Entire Abdomen Research Articles

Effect of Aloe Vera Gel on prevention of Striae Gravidarum

Introduction: Striae Gravidarum is a skin physiological change in purple that many women experience during pregnancy and due to the accompanying problems, they suffer from stress and worries about beauty, low self-esteem and psychological problems. This study was performed with aim to determine the effect of aloe vera gel on prevention of striae gravidarum in nulliparous pregnant women. Methods: This triple-blind randomized clinical trial study with a control group was performed in 2019 on 90 nulliparous women with gestational age of 18-20 weeks referring to the selected centers affiliated to Shahid Beheshti University of Medical Sciences in Tehran. The subjects were randomly assigned to one of the three groups of aloe vera gel or placebo. The participants receiving aloe vera gel and placebo group daily massaged 3 cm of the gel for 2 minutes on the entire abdomen for 8 weeks, and the control group did not use any substances on the skin of the abdomen. After 8 weeks, the severity of striae was assessed by the Davy method, the severity of pruritus by the Kamini method, and the severity of the erythema by the Atwal method. Data were analyzed by SPSS software (version 20) and Kruskal-Wallis statistical test. P 0.05). Kruskal-Wallis statistical tests showed that the incidence of striae (p = 0.001), the severity of pruritus and erythema (p = 0.001) at 28th weeks of pregnancy was significantly lower in the Aloe Vera gel group than the other two groups. Also, the chance of increasing the severity of striae in the placebo group and the aloe vera gel group were 75 and 95 lower than the control group, respectively. Conclusion: Aloe vera gel has an effect on preventing striae gravidarum and reducing itching and erythema. Aloe vera gel can be recommended to pregnant women as a low-cost method for preventing striae gravidarum.

Adölesan kız çocuklarında hidrosalpinks: İki olgu ne öğretti?

Hydrosalphinx is the fallopian tubes getting filled with fluid due to their blockage. It usually occurs with obstruction of fallopian tubes after infection in women of sexually active age. The aim of this article is to draw attention to hydrosalpinx in adolescent girls because of two adolescent cases. First case; a cystic lesion of 38x51x76 mm in the right adnexal region was detected in the lower abdominal magnetic resonance imaging of a 13-year-old girl who presented with the complaint of abdominal pain and vomiting. Right tubal torsion and hydrosalpinx were detected during abdominal exploration. The tube was detorsioned and marsupialization was applied to the hydrosalpinx. Second case; a cystic lesion with dimensions of 24x12x35 cm was detected in the abdominal ultrasonography of a 16-year-old girl who presented with the complaint of abdominal pain and a palpable mass. On abdominal exploration, a right hydrosalpinx filling the entire abdomen was detected. Tubal excision was performed. Both cases have not been undergone any intraabdominal surgery previously. Hydrosalpinx is very rare in adolescent girls. Hydrosalpinx also should be considered in lower abdominal pain. Cases should be examined in terms of preventing infertility problems in future carefully, development of adhesion should be curtailed and parents should be informed in detail.

Techniques of Laparoscopic Single Site Left Giant Ovarian Cystectomy Utilizing Traditional Instruments

Study Objective Single-site laparoscopy surgery is the most minimally invasive surgery for a gynecologic procedure, but traditional laparoscope surgery has the limitation of lack of exposure and limited surgical space when using traditional surgical instrumentation, such as in a giant ovary cyst. Trans-umbilical natural orifice transluminal endoscopic surgery (NOTES) offers similar benefits of traditional laparoscope surgery but also expands the horizon of traditional laparoscope surgery by allowing the surgeon to perform procedures that are typically limited to an abdominal approach. The advantages of NOTES may include no incisional pain as well as a better cosmetic outcome. These benefits help outweigh the obstacle of learning this novel approach. Our objective is to demonstrate the trans-umbilical NOTES technique as a combination of traditional laparoscope surgical skill with single-site surgical skill. Design Stepwise demonstration of the trans-umbilical NOTES technique for giant ovarian cystectomy with narrated video footage. Setting Academic tertiary care hospital. Patients or Participants A 27-year-old woman. Interventions Trans-umbilical NOTES giant ovarian cystectomy with combined abdominal surgical and single-site surgical skills. Measurements and Main Results A 27-year-old woman (gravida 1 para 1) with pelvic MRI: giant cyst of left ovary, size 145.6 * 83.1 * 170.1mm, no papillary structure requested ovary cyst removal with ovary preservation. She presented with a 1-year history of left pelvic pain. The giant ovary cyst was removed with minimal blood loss, and pathology revealed a ovarian teratoma. The patient had resolution of her left-sided pelvic pain. Conclusion Combined with traditional abdominal surgical skill, single-site surgical skills allow the surgeon to access the entire abdomen and perform ovarian cystectomy through a trans-umbilical single port. Trans-umbilical NOTES giant ovary cystectomy is not only possible but allows ovary cystectomy to be performed with minimal abdominal incision.

