Computed Tomography Abdominal Scans Research Articles

Effect of the COVID-19 pandemic on emergency department utilization of computed tomography scans of appendicitis and diverticulitis

PurposeInvestigating the effect of the COVID-19 lockdown on adult patient visits, computed tomography (CT) abdominal scans, and presentations of appendicitis and diverticulitis, to emergency departments (ED) in St. John’s NL.MethodsA retrospective quantitative analysis was applied, using ED visits and Canadian Triage and Acuity Scale (CTAS) scores. mPower (Nuance Communications, UK) identified CT abdominal scan reports, which were categorized into (1) normal/other, (2) appendicitis, or (3) diverticulitis. Time intervals included pre-lockdown (January–February), lockdown (March–June), and post-lockdown (July–August). Data from 2018 to 2019 (January–August) were used to generate expected patient volumes for 2020, and pre- and post-lockdown were included to control for other variables outside the lockdown.ResultsChi-squared goodness of fit tested for deviations from predicted means for 2018–2019. Compared to expectations, daily ED visits from January to August 2020 showed a significant (p < 0.001) decrease in patient volumes independent of gender, age, and CTAS scores. During and post-lockdown, CT abdominal scans did not drop in proportion to patient volume. Appendicitis presentations remained indifferent to lockdown, while diverticulitis presentations appeared to wane, with no difference in combined complicated cases in comparison to what was expected.ConclusionDuring lockdown, significantly fewer patients presented to the ED. The proportion of ordered CT abdominal scans increased significantly per person seen, without change in CTAS scores. Considering combined pathology cases increased during the lockdown, ED physicians were warranted in increasing abdominal imaging as patients did not avoid the ED. This may have resulted from a change in clinical practice where the uncertainty of COVID-19 increased CT scan usage.

A Comparison of the Mean CTDIvol and DLP Values for Adult Abdominal CT Examination for MTRH, Eldoret Hospital, St. Luke’s Hospital and Mediheal Hospital: A Retrospective Study

Background: Advances in Computed Tomography (CT) have facilitated widespread use of medical imaging while increasing patient lifetime exposure to ionizing radiation. In Kenya we use the international DRLs as our point of reference and so far, no regional protocols for abdominal CT scan have been adopted. This study endeavors to form a basis for dose reference levels protocols for abdominal CT scan in Uasin Gishu County. Objective: To compare the mean CTDIvol and DLP values for adult abdominal CT examination for MTRH, Eldoret Hospital, St. Luke’s Hospital and Mediheal Hospital. Methods: This was a retrospective review of CT scans of 700 adult patients conducted in Uasin Gishu healthcare system at MTRH, Eldoret Hospital, Mediheal Hospital and St. Luke’s Hospital in a period of 1 year in the year 2021 using systematic and consecutive sampling. The Volumetric CT-dose index (CTDIvol) and dose length product (DLP) length from CT abdominal scans for the adults were collected from the various CT scans dose tracking software’s. Results: The mean age of patients who underwent CT abdominal scans was 52 years with majority being females at 53 %. The mean CTDIvol was 81. (SD=22.2) and the mean DLP values was 1699.1 (SD=1053.1). Comparison by scan model demonstrated the median for the Total DLP and for the CTDIvol significantly differed by the model with the median for the Neusoft model being highest at 2538 mGy.cm and 10.3mGy respectively while those for the Siemens were the lowest for the two markers at 1318.5 mGy.cm for the DLP and 5.39mGy respectively. These findings were statistically significant with a p value of &lt; 0.001. Comparison by the type of facility showed that the median DLP and CTDIvol values were significantly higher in the public facilities at 1668.8mGy.cm and 6.3mGy respectively when compared to private facilities at 1282.4mGy.cm and 5.9mGy with a p value of &lt;0.001. The Local Dose reference level (LDRL) was set as the median value for CTDIVOL and DLP at 6.1mGy and 1465 mGy.cm respectively. Conclusions: The LDRLs for the patients undergoing abdominal CT examination in Uasin Gishu healthcare system were markedly lower than the regional and the international values for the same abdominal CT examination.

