain in 12 (85.7%), followed by infections and a systemic reaction in 9 (64.3%). The median symptom incubation time was 37 days. 11 (78.5%) patients underwent abdominal X-rays, and 13 (92.8%) had abdominal ultrasounds, with 4 (28.6%) X-rays and 5 (35.7%) abdominal ultrasounds being deemed non-diagnostic. An abdominal-pelvic CT scan was done on 11 (78.5%) individuals, with the results being diagnostic in 10 (71.4%) and non-diagnostic in one (7.1%). The leading causes for gossypiboma occurrence were prolonged surgical procedures > one hour and emergency in 7 (50.0%) cases, followed by multiple surgical team involvement and change in nursing staff during procedures in 5 (35.7%) cases. A gossypiboma or retained foreign body diagnosis can be achieved through comprehensive patient history, radiologist-surgeon interaction, understanding of risk factors, and familiarity with imaging patterns. Safety procedures should be robust and straightforward, and effective communication among surgical professionals can help minimize medical negligence and protect patients in chaotic situations.Furthermore, the surgeon should adhere to the standard prescribed method and report cases of retained surgical sponges.

549 Reducing Inappropriate Abdominal X-Rays Requests for Acute Abdominal Pain in the Emergency Department: A Quality Improvement Project

549 Reducing Inappropriate Abdominal X-Rays Requests for Acute Abdominal Pain in the Emergency Department: A Quality Improvement Project

Standardized Gastrografin Protocol for Small Bowel Obstructions in Community Hospital Setting

Introduction: Small bowel obstructions (SBO) are diagnosed and treated variously. The purpose of this study is to determine whether the use of Gastrografin oral hyperosmolar contrast and serial abdominal X-rays will lead to a decreased length of stay, readmission rate, and need for surgical intervention versus current management of patients with SBO. Methods: A retrospective review of patients who presented to our hospital with the diagnosis of SBO over two years was performed. Patients were excluded if their clinical status led to emergent operative intervention, were admitted within 30 days of bowel surgery, or were <18 years old. The leading variable for analysis was patients undergoing Gastrografin protocol versus those that did not. The leading outcome was hospital length of stay. Secondary outcomes included number of CT scans during admission, progression to surgery and 30-day readmission rate. Analyses were performed using both unpaired T-tests and Chi-squared tests. Results: A total of 55 patients with a SBO that met study criteria were reviewed. Total patients who underwent Gastrografin protocol were 24 versus 31 who did not. Gastrografin protocol patients had a decreased length of stay (mean, 2.2 days vs 3.9 days, p=0.0048) and decreased number of CT scans during admission (mean, 1.0 scans vs 1.35 scans, p=0.0027) compared to non-protocol patients. Both Gastrografin protocol and non-protocol groups had similar progression to surgical intervention (4.2% vs 16.1%, p =0.158) and 30-day readmission rate (12.5% vs 16.1%, p=0.70). Conclusion: The Gastrografin protocol decreases length of stay and number of CT scans for patients admitted with SBO.

Impact of Different Grids on the Quality of Abdominal Radiography Images

Impact of Different Grids on the Quality of Abdominal Radiography Images

Testing in functional constipation-What's new and what works.

Constipation is among the most common symptoms prompting a consultation with a paediatric gastroenterologist. While most patients will respond to lifestyle and dietary changes and conventional therapy, some may require diagnostic studies. To review the diagnostics studies used to evaluate children with functional constipation. There is no evidence to support the routine use of abdominal X-rays in the evaluation of paediatric constipation. Colon transit by radiopaque markers (ROM) should be indicated when medical history does not match clinical findings, to guide colon manometry (CM) performance and to discriminate between faecal incontinence from functional constipation and non-retentive faecal incontinence. Colon scintigraphy may be useful as an alternative to ROM. Lumbar spine MRI may be indicated to evaluate for spinal abnormalities. The role of defecography has not been properly evaluated in children. Anorectal manometry in children is indicated primarily to evaluate anal resting pressure, presence and quality of the recto-anal inhibitory reflex and simulated defecation manoeuvres. The CM is indicated to guide surgical interventions after failing medical therapy. The goal of these studies is to identify treatable causes of constipation. Most of these studies are designed to evaluate anatomy, transit and/or colon/rectum motility function and are primarily indicated in those who fail to respond to conventional therapy.