Transvaginal Natural Orifice Transluminal Endoscopic (vNOTES) Hysterectomy: A Novel Route for Uterus Removal

Study Objective To demonstrate the feasibility of Transvaginal Natural Orifice Transluminal Endoscopic (vNOTES) hysterectomy. Design Stepwise demonstration with narrated surgical video. Setting A university-affiliated center. Patients or Participants A 52-year-old gravida 2, para 2 woman with a 10 cm fibroid presented with a 2-year history of frequent micturition. Ultrasound showed fibroids and bilateral ovarian cysts. Interventions After injecting dilute vasopressin in the cervix, the vaginal mucosa was incised circumferentially. Posterior and anterior colpotomy was made. Then bladder pillars were clamped. Single-site port was successfully placed and pneumoperitoneum was established. After the survey of upper abdomen, progressive clamping from the cardinal ligaments to the level of the broad ligament was performed. Then the proper ligaments of ovary were clamped and bilateral oophorosalpingectomy was performed. The specimen was then delivered to the vagina. The vaginal cuff was closed with running stich. Measurements and Main Results The surgery was successfully conducted with operating time of 120 minutes and blood loss of 20 ml. The uterus weighed 410 g. The patient recovered well and had resolution of frequent micturition. Conclusion vNOTES is feasible for hysterectomy. Combined with traditional transvaginal colpotomy, vNOTES allows the access to the entire abdomen and completion of hysterectomy through a transvaginal single port. Transvaginal NOTES Hysterectomy benefits specimen removal and leads no abdominal incision.

The use of bi-pedicled DIEP flap for unilateral breast reconstruction: a 5-year retrospective study

The deep inferior epigastric perforator (DIEP) flap is currently the flap of choice for autologous breast reconstruction. When the amount of tissue transferred needs to be maximised, a bi-pedicled DIEP flap allows harvesting the entire lower abdomen. A retrospective analysis was conducted including patients who had unilateral breast reconstruction with bi-pedicled DIEP flaps between January 2013 and December 2017. Demographic information, operation notes and post-operative course were reviewed. Mann-Whitney-Wilcoxon and Fischer’s exact tests were used to look for a statistically significant association between complications and intra-operative modalities. Forty-four cases were reviewed. Half of these patients underwent delayed breast reconstructions, 40.9% underwent immediate reconstructions and 10% were salvage cases. The majority of the cases (52.3%) had an initial anastomosis of the secondary pedicle to either a side branch (38.6%) or the superior continuity (13.6%) of the primary pedicle (intra-flap anastomosis). Twenty-seven percent of the intra-flap arterial anastomoses were performed using vessel couplers. The remaining 47.7% of the cohort had anastomoses of both pedicles to the internal mammary (IM) vessels anterogradely and retrogradely. There were no flap failures. The cases in which both pedicles were anastomosed with IM vessels had an overall higher complications rate, but were not related to flap failures or anastomotic issues. Intra-flap anastomosis on the other hand is a reliable alternative including the possibility of vessel coupler application to smaller arteries of this approach. In our experience, bi-pedicled DIEP flaps are a safe alternative for unilateral breast reconstruction when the amount of harvested tissue needs to be maximised. Level of evidence: Level III, therapeutic study.