CONTRAST-ENHANCED COMPUTED TOMOGRAPHIC FINDINGS OF APPARENTLY CLINICALLY NORMAL CHEETAH (ACINONYX JUBATUS) LIVERS.

Hepatic veno-occlusive disease (VOD) is a significant cause of morbidity and mortality in captive cheetahs (Acinonyx jubatus), and the appearance of this disease in humans by computed tomography (CT) has been well described. Contrast-enhanced CT abdominal scans of cheetahs without evidence of hepatic disease (n = 5) were reviewed retrospectively to describe the normal appearance of cheetah livers as an aid to antemortem VOD diagnosis. Despite having no clinical signs, clinical pathology abnormalities, or hepatic biopsy histopathology supportive of VOD, all five cheetahs had at least one VOD consistent finding on CT. The results of this study suggest that given the progressive and potentially subclinical nature of VOD, CT could serve as a noninvasive screening tool and be used to monitor disease progression.

Accurate Liver Border Identification Model in CT Scan Images

The liver is an important organ in human body with certain variations in its edges, color, shape and pixel intensity distribution. These uncertainties may be because of various liver pathologies, hereditary or both. Along with it, liver has close proximity to its nearby organs. Hence, identifying liver in scanned images is a challenging step in image processing. This task becomes more imprecise when liver diseases are present at the edges. The liver segmentation is prerequisite for liver volumetry, computer-based surgery planning, liver surgery modelling, surgery training, 3D view generation, etc. The proposed hybrid segmentation method overcomes the problems and identifies liver boundary in Computed-Tomography (CT) scan images accurately. In this paper, the first step is to study statistics of pixel intensity distribution within liver image, and novel methodology is designed to obtain thresholds. Then, threshold-based segmentation is applied which separates the liver from abdominal CT scan images. In the second step, liver edge is corrected using improved chain code and Bresenham pixel interconnection methods. This provides a precise liver image. The initial points are located inside the liver region without user interventions. These initial points evolve outwardly using Fast Marching Method (FMM), identifying the liver boundary accurately in CT abdominal scan images.

Fully automatic liver attenuation estimation combing CNN segmentation and morphological operations.

Manually tracing regions of interest (ROIs) within the liver is the de facto standard method for measuring liver attenuation on computed tomography (CT) in diagnosing nonalcoholic fatty liver disease (NAFLD). However, manual tracing is resource intensive. To address these limitations and to expand the availability of a quantitative CT measure of hepatic steatosis, we propose the automatic liver attenuation ROI-based measurement (ALARM) method for automated liver attenuation estimation. The ALARM method consists of two major stages: (a) deep convolutional neural network (DCNN)-based liver segmentation and (b) automated ROI extraction. First, liver segmentation was achieved using our previously developed SS-Net. Then, a single central ROI (center-ROI) and three circles ROI (periphery-ROI) were computed based on liver segmentation and morphological operations. The ALARM method is available as an open source Docker container (https://github.com/MASILab/ALARM). Two hundred and forty-six subjects with 738 abdomen CT scans from the African American-Diabetes Heart Study (AA-DHS) were used for external validation (testing), independent from the training and validation cohort (100 clinically acquired CT abdominal scans). From the correlation analyses, the proposed ALARM method achieved Pearson correlations=0.94 with manual estimation on liver attenuation estimations. When evaluating the ALARM method for detection of nonalcoholic fatty liver disease (NAFLD) using the traditional cut point of <40HU, the center-ROI achieved substantial agreements (Kappa=0.79) with manual estimation, while the periphery-ROI method achieved "excellent" agreement (Kappa=0.88) with manual estimation. The automated ALARM method had reduced variability compared to manual measurements as indicated by a smaller standard deviation. We propose a fully automated liver attenuation estimation method termed ALARM by combining DCNN and morphological operations, which achieved "excellent" agreement with manual estimation for fatty liver detection. The entire pipeline is implemented as a Docker container which enables users to achieve liver attenuation estimation in five minutes per CT exam.

Computed Tomography Dose in Paediatric Care: Simple Dose Estimation Using Dose Length Product Conversion Coefficients.