Management of Strangulated Richter’s Hernia in a Resource-Limited Setting: Report of Two Cases and Literature Review

Richter’s hernia is a rare type of abdominal wall hernia characterized by high morbidity and mortality. It occurs when the anti-mesenteric border of the bowel is partially trapped in a tight hernial ring. The femoral ring is the most common site, with the ileum being the most frequently involved intestinal segment. However, the advent of laparoscopic surgery has introduced another potential site for Richter’s hernia formation. In our region, this pathological entity is exceptionally diagnosed due to limited access to abdominal imaging and delayed management. Additionally, the wide variety of clinical manifestations resulting from incomplete intestinal obstruction makes it particularly difficult to diagnose. Consequently, it is usually identified during surgery. We present here the case of two adult patients (a 33-yeairs-old woman and a 59-year-old man), the first with a history of surgical procedures and the second with a spontaneously reducible painless inguinal swelling. They were transferred to the surgical emergency department for an acute abdomen with abdominal distension and cessation of matter and gas. Clinical and paraclinical examinations (including hydroaeric level on abdominal X-ray) indicated mechanical intestinal obstruction. Emergency laparotomy, necessitated by the unavailability of abdominal computed tomography due to financial constraints, confirmed the diagnosis of Richter's hernia, with the first case located in the right inguinal region and the second in the linea alba. Surgical management involved reduction of the hernia contents and suture repair in both cases. Despite requiring bowel resection in the second patient, the postoperative course was straightforward. These two rare cases highlight that emergency exploratory laparotomy is the cornerstone of Richter hernia management in resource-limited conditions.

Insulinoma in a Boxer- A case report

A nine-year-old female Boxer was presented to the Small Animal Medicine outpatient unit of Teaching Veterinary Hospital, Madras Veterinary College with the complaint of weakness and occasional ataxia. The general clinical, physical and neurological examinations were found to be normal except for the history of weakness and ataxia. The complete blood count was normal. Serum biochemistry revealed hypoglycemia and the amended insulin to glucose ratio was 187.4. Abdominal ultrasonography and radiography examination were unrewarding. Contrast CT revealed presence of multiple nodular lesions over the pancreas suggestive of insulinoma. The hypoglycemic episodes were managed with dextrose solution followed by dietary management, prednisolone and octreotide. The animal responded to treatment with an improvement in blood glucose level.

Association of single nucleotide genetic polymorphisms of vitamin D receptor and calcium-sensitive receptor with calcium-containing kidney stones in Chinese Dai populations: a prospective multi-center study.

To evaluate the association between vitamin D receptor (VDRs) and calcium-sensitive receptor (CaSR) gene polymorphisms and calcium-containing kidney stones (CCKS) in Dai populations. A total of 160 CCKS patients and 87 healthy controls were included in this study. CCKS was confirmed using urological computed tomography (CT), plain abdominal radiograph, or surgical lithotomy. Stone samples obtained during surgery were analyzed using infrared spectroscopy. Venous blood and 24-h urine samples were collected and analyzed using Sanger sequencing and high-performance liquid chromatography, respectively. Genetic variants in the VDR gene (rs7975232, rs2228570, rs731236, and rs1544410) and CaSR gene (rs7652589, rs1801725, and rs1042636) were identified through sequence analysis. Analysis of genotype and allele frequencies revealed that the rs7975232 polymorphism in the VDR gene and the rs7652589 allele in the CaSR gene were significantly associated with CCKS. Furthermore, patients carrying the AC and AA genotypes of rs7975232 showed a higher incidence of hypocitraturia compared to those with other genotypes (p < 0.05). The AA and GG genotypes of rs1042636 and the AA genotype of rs7652589 were significantly associated with hypercalciuria (p < 0.05). CCKS in this study population may be closely related to hypocitraturia caused by the VDR locus rs7975232 polymorphism and hypercalciuria caused by the CaSR locus rs1042636 and rs7652589 polymorphism.

CT-Based AI model for predicting therapeutic outcomes in ureteral stones after single extracorporeal shock wave lithotripsy through a cohort study.