A case of papillomatous ovarian cyst

Mrs. M. R. H. 44 years old, widow, mother of three children; enjoyed excellent health until the first birth, 24 years ago. Since then, she began to complain of pain in the uterus and in the ovaries. After suffering typhoid fever 8 years ago, the pain intensified and spread to the entire abdomen and lower back. Having examined her at different times, four doctors consistently found the following: cervical rupture; endocervicitis; swelling in the left side of the abdomen; fibroma. Finally, in one of the hospitals, a malignant tumor associated with the liver (?) Was diagnosed. The mass that had fallen out of the vagina in this American hospital could not be corrected and was limited to light laxatives.

Preliminary analysis of interaction of the fat fraction in the sacroiliac joint among sex, age, and body mass index in a normal Chinese population.

ObjectiveIterative decomposition of water and fat with echo asymmetry and least-squares estimation-iron quantification (IDEAL-IQ) is a noninvasive and objective method used to quantitatively measure fat content. Although this technique has been used in the entire abdomen, IDEAL-IQ findings in the sacroiliac joint (SIJ) have rarely been reported. This preclinical study was performed to quantify the amount of fat in the SIJ in healthy volunteers by IDEAL-IQ.MethodsFrom April to November 2017, 60 healthy volunteers with low back pain were included in this retrospective study. The participants were allocated into groups by age (15–30, 31–50, and ≥51 years), sex (male and female), and body mass index (BMI) (<18.5, 18.5–23.9, and ≥24.0 kg/m2). The iliac-side (Fi) and sacral-side (Fs) fat fractions were obtained in all groups. Two- and three-factor multivariate analyses were performed to analyze the effects of sex, age, and BMI on the Fi and Fs.ResultsThe interaction among sex, age, and BMI had no statistically significant effect on the dependent variable. Both Fi and Fs were significantly influenced by age. Fs was significantly influenced by sex.ConclusionThe IDEAL-IQ sequence can be used to quantitatively assess the SIJ fat content in healthy volunteers.

Spontaneous Ovarian Hyperstimulation Syndrome in Second Pregnancy of a Healthy Pregnant Woman

pontaneous ovarian hyperstimulation syndrome (OHSS) is an uncommon type of OHSS that is characterized by gastrointestinal symptoms and complications of accommodation of body fluids in third spaces in the absence of medical ovarian stimulations. This syndrome is mostly seen in multiple or molar pregnancies with an underlying medical condition such as hypothyroidism. Treatment of spontaneous OHSS depends on the patient’s clinical condition. Appropriate management will warrant a successful pregnancy. The aim of this report is to introduce a case of spontaneous ovarian hyperstimulation syndrome in second pregnancy of a healthy pregnant woman. The patient was a 8 weeks pregnant female who referred to gynecology and obstetrics clinic because of gradual abdominal distension, abdominal pain and nausea from one month ago. The patient didn't have any history of the specific predisposing factors of OHSS such as thyroid gland dysfunction or multiple pregnancies. Abdominal sonography showed enlarged ovaries with prominent follecules as well as free fluid in the entire abdomen. Elevated levels of HCG (312850 mlU/ml) and carcinoembryonic antigen (106 U/ml) were the remarkable laboratory findings. We successfully controlled the patient by conservative management and the size of ovaries returned back to normal by 17th weeks of gestation. On sonographic follow-ups, untill delivery, the patient was symptom-free and a healthy infant was born. While spontaneous OHSS is a rare and life-threatening condition, conservative management including albumin and anticoagulant administration as well as paracentesis of body third space fluids, will be a promising approach in the stable patients.