BackgroundThe use of multislice computed tomography (MSCT) is increasing worldwide; at the same time, there is a growing awareness of the future risk of cancer associated with greater exposure to radiation. Therefore, there is a need for an accessible method of effective dose estimation. This study aims to estimate the effective doses (EDs) of a variety of paediatric computed tomography (CT) examinations in five age groups using recently published age- and region-specific dose length products (DLPs) as effective dose conversion coefficients.MethodsA retrospective review was performed over a 12-month period. Patients were assigned to one of five age groups: neonatal, 1-, 5-, 10- and 15-years-old. Age- and region-specific conversion coefficients were applied to the DLP data displayed on the CT console in order to estimate the ED.ResultsOver the 12-month period, there were a total of 283 CT scans, 211 of which were selected for study. The ED estimates for plain CT brain scans in neonatal, 1-, 5-, 10- and 15-yearolds were 2.5, 1.5, 1.4, 1.3 and 0.8 mSv, respectively. For the corresponding CT abdominal scans, the results were 18.8, 12.9, 7.8, 8.6 and 7.5 mSv; these were the highest values recorded. High-resolution CT (HRCT) temporal scans showed EDs of 2.9, 1.8, 1.5 and 1.1 mSv in 1-, 5-, 10- and 15-years-old, respectively. CT scans of the helical thorax had an estimated ED of 4.8, 4.2 and 7.0 mSv in 5-, 10- and 15-years-old, respectively.ConclusionAn inverse relationship between age and effective dose was demonstrated in CT scans of the brain and abdomen/pelvis. In general, our study showed lower overall EDs compared to other centres.

The Use of Computed Tomography Abdominal Scans for Gastrointestinal Bleeding in the Emergency Department: A Single Center Study

Introduction: Gastrointestinal (GI) bleeding comprises roughly 20% of the emergency department (ED) visits in the United States currently. There are established algorithms of management for suspect upper or lower GI bleed. These algorithms recommend early procedures, such as endoscopy and colonoscopy. However, many patients continue to receive computed tomography (CT) of their abdomen prior to these procedures in the ED. The goal of this study is to evaluate the inappropriate use of CT scans, including angiography, in the ED for GI bleeds. Methods: Retrospective chart review of patients over the age of 18 who presented to the ED with a GI bleed and had a CT scan of their abdomen between the years 2010-2016. Results: 643 patients had a CT scan in the ED who also had a GI bleed. 129 patients (20.1%) had a CT abdomen, including angiography, for indication of GI bleed. 74 patients (11.5%) had CT for indication abdominal pain and GI bleed. Out of the 129 patients who had a CT done exclusively for GI bleed, 15 (11.6%) had revealed GI bleed, with the most common being diverticular bleed. 14 out of the 74 (19%) patients with GI bleed and abdominal pain revealed GI bleed. 125 of these patients 102 (81.6%) had a source of bleed identified later via endoscopy, colonoscopy, video capsule endoscopy (VCE) and/or push enteroscopy. Conclusion: CT abdominal scans are being over utilized in the ED for the indication of GI bleed. Thus, this causes patients to receive more unnecessary radiation and increases the burden on the costs of the health care system. We suggest increasing the awareness of the yield of abdominal imaging in gastrointestinal bleeding and using this data to develop interdisciplinary algorithms that combine clinical judgement, imaging, and endoscopic modalities to better manage patients.

Low Serum Free Triiodothyronine Is Associated with Increased Risk of Decompensation and Hepatocellular Carcinoma Development in Patients with Liver Cirrhosis