Exploring the efficacy of an artificial intelligence (AI) model derived from the analysis of CT images to precisely forecast the therapeutic outcomes of singular-session extracorporeal shock wave lithotripsy (ESWL) in the management of ureteral stones. A total of 317 patients diagnosed clinically with ureteral stones were included in this investigation. Unenhanced CT was administered to the participants within the initial fortnight preceding the inaugural ESWL. The internal cohort consisted of 250 individuals from a local healthcare facility, whereas the external cohort comprised 67 participants from another local medical institution. The proposed framework comprises three main components: an automated semantic segmentation model developed using 3D U-Net, a feature extractor that integrates radiomics and autoencoder techniques, and an ESWL efficacy prediction model trained with various machine learning algorithms. All participants underwent thorough postoperative follow-up examinations four weeks hence. The efficacy of ESWL was defined by the absence of stones or residual fragments measuring ≤2mm in KUB X-ray assessments. Model stability and generalizability were judiciously validated through a fivefold cross-validation approach and a multi-center external test strategy. Moreover, Shapley Additive Explanations (SHAP) values for individual features were computed to elucidate the nuanced contributions of each feature to the model's decision-making process. The semantic segmentation model we constructed exhibited an average Dice coefficient of 0.88 ± 0.08 on the external testing set. ESWL classifiers built using Support Vector Machine (SVM), Random Forest (RF), XGBoost (XB), and CatBoost (CB) achieved AUROC values of 0.78, 0.84, 0.85, and 0.90, respectively, on the internal validation set. For the external testing set, SVM, RF, XB, and CB predicted ESWL with AUROC values of 0.68, 0.79, 0.80, and 0.83, respectively, with the last one being the optimal algorithm. The radiomics features and auto-encoder features made significant contributions to the decision-making process of the classification model. This investigation unmistakably underscores the remarkable predictive prowess exhibited by a scrupulously crafted AI model using CT images to precisely anticipate the therapeutic results of a singular session of extracorporeal shock wave lithotripsy for ureteral stones.

Ultrasound role in diagnosis and as an assisting tool in prognostication of surgery in neonates with necrotizing enterocolitis

ObjectiveAbdominal ultrasonography (AUS) assessment of the neonatal abdomen is emerging as a potential useful addition to traditional abdominal radiographs (AXR) to confirm the diagnosis of necrotizing enterocolitis (NEC). The goal of this study was to assess the abdominal sonographic findings of premature infants with NEC, in order to determine whether AUS is more effective than AXR in the diagnosis of NEC. MethodsThis cross-sectional study was performed on consecutive neonates with clinical suspicion of NEC admitted in our hospital’s NICU (Ali-Asghar Children’s Hospital, Tehran, Iran). We prospectively evaluated the hospitalized subjects using AXR and AUS from May 2018 to May 2020. ResultsA total of 53 neonates were included in the study. These patients were divided into two groups: suspected NEC patients (stage I) including 31 subjects and definite NEC patients (stage II and III) including 22 neonates. We found a substantial agreement between the two modalities regarding the detection of pneumoperitoneum and pneumatosis intestinalis (κ: 0·658 for both). The concordance concerning portal venous gas detection was considered slight (κ: 0·315). Thirty-eight patients did not show any signs of portal venous gas in either of AUS or AXR. On the contrary, four patients demonstrated evidences of portal venous gas in both AUS and AXR. AUS detected ten more portal venous gas than AXR. AXR found no cases with positive portal venous gas that were undetected by AUS. The most predictive indicator for surgical intervention in neonates was the presence of free echogenic ascites and loculated fluid. ConclusionOur findings demonstrated that AUS is superior to AXR in demonstrating portal venous gas and pneumatosis intestinalis. Hence, it seems that AUS is a useful adjunct to AXR in the management of NEC.

Enhancing surgical decision-making in NEC with ResNet18: a deep learning approach to predict the need for surgery through x-ray image analysis.

Necrotizing enterocolitis (NEC) is a severe neonatal intestinal disease, often occurring in preterm infants following the administration of hyperosmolar formula. It is one of the leading causes of neonatal mortality in the NICU, and currently, there are no clear standards for surgical intervention, which typically depends on the joint discretion of surgeons and neonatologists. In recent years, deep learning has been extensively applied in areas such as image segmentation, fracture and pneumonia classification, drug development, and pathological diagnosis. Investigating deep learning applications using bedside x-rays to help optimizing surgical decision-making in neonatal NEC. Through a retrospective analysis of anteroposterior bedside chest and abdominal x-rays from 263 infants diagnosed with NEC between January 2015 and April 2023, including a surgery group (94 cases) and a non-surgery group (169 cases), the infants were divided into a training set and a validation set in a 7:3 ratio. Models were built based on Resnet18, Densenet121, and SimpleViT to predict whether NEC patients required surgical intervention. Finally, the model's performance was tested using an additional 40 cases, including both surgical and non-surgical NEC cases, as a test group. To enhance the interpretability of the models, the study employed 2D-Grad-CAM technology to describe the models' focus on significant areas within the x-ray images. Resnet18 demonstrated outstanding performance in binary diagnostic capability, achieving an accuracy of 0.919 with its precise lesion imaging and interpretability particularly highlighted. Its precision, specificity, sensitivity, and F1 score were significantly high, proving its advantages in optimizing surgical decision-making for neonatal NEC. The Resnet18 deep learning model, constructed using bedside chest and abdominal imaging, effectively assists clinical physicians in determining whether infants with NEC require surgical intervention.

