Contrast-enhanced Abdominal Tomography Research Articles

Duodenal-Jejunal Stenosis as a Manifestation of Eosinophilic Gastroenteritis: A Case Report

Introduction: Eosinophilic gastroenteritis (EGE) is a rare disorder characterized by eosinophilic infiltration of the stomach and small intestine. Its clinical manifestations depend on the extent, location, and depth of the inflammatory infiltrate. The pathogenesis remains unclear, but it may be related to food allergy or other hypersensitivity reactions in some patients. Untreated cases can cause intestinal stricture or perforation, making timely diagnosis and intervention essential. Clinical case: A 13-year-old male adolescent was hospitalized due to symptoms suggesting intestinal obstruction or alterations in intestinal motility. Medical imaging revealed significant gastric distension and delayed gastric emptying. An endoscopic study showed a “snake-skin” pattern, duodenitis due to food stasis, a 2 cm ulcer, and stenosis in the duodenum. The biopsy confirmed EGE with significant irregular eosinophilic infiltration of the lamina propria. A panendoscopy was performed after steroid treatment without being able to assess the site of stenosis and perform pneumatic dilation. After completing the immunomodulatory management, a contrast-enhanced abdominal tomography was performed showed a significant decrease in the intestinal lumen, therefore an exploratory laparotomy with a lateral to lateral jejune-jejunal anastomosis was performed. Discussion: EGE is a rare inflammatory disorder characterized by eosinophilic infiltration of the stomach and small intestine. Symptoms are based on the affected gastrointestinal tract segment. In this case, our patient presented intestinal obstruction symptoms with endoscopic biopsies and a histopathological study confirmed eosinophil infiltration. Treatment typically involves identifying potential triggers and corticosteroids to reduce inflammation and symptoms. However, in this case, a decrease in the intestinal lumen was observed, therefore an elective surgical resection was performed. Conclusion: Eosinophilic gastroenteritis is a rare disorder that requires strong clinical suspicion to be diagnosed, which is why its knowledge is important. In this case, gastrointestinal symptoms, radiological and endoscopic images, in addition to the histopathological report, were key tools for integrating the diagnosis. Although management with steroids and immunomodulators was not successful, surgical management became an appropriate option as definitive treatment.

Bilateral Thigh Abscess Due to Rectal Fistula: A Rare Case Report With Silent Clinical Presentation

A 53-year-old male patient who underwent a rectal cancer operation nine years ago was evaluated with complaints of pain and swelling in the lateral thigh. Radiological imaging revealed abscess foci in the right thigh muscles. Surgical drainage and debridement were performed but developed recurrence. Contrast-enhanced abdominal tomography was performed due to a positive medical history and it was seen that an enterocutaneous fistula was formed from the anastomosis site of previous cancer surgery to both sides of the thigh. Bilateral thigh abscesses were drained and radical debridement was performed in the same session with surgery for the fistula. Pathological examination of the surgical specimens showed no evidence of cancer and the patient was discharged on the 14th postoperative day with complete resolution of the infection. Hip abscesses are rare, delays in the diagnosis and treatment of the underlying cause in cases of abscess secondary to abdominal or pelvic pathologies lead to an increase in mortality. Therefore, it should be kept in mind that thigh abscesses may be another side of the coin besides being seen as an isolated infection.

The effect of procalcitonin and immature granulocyte ratio in predicting the development of acute necrotizing pancreatitis: evidence from 582 cases.

Acute pancreatitis (AP) is one of the diseases that surgical clinics deal with the most. While mortality rates are approximately 1% in all cases, this rate may increase to 15% in pancreatic necrosis cases. Therefore, early diagnosis and treatment are very important in necrotizing pancreatitis. Our aim in this study is to present the guiding effectiveness of procalcitonin and immature granulocyte ratios (IG%) in planning the early diagnosis and treatment of acute necrotizing pancreatitis. 582 patients hospitalized in our clinic with the diagnosis of acute pancreatitis were included in this study. All patients were divided into two groups as acute edematous pancreatitis (AEP) and acute necrotizing pancreatitis (ANP) according to tomography results. White blood cell (WBC) count, procalcitonin, IG%, C-reactive protein (CRP), amylase and lipase, albumin, CRP/albumin levels were recorded. The differences between the two groups were analyzed statistically. According to the results of contrast-enhanced abdominal tomography (CECT), 525 patients were diagnosed with AEP and 57 with ANP. WBC, CRP, procalcitonin, IG and CRP/albumin were found to be significantly higher in ANP patients when compared to AEP (p<0.0001). According to the ROC analysis result, procalcitonin (AUROC: 0.999), IG% (AUROC: 0.995), WBC count (AUROC: 0.841), CRP (AUROC: 0.947), albumin (AUROC: 0.862), and CRP/albumin (AUROC: 0.946) ratio were markers that could be used for early prediction of ANP. Early diagnosis of ANP can reduce morbidity and mortality. Procalcitonin and IG% levels can be easily accessible and effective markers in the early diagnosis of ANP and in the planning of treatment.