Background: FT3 levels in plasma may provide a marker for liver status in cirrhosis. Aim: The aim is to correlate thyroid functions with hepatic status in compensated and decompensated cirrhosis, and to study their effect on development of HCC. Settings and Design: Prospective controlled cohort study. A total of 58 patients with liver cirrhosis were recruited from Kasr AlAiny ER and outpatient clinics. Patients were categorised into compensated (11), decompensated (39) and patients with hepatocellular carcinoma (8). The study also included 12 healthy controls. Methods and Material: Liver function tests, TSH, FT4 and FT3 and abdominal ultrasound and triphasic computed tomography abdominal scans were done. Statistical Analysis Used: Chi-square and unpaired t-tests were used for comparison. One way ANOVA and Kruskal Wallis tests were used to compare more than two groups. Spearman Correlation followed by logistic regression analysis of significant variables was used to find predictors of dependent variables. Results: The frequency of patients with low FT3 was significantly higher in patients with liver cirrhosis (48%), and HCC (50%) than control subjects (12%) (p-value < 0.001). Mean serum FT3 was lowest among decompensated patients (2 pg/ml ± 0.7), followed by patients with HCC (2.5 pg/ml ± 0.7) and highest among compensated patients (3.7 pg/ml ± 0.4), p-value < 0.001. Logistic regression analysis showed that low FT3, male gender, ulcer bleeding and encephalopathy were independently associated with the development of HCC (OR, 95% CI: 1.1, 0.3 - 8). Conclusions: Low FT3 is common among patients with decompensated liver cirrhosis and HCC. FT3 shows a significant negative correlation with severity of liver disease and deterioration of liver function. Low FT3 shows a significant independent association with HCC.

Adipose tissue attenuation as a marker of adipose tissue quality: Associations with six-year changes in body weight.

Weight gain is associated with fat volume increases, but associations with fat quality are less well characterized The associations of weight change with visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volume and attenuation were investigated. Computed tomography abdominal scans were acquired on a Framingham Heart Study subset (N=836; 40.2% women; mean age 45.7years), a mean of 6.1years apart. Fat attenuation estimated fat quality. Mean weight change was +2.0 (SD 6.8; IQR -0.7, 5.0)kg in women and +2.7 (SD 6.0; IQR -0.5, 5.4)kg in men. Per 2.5kg weight increase in women, VAT volume increased 126cm(3) (95% CI, 112-140, p<0.0001), SAT volume increased 258cm(3) (95% CI, 239-278, p<0.0001), and fat attenuation decreased (i.e., fat quality worsened) in VAT and SAT (p<0.0001). Increasing VAT volume was associated with decreasing fat attenuation even after accounting for weight change. Relative to weight-stable women (n=129), women who lost >2.5kg (n=58) had smaller SAT attenuation decreases (p<0.0001). Similar patterns were seen in men. Weight gain was associated with decreases in fat attenuation independent of VAT and SAT volume changes. These findings highlighted the associations of weight gain and worsening fat attenuation, suggesting fat attenuation may be dynamic.

Incidental findings detected on emergency abdominal CT scans: a 1-year review.

In recent years, there has been a substantial rise in the use of computed tomography (CT) in the emergency medicine setting. Accordingly, with increased CT usage there has been an upsurge in incidental pathology detection. A retrospective review of all emergency CT abdominal scans performed at a university teaching hospital was examined. The frequency of incidental findings, their clinical significance and workload effect for the radiology department was assessed. 1155 patients had an emergency abdominal CT scan of which 700 had incidental findings detected. Of the incidental findings, 143 were deemed indeterminate requiring urgent investigations. Twenty-four occult neoplasms were confirmed subsequently. Additionally, 259 patients were recommended for additional diagnostics. The cumulative effect of the initial emergency abdominal CT was 15,015 relative value units (RVU). Subsequent imaging of incidental findings resulted in another 1674 RVU workload for radiology. Incidental findings cause considerable debate and concern over which patients require significant follow-up, investigations, and/or surveillance. This exerts significant pressures on sub-specialties for their expert input, with increased workload and implications on healthcare service provision.

Consistent Surgeon Evaluations of Three-Dimensional Rendering of PET/CT Scans of the Abdomen of a Patient with a Ductal Pancreatic Mass