A case of intermittent bilious emesis in a term neonate: a case report and brief review of literature

BackgroundNeonatal intestinal obstruction is a complex condition that poses challenge in management. Prompt recognition and appropriate management are crucial to prevent complications. We present a case of a term neonate with intermittent bilious vomiting.Case presentationThe baby underwent routinely performed investigations, including abdominal radiography and ultrasound, which provided inconclusive results. However, contrast-enhanced computed tomography revealed a web at duodenojejunal flexure. Exploratory laparotomy confirmed the diagnosis, and surgical intervention was performed. The baby’s postoperative course was prolonged with a gradual transition from parenteral nutrition to enteral feeds.ConclusionThis case highlights a rare cause of intestinal obstruction, the unusual location of duodenal web, the importance of maintaining a high index of suspicion for intestinal obstruction, even in the absence of classical signs, and the value of utilizing contrast-enhanced computed tomography when initial investigations are inconclusive.

FECALOME GEANT A PROPOS D’UNE OBSERVATION ET REVUE DE LA LITTERATURE A L’HOPITAL DONKA

Fecal impaction is a mass of hardened fecal matter impacted primarily in the rectum and sigmoid. The most common sites of fecal impaction are the sigmoid colon and the rectum. We report a case of giant ileocecal fecal impaction causing OIA which was treated surgically. Case report: 25-year-old patient, student, admitted to the department for progressive abdominal pain accompanied by cessation of materials and gases, and abdominal bloating lasting for two (2) weeks. As a history, we noted stubborn constipation and episodes of subocclusion. The clinical examination noted a deterioration in general condition WHO stage I, conjunctival hypocoloration, polypnea at 35 cycles/mm and tachycardia at 100/min. The abdomen was very distended and tympanic, intestinal peristalsis was inaudible. Rectal examination revealed vacuity of the rectal bulb. The diagnosis of OIA/VCP was made; the unprepared abdominal X-ray showed aerocolia; biological examination, normochromic and normocytic anemia at 10g/l. Intraoperatively, we found a giant ileocecal fecal impaction extending from the rectosigmoid hinge to the last ileal loops (50 cm from the ileocecal angle) on dolichomegacolon. (Figure 2) We carried out a sigmoidectomy to extract the fecal impaction which weighed 15 KG (figure 3), using the colostomy according to Hartmann. The operating part addressed to the anapath did not show any particularity. Three (3) months later we restored continuity. The ileal fecal masses were extracted manually. The postoperative course was simple; 16 weeks after the first intervention we restored continuity. Conclusion: Fecal impaction occurs when a large amount of fecal matter is compacted and cannot be evacuated spontaneously. It is significantly common in severe chronic constipation and in other at-risk patients with anatomical or functional anorectal abnormalities. Key words: giant fecal impaction, intestinal obstruction, Donka Hospital.

Abdominal radiographic features of anticoagulant rodenticide toxicity in 14 dogs and 2 cats.

Anticoagulant rodenticide toxicity is commonly encountered in veterinary practice that can result in internal bleeding. We have observed dogs with retroperitoneal hemorrhage secondary to anticoagulant rodenticide toxicity. However, abdominal radiographic changes in dogs with rodenticide toxicity have not been studied and retroperitoneal hemorrhage secondary to rodenticide toxicity has rarely been reported. The objective is to describe abdominal radiographic features of anticoagulant rodenticide toxicity and concurrent thoracic radiographic changes in dogs and cats. Dogs and cats diagnosed with rodenticide toxicity and with available abdominal radiographs were included in this retrospective analysis. Board-certified radiologists reviewed the abdominal and thoracic radiographs. Evaluation of abdominal radiographic changes included assessment of peritoneal or retroperitoneal effusion, subcutaneous hemorrhage, and internal hemorrhage of abdominal organs. Fourteen dogs and two cats with confirmed rodenticide toxicity were included in the study. In dogs, retroperitoneal effusion (28.6%) was the most commonly observed abdominal radiographic change, followed by peritoneal effusion (14.3%). Thoracic radiographic changes in dogs included pleural effusion (63.6%) and mediastinal widening (63.6%) as the most common findings, followed by pulmonary hemorrhage (36.4%) and tracheal narrowing (36.4%). Subcutaneous hemorrhage or edema (9.1%) was also noted. No abdominal radiographic changes consistent with hemorrhage secondary to rodenticide toxicity were noted in the two cats. Based on our findings, it is suggested that rodenticide toxicity may result in retroperitoneal effusion even in the absence of thoracic disease. Therefore, abdominal radiographs may be valuable when suspecting hemorrhage due to coagulopathy. However, abdominal radiographic changes associated with rodenticide toxicity are considered rare in cats.