Incidentally Detected Gastric Cancer in Pancreaticoduodenectomy Specimen

The incidence of synchronous pancreatic carcinoma with another carcinoma varies between 1.2% and 20%. Synchronous incidence of pancreatic cancer and stomach cancer is quite low. In our study, a 63-year-old male patient was admitted to our clinic with complaints of fatigue, weight loss and jaundice. In contrast-enhanced abdominal tomography, a lesion with malignant radiological features was observed in the head of the pancreas. Signet-ring cell gastric cancer was found incidentally in the antrum of the stomach in the pathology specimen. Thereupon, a complementary total gastrectomy operation was performed on the patient. Coexistence of gastric and pancreatic cancer is a clinically serious condition. However, surgery can be curative in completely resectable tumors.

Surgical management of renal cell carcinoma with associated tumor thrombus extending into the inferior vena cava: A 10-year single-center experience.

Renal cell carcinoma (RCC) is a tumor that has a tendency of vascular invasion by extending to the inferior vena cava (IVC) after the renal vein. The total resection of the renal tumor and tumor thrombus is considered the optimal treatment. In our study, we aimed to present the results related to 34 consecutive cases of RCC with tumor thrombus. Of the 442 patients diagnosed with renal tumors between January 2008 and January 2018, 34 (7.6%) had tumor thrombus over the renal vein extending to the IVC. The data of the 34 patients with tumor thrombus were retrospectively reviewed and included in the study. All the 34 patients underwent radical nephrectomy with tumor thrombectomy. The presence of thrombus was evaluated using contrast-enhanced abdominal tomography, magnetic resonance imaging, or color Doppler ultrasonography. The level of thrombus was classified using the Mayo Clinic tumor thrombus classification. Surgery was performed transperitoneally through a modified Chevron incision and mostly in collaboration with other clinics. Complications were classified according to the Clavien system. Of the 34 patients, 22 were males and 12 were females. The mean follow-up period was 36±27.2 months in patients who had a mean age of 61±10.9 years. The mean tumor size was 10.5±3.3 cm. The number of patients according to the thrombus levels I, II, and III were 20, 9, and 5, respectively. The average blood loss was 744±285.4 mL. Radical surgery for all patients who had direct invasion to the vena cava wall and/or level II and III was performed by gastrointestinal and cardiothoracic surgeons. Cardiopulmonary bypass was not performed in any patient. Minor complications (Clavien grades 1-2) were seen in 8 (23.5%) patients, while 2 (5.8%) patients had major complications (Clavien grades 3-5). The mean follow-up period was 36 months (range, 6-72 months). The overall 5-year survival rate was 85.2%. We think that radical nephrectomy and caval thrombectomy is a safe and effective method in patients with RCC without tumor exceeding the diaphragmatic level. We believe that the surgical success rate can be increased using a multidisciplinary approach in selected cases.

A Rare Duodenal Mass, Brunneroma: Case Report

A 65 years old female patient referred to our clinic was diagnosed with ileus following laparoscopic cholecystectomy. Contrast-enhanced abdominal tomography (CT) had earlier been applied to determine the underlying cause of ileus. A hypodense 52 × 32 mm sized mass was incidentally detected in the first and second sections of duodenum. In upper gastric endoscopy, submucosal located mass was observed in the first section of the duodenum at the posterior wall, which was not blocking the passage of endoscope. Positron emission tomography (PET) CT examination with a standardized uptake value (SUVmax) of 6 showed a potential malignancy. As the patient’s clinical condition worsened, exploratory surgery was planned. Small bowel adhesions and strangulation were detected. Transduodenal biopsy was taken. Pathological examination revealed hyperplastic Brunner’s glands, which was considered to be Brunner’s Gland Adenoma. Patient was discharged at postoperative day 12 with cure. For diagnosis of BGA, endoscopic ultrasonography and contrasted tomography can be used. In symptomatic cases, transduodenal resection can be performed. In the case of non-symptomatic and incidentally detected duodenal masses, however, PET-CT would be useful. A SUVmax lower than 2.3 suggests a benign mass and a higher value over 5 in PET-CT have a high risk of malignancy. As in this case, gastrointestinal system tumors with a SUVmax greater than 5 is not always related with malignancy. In conclusion, for regular bordered mass images, which are detected at this localization, BGA should be kept in mind for differential diagnosis. Patients with BGA should be followed-up for malignancy and recurrence.

Lower abdominal pain in an immunocompromised diabetes mellitus patient

A 64-year old female patient presented to the emergency department with complaints of acute lower abdominal pain. She had poorly controlled hyperglycemia and multiple cranial glial tumors treated with steroids and radiotherapy. Her vital signs were body temperature 36.5 °C, blood pressure 110/70 mmHg, and heart rate 90 beats per minute. Her physical examination revealed lower abdominal pain. Her laboratory tests showed blood glucose 259 mg/dL (70–105), leukocytes 16.5 103/uL (4.23–9.07), C-Reactive protein (CRP), 8.49 mg/dL (0–0.34). Gram negative bacilli were detected on direct microscopic examination of urine. Contrast-enhanced abdominal tomography is shown in Fig. 1, Fig. 2. Fig. 1 Contrast-enhanced abdominal tomography showed gas in the bladder wall and an air-fluid level within the lumen of the bladder. Fig. 2 Contrast-enhanced abdominal tomography showed gas in the bladder wall and an air-fluid level within the lumen of the bladder.