Two-dimensional (2D) positron emission tomography (PET) and computed tomography (CT) are used for diagnosis and evaluation of cancer patients, requiring surgeons to look through multiple planar images to comprehend the tumor and surrounding tissues. We hypothesized that experienced surgeons would consistently evaluate three-dimensional (3D) presentation of CT images overlaid with PET images when preparing for a procedure. We recruited six Jefferson surgeons to evaluate the accuracy, usefulness, and applicability of 3D renderings of the organs surrounding a malignant pancreas prior to surgery. PET/CT and contrast-enhanced CT abdominal scans of a patient with a ductal pancreatic mass were segmented into 3D surface renderings, followed by co-registration. Version A used only the PET/CT image, while version B used the contrast-enhanced CT scans co-registered with the PET images. The six surgeons answered 15 questions covering a) the ease of use and accuracy of models, b) how these models, with/without PET, changed their understanding of the tumor, and c) what are the best applications of the 3D visualization, on a scale of 1 to 5. The six evaluations revealed a statistically significant improvement from version A (score 3.6±0.5) to version B (score 4.4±0.4). A paired-samples t-test yielded t(14) = −8.964, p<0.001. Across the surgeon cohort, contrast-enhanced CT fused with PET provided a more lifelike presentation than standard CT, increasing the usefulness of the presentation. The experienced surgeons consistently reported positive reactions to 3D surface renderings of fused PET and contrast-enhanced CT scans of a pancreatic cancer and surrounding organs. Thus, the 3D presentation could be a useful preparative tool for surgeons prior to making the first incision. This result supports proceeding to a larger surgeon cohort, viewing prospective 3D images from multiple types of cancer.

Variations of celiac axis, common hepatic artery and its branches in 600 patients

Purpose:To evaluate the spectrum of celiac axis, common hepatic artery (CHA), right, left, middle hepatic artery and gastroduodenal artery variations by using spiral computed tomography (CT).Materials and Methods:A retrospective review of Multidetector CT (MDCT) abdominal angiography scans was performed in patients sent for various liver and other abdominal pathologies between January 2012 and February 2013. A total of 600 patients were evaluated. Definitions of CHA, ambiguous celiac axis, course and division patterns of CHA, replaced hepatic artery, accessory hepatic artery and middle hepatic artery were used as proposed by Song et al., Covey et al., and Wang et al. The pattern of the aortic origin of branches of celiac axis, common hepatic artery and its branches was analyzed.Results:Six types of celiac axis anatomic variations were identified in our study. A total of 546 of the 600 patients had a normal celiac axis anatomy. Anatomic variations were seen in 5.5% of patients. Ambiguous anatomy was seen in 3.5% of the patients. CHA originated from celiac axis in 95.83% of the patients. Variations in anatomic origin of CHA were seen in 8 patients. Ambiguous dual pathway was seen in 4 patients. Normal Sp-preportal course of CHA was identified in 97.78% of cases, Sp-retroportal course in 7 patients, Tp-preportal course in 2, Tp-retroportal in 1, Ip-preportal in 1 and through Ligamentum venosum in 2 patients. Normal origin of RHA from HAP was seen in 79.6% patients. Replaced origin of RHA was seen in 15.16% cases and Accessory origin of RHA was seen in 5.16% cases. LHA originated from HAP in 81.5% patients. Replaced LHA origin was seen in 10.8% cases and Accessory LHA origin seen in 7.6% cases. MHA originated from RHA in 41.3% patients, LHA in 27.83% and from CHA in 4.5% cases. Origin of MHA could not be defined in 26.3% of patients. GDA originated from CHA in 97.6% of patients, from celiac axis in 1.6%, from RHA in 0.33% in patients. Trifurcation of CHA was seen in 7.16% and quadrifurcation of CHA in 2.16%.Conclusion:CT Angiography is a safe and highly sensitive and accurate modality for evaluation of arterial anatomy and its variants.

Successful treatment of a 14-year-old patient with intestinal malrotation with laparoscopic Ladd procedure: case report and literature review

Midgut malrotation is an anomaly of intestinal rotation that occurs during fetal development and usually presents in the neonatal period. We present a rare case of malrotation in a 14-year-old patient who presented with cramping, generalized right abdominal pain, and vomiting for a duration of one day. A computed tomography abdominal scan and upper gastrointestinal contrast studies showed malrotation of the small bowel without volvulus. Laparoscopy revealed typical Ladd’s bands and a distended flabby third and fourth duodenal portion extrinsically obstructing the misplaced duodeno-jejunal junction. The Ladd procedure, including widening of the mesenteric base and appendectomy, was performed. Symptoms completely resolved in a half-year follow up period. Patients with midgut malrotation may present with vague abdominal pain, intestinal obstruction, or intestinal ischemia. The laparoscopic Ladd procedure is feasible and safe, and it appears to be as effective as the standard open Ladd procedure in the diagnosis and treatment of teenage or adult patients with intestinal malrotation.