Evaluation of feasibility and image quality of a new radial quantitative T2 weighted imaging sequence for liver MRI

ObjectivesTo evaluate the clinical feasibility of a new T2 weighted sequence to calculate T2 relaxation times (T2RT) of liver lesions using two-dimensional radial turbo spin echo (2DRTSE) and to evaluate this sequence by performing image quality and relaxation time comparison of multiple liver lesions. Materials and methodsThis prospective analysis of 2DRTSE sequences (using 22 echoes) was performed in 19 patients with 36 liver lesions. Two radiologists independently obtained T2RTs for liver lesions and scored image quality and image artifacts. Lesions were classified as cyst, hemangioma, solid, or necrotic. T2RT values were compared. Inter-reader agreement was evaluated. ResultsThe 2DRTSE images were considered good quality with few artifacts by both radiologists. Nineteen patients were included in the study, with a total of 36 liver lesions. Two of the liver lesions were classified as cysts, 7 as hemangiomas, 4 as necrotic lesions, and 23 as solid lesions. The concordance correlation coefficient was 0.996 for the calculated T2RT of each liver lesion between the two readers, indicating good agreement. There was statically significant difference of the calculated T2RT for each lesion type. ConclusionThe 2DRTSE sequence can be performed and provides good T2W image quality and a quantitative T2RT map of the entire abdomen. The liver lesions can be distinguished based on the calculated T2RT using this technique. 2DRTSE could potentially supplant the current T2-weighted imaging sequence with the benefit of quantitative T2RTs.

The endoparasitic larval stages of Eoxenos laboulbenei: An atypical holometabolan development (Strepsiptera, Mengenillidae)

Endoparasitic larval stages of Eoxenos laboulbenei were documented with different techniques, with a main focus on the male tertiary larva. Two discrete endoparasitic stages occur, the secondary and the tertiary larva. The presence of large compound eyes and externally visible wing buds in the tertiary larva is a unique feature within Holometabola. The brain with large optic lobes is followed by a single postcephalic ganglionic complex. The cephalic musculature is greatly reduced but pharyngeal dilators and muscles associated with the mouth field are present. Postcephalic sclerites are absent except for the pronotum. The segmented legs bear filiform pretarsal claws. The indirect flight muscles fill up a large part of the metathorax. The 10-segmented abdomen lacks appendages. Pleural folds are present on the thorax and abdomen. The digestive tract is characterized by a very short oesophagus. The large midgut and the narrow hindgut are disconnected. Six short Malpighian tubules are present. Large testes fill out almost the entire abdomen. In contrast to the tertiary larva, the muscles of the secondary larva are not fully differentiated. Cephalic appendages are present as bud-shaped anlagen. The legs lack a pretarsal claw. The developmental transformations are outlined and discussed, also with respect to phylogenetic implications.

Laparoscopy in the management of a child with giant pseudocyst of the greater omentum

Introduction . Greater omentum cysts found in children belong to a rare pathology occurring as frequent as 1:23000. During the majority of observations, they are diagnosed during an ultrasound examination and abdominal computed tomography. However, in some cases it is impossible to restore an organ from which a cyst can originate using visual non-invasive methods. Purpose . This paper presents a clinical case of surgical treatment of a 7-year-old child with giant pseudocyst of the greater omentum. Materials and methods . The patient complained of periodic pains in the abdomen and increased abdominal size. The diagnosis was made following an abdominal ultrasound examination when a giant liquid formation (200×180×220 mm) was found. Subsequent MRI and CT tests of the abdomen gave a view of a cystic formation which was allegedly a cystadenoma of the left ovary. A cystic formation occupying the entire abdominal cavity was detected during a laparoscopy. Puncture and aspiration of 2.7 L of serous and hemorrhagic liquid were performed. It was found out that the formation originated from the greater omentum. The greater omentum was resected within healthy tissues along the mesocolonic border and cystic membranes were removed via a separate incision. Conclusion . When diagnosing large cystic abdominal formations, a final diagnosis of organ origin can sometimes be established during laparoscopy only when endosurgical treatment could be done (in the presence of a respective technique and educated specialists).

A Novel Zebrafish Model of Metastasis Identifies the HSD11β1 Inhibitor Adrenosterone as a Suppressor of Epithelial-Mesenchymal Transition and Metastatic Dissemination.