Artificial Intelligence vs. Doctors: Diagnosing Necrotizing Enterocolitis on Abdominal Radiographs

BackgroundRadiographic diagnosis of necrotizing enterocolitis (NEC) is challenging. Deep learning models may improve accuracy by recognizing subtle imaging patterns. We hypothesized it would perform with comparable accuracy to that of senior surgical residents. MethodsThis cohort study compiled 494 anteroposterior neonatal abdominal radiographs (214 images NEC, 280 other) and randomly divided them into training, validation, and test sets. Transfer learning was utilized to fine-tune a ResNet-50 deep convolutional neural network (DCNN) pre-trained on ImageNet. Gradient-weighted Class Activation Mapping (Grad-CAM) heatmaps visualized image regions of greatest relevance to the pretrained neural network. Senior surgery residents at a single institution examined the test set. Resident and DCNN ability to identify pneumatosis on radiographic images were measured via area under the receiver operating curves (AUROC) and compared using DeLong's method. ResultsThe pretrained neural network achieved AUROC of 0.918 (95% CI, 0.837–0.978) with an accuracy of 87.8% with five false negative and one false positive prediction. Heatmaps confirmed appropriate image region emphasis by the pretrained neural network. Senior surgical residents had a median area under the receiver operating curve of 0.896, ranging from 0.778 (95% CI 0.615–0.941) to 0.991 (95% CI 0.971–0.999) with zero to five false negatives and one to eleven false positive predictions. The deep convolutional neural network performed comparably to each surgical resident's performance (p > 0.05 for all comparisons). ConclusionsA deep convolutional neural network trained to recognize pneumatosis can quickly and accurately assist clinicians in promptly identifying NEC in clinical practice. Level of EvidenceIII (study type: Study of Diagnostic Test, study of nonconsecutive patients without a universally applied “gold standard”)

A plain abdominal x-ray may direct the diagnosis of primary hyperoxaluria

A plain abdominal x-ray may direct the diagnosis of primary hyperoxaluria

CONCURRENT OCCURRENCE OF PROSTATOMEGALY AND CYSTOLITHIASIS IN AN INTACT TERRIER DOG

An intact male terrier dog aged 6.25 years was referred with a history of dysuria and intermittent hematuria for the past 2 years. Clinical examination, abdominal radiography and ultrasonography revealed the presence of prostatomegaly and cystolithiasis. A large radio-opaque calculus was observed inside the urinary bladder and ultrasonographic size of the prostate gland was [Formula: see text]. The animal was diagnosed with benign prostatic hyperplasia based on anamnesis, physical examination findings and paraclinical investigations. The presence of a single large calculus within the urinary bladder was associated with incomplete voiding resulting from enlargement of the prostate. The bladder calculus which was removed by cystotomy was a mixed type of stone consisting of ammonium (10%), phosphate (20%), calcium (20%), oxalate (40%) and magnesium (10%). The enlargement of the prostate gland was also confirmed by intraoperative examination. Cystolithiasis associated with canine benign prostatic hyperplasia has not been previously reported in the literature.

NON-SURGICAL MANAGEMENT OF PERFORATED JEJUNAL DIVERTICULUM

Jejunal diverticulitis complicated by perforation is rare and shows an uncharacteristic presentation and thus poses a difficulty in the early diagnosis ofthe condition.However, diverticulitis and its complications should always be considered in geriatric men who present with an acute abdomen. We describe a 77-year-old man who originally presented with acute abdominal pain having free gas under right dome of diaphragm on X-ray abdomen, upon further evaluation with CT abdomen, a diagnosis of contained jejunal diverticular perforation was made.Onceoptimized he was then managed non-operatively with intravenous fluids, antibiotics, and total parenteral nutrition and supportive care. His overall recovery during hospitalization was uneventful. A follow-up CT abdomen showed no new pocket of fluid or free air. As jejunal perforation is a rare finding, early laparotomy done based upon free gas on X-ray alone may be correlated with an overall higher risk of mortality due to the diseases proximity to duodenojejunal flexure and thus conservative management in selected group of patients may prevent inadvertent celiotomy and morbidity and mortality arising out of it.