Péliose splénique isolée : à propos d’un cas

Peliosis is a rare vascular lesion that is usually found in the liver, and less frequently in other hematolymphoid organs. We report a case of isolated splenic peliosis discovered in a 65-year-old man with an erysipelas and a thrombocytopenia. The computed tomography abdominal scan revealed an heterogen multinodular splenic mass. Splenectomy was performed and platelet counts returned to normal levels. The histopathologic examination revealed dilations of sinuses in the red pulp. The endothelial cells lining cavities stain for CD8 and CD31 but not for CD34. Splenic peliosis is a rare benign disease of unknown aetiology, which belongs to the group of vascular neoplasms of the spleen. The final diagnosis is based on the pathology examen. We review the histologic and immunohistochemical arguments of this diagnostic and expose the differential diagnoses.

Multiple calcifying fibrous tumors in the small intestine and the mesentery

Calcifying fibrous tumor (CFT) is a rare and benign tumor. Histological features are hyalinized fibroblast-poor tissue, infiltrative inflammatory cells mainly composed of lymphocytes or plasma cells, and psammoma bodies or dystrophic calcification. The pathogenesis is unknown. We treated a 30-year-old man who suffered from abdominal pain, nausea and vomiting for 2 days. After X-ray examination, we did not find any ileus, hollow organ perforation or genitourinary tract abnormalities and therefore strongly suspected acute ruptured appendicitis. An appendectomy was therefore performed immediately. Multiple tumors were found during surgery, and pathological examination confirmed the diagnosis of CFT. After surgery, the previous symptoms were relieved and the patient recovered completely. However, another nodule in the greater omentum was found by a computed tomography abdominal scan 4 months later. For CFT with a large tumor and recurrent symptoms, we recommend complete excision as the best treatment. For a case of asymptomatic CFT with a small tumor, long-term follow-up should suffice.

Umbilical polyp in adulthood: A rare presentation

Vitello-intestinal duct anomalies are rare and occur in 1-2% of the population. These anomalies may even present in adulthood with a spectrum of umbilical disorders that require surgical correction. We present a rare case of an umbilical polyp in a 25-yearold African female which was successfully resected surgically. CASE REPORT A 25-year-old African female presented with an umbilical mass with an associated umbilical discharge from childhood. A CT abdomen showed no intra-abdominal communication. At surgery, an umbilical polyp was excised, the histology of which revealed columnar epithelium with villi formation suggesting small intestinal mucosa (fig. 1). Figure 1 Figure 1: Umbilical polyp with underlying stalk attached to the umbilicus DISCUSSION The vitello-intestinal duct (VD) connects the embryonic yolk sac to the midgut and usually obliterates by the 8 th week of gestation. In 2% of the population, the duct may persist in varying degrees and present with a spectrum of congenital umbilical anomalies. The most common umbilical anomaly is the umbilical polyp which is often lined by small-bowel mucosa and less commonly, pancreatic and gastric mucosa. Nix and Young classified the vitello-intestinal duct anomalies into four major categories: complete patent VD (umbilical enteric fistula); partially patent VD including peripheral portion (umbilical sinus), intermediate portion (vitelline cyst), and enteric portion (Meckel's diverticulum); mucosal remnant at the umbilicus (umbilical polyp); and congenital band (obliterated VD) (fig. 2). Figure 2 Figure 2 (drawn by Cheddie S): A – Meckel’s diverticulum with fibrous band; B – Vitelline cyst; C – Vitelline fistula Umbilical polyps are generally regarded as innocuous but may be associated with other vitello-intestinal duct defects Umbilical polyp in adulthood: A rare presentation 2 of 3 such as underlying sinus, cyst, fistula, or band. When it is associated with other abnormalities, more complicated features, such as fecal fistula, infected cyst, or herniation of small bowel, may occur. The umbilical polyp may rarely arise from urachal remnants. Ultrasonography or computed tomography abdominal scans are recommended to exclude associated intra-abdominal anomalies. Surgical resection of the umbilical polyp is the treatment of choice; the extent of resection being guided by pre-operative imaging and intra-operative inspection of the base of the polyp. Patients should be consented for laparotomy; however, routine exploration of the peritoneal cavity is unnecessary.

Adult Intestinal Malrotation: A Case Report

Midgut malrotation is an anomaly of intestinal rotation which occurs during fetal development and usually presents in the neonatal period. It is rare for malrotation to present in adulthood. We present a case of malrotation in an adult female patient who presented with cramping generalized right abdominal pain and vomiting of one day duration. A computed tomography abdominal scan and upper gastrointestinal contrast studies showed malrotation of the small bowel. The patient was consented for exploratory laparotomy during which typical Ladd’s bands and a distended flabby third and fourth duodenal portion extrinsically obstructing the misplaced duodeno-jejunal junction were recognized. Detorsion of the twisted mesentery, lysis of the bands, appendectomy and a side-to-side duodeno-jejunal anastomosis were performed. Complete resolution of symptoms is noted in a two-year follow-up period.

La transformation angiomatoïde nodulaire sclérosante de la rate

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a complex vascular lesion recently described. We present a case of SANT occurring in a 49-year-old woman who was treated for choroid melanoma. The computed tomography abdominal scan revealed an asymptomatic mass in the spleen. Splenectomy was performed due to the risk of metastasis from the melanoma. The histopathologic examination revealed an angiomatoid lesion composed of three types of vessels recapitulating the normal composition of the red pulp of the spleen. In this report, we discuss the pathology of this lesion and the differential diagnosis of SANT with other lesions such as hemangiomas, hamartomas and inflammatory pseudotumors.

Idiopathic mesenteric venous thrombosis: Report of a case

Idiopathic mesenteric venous thrombosis is a rare entity. An early diagnosis and thrombolytic and anticoagulant therapy are very important. We report a case of a patient, without any specific known risk factor, with small intestinal ischemia secondary to superior mesenteric vein thrombosis (SMVT). In our case, only a computed tomography (CT) abdominal scan permitted the diagnosis of SMVT. The patient was successfully treated by resection of the infarcted bowel with primary anastomosis and immediate postoperative anticoagulation. Diagnosis of intestinal ischemia from mesenteric venous thrombosis (MVT) is often delayed because the symptoms are nonspecific. Moreover, when there is not any known predisposing factor, the diagnosis may become even more difficult with significant morbidity and mortality. CT abdominal scan done early in case of nonspecific abdominal pain, since the patients had a previous history of venous thrombosis, may not require a surgical treatment of MVT.

Computed tomography, angiography, and endoscopic retrograde cholangiopancreatography in the nonoperative management of hepatic and splenic trauma.

There is a marked trend toward nonoperative management of abdominal trauma. This has been possible thanks to the advances in imaging and interventional techniques. In this work we review in which way computed tomography (CT) abdominal scans, angiography, and endoscopic retrograde cholangiopancreatography (ERCP) can guide the nonoperative management of hepatic and splenic trauma. The CT abdominal scan with intravenous contrast is the "departure imaging" of choice for the nonoperative management of hepatic and splenic trauma in the hemodynamically stable patient. It is the most accurate test for detecting, defining, and characterizing these injuries, the associated hemoperitoneum, and other abdominal abnormalities (the hollow viscus injuries missed on the CT scan were detected by clinical parameters and had no negative consequences in the outcome). It has an accuracy of more than 95% for these injuries, but CT grading alone cannot decide which patient can be treated conservatively and which patient requires surgery. Its usefulness for follow-up seems challenging. Angiography can be therapeutic, thereby avoiding surgery (some report that angiography can be performed even in patients with active bleeding as damage control); if vessel injury, active bleeding or hemobilia are suspected on the basis of a CT scan in a stable patient, angiography should be carried out. ERCP should be performed in patients with suspected injury to the biliary tree, even with normal iminodiacetic acid radionuclide scanning (HIDA) if symptoms persist. A biliary stent can be placed. Indications for angiography and ERCP remain unclear.