Metastasis of cancer cells is multi-step process and dissemination is an initial step. Here we report a tamoxifen-controllable Twist1a-ERT2 transgenic zebrafish line as a new animal model for metastasis research, and demonstrate that this model can serve as a novel platform for discovery of antimetastasis drugs targeting metastatic dissemination of cancer cells. By crossing Twist1a-ERT2 with xmrk (a homolog of hyperactive form of EGFR) transgenic zebrafish, which develops hepatocellular carcinoma, approximately 80% of the double transgenic zebrafish showed spontaneous cell dissemination of mCherry-labeled hepatocytes from the liver to the entire abdomen region and the tail region. The dissemination is accomplished in 5 days through induction of an epithelial-to-mesenchymal transition. Using this model, we conducted in vivo drug screening and identified three hit drugs. One of them, adrenosterone, an inhibitor for hydroxysteroid (11-beta) dehydrogenase 1 (HSD11β1), has a suppressor effect on cell dissemination in this model. Pharmacologic and genetic inhibition of HSD11β1 suppressed metastatic dissemination of highly metastatic human cell lines in a zebrafish xenotransplantation model. Through downregulation of Snail and Slug, adrenosterone-treated cells recovered expression of E-cadherin and other epithelial markers and lost partial expression of mesenchymal markers compared with vehicle-treated cells. Taken together, our model offers a useful platform for the discovery of antimetastasis drugs targeting metastatic dissemination of cancer cells. IMPLICATIONS: This study describes a transgenic zebrafish model for liver tumor metastasis and it has been successfully used for identification of some drugs to inhibit metastatic dissemination of human cancer cells.

Ultrasound diagnosis of peptic ulcer perforation - a case report

Introduction. Peptic ulcer perforation is an urgent, life-threatening condition that requires prompt diagnosis and emergency surgical treatment. It is a focal defect of the pylorobulbar zone that affects all the layers and allows intraluminal content to leak into the peritoneal/retroperitoneal cavity. The aim of this study is point to ultrasonography as a good diagnostic modality in identifying peptic ulcer perforation when it is clinically unrecognized. Case Report. We report a case of a 36-year-old man who came to the Emergency Center of the Clinical Center of Vojvodina complaining of a sudden severe pain in the entire abdomen. The patient reported previous dyspeptic symptoms. Emergency transabdominal ultrasonography was perfomed, and a peptic ulcer perforation was suspected. It significantly shortened the time to urgent surgical treatment and the diagnosis was confirmed. Conclusion. Pneumoperitoneum, collection of extraluminal free fluid with gas bubbles around the lesion, inflammatory thickening and discontinuity of the pylorobulbar wall, with or without focal hyperechogenic line (perforation zone) are ultrasound findings suggestive of peptic ulcer perforation.

Outcome and Complications of Laparoscopic Appendectomy in Almak Nimir University Hospital Shendi University Single Centre Experience, Sudan

Introduction: Appendicitis is the most common cause of abdominal pain and a prevalent reason for emergency surgery. Laparoscopic appendectomy is the method of choice, owing to its many advantages, less invasiveness, faster recovery and adequate exploration of the entire abdominal cavity than to observation in unequivocal cases. Laparoscopic surgery can serve as a diagnostic tool for patients with suspected acute appendicitis (AA), specially for female because of its low associated morbidity and mortality and it affords a direct diagnosis of the problem, allowing determination of the appropriate treatment. It is concluded that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis. This study aim to evaluate the outcome and complications of laparoscopic appendectomies in Almak Nimir University Hospital Shendi University single centre experience. Material and Methods: This is a prospective observational hospital base study on patients who underwent laparoscopic appendectomy for acute appendicitis from January to June 2019 in Almak Nimir University Hospital Shendi University, Sudan. 143 patients underwent laparoscopic appendectomies for acute appendicitis or suspected acute appendicitis.Results: Out of the 143 patients analyzed, female predominant 124(86.7%) and male were 19 (13.3%). 5 cases (3.5%) were converted to open surgery, intraabdominal abscess encountered in 2 patients 1.4%. Surgical-site infection was observed in 6 patients (4.2%). The study showed statistically significant negative-positive appendectomy (normal appendix but another pathology found). Conclusions: Laparoscopic surgery can serve as a diagnostic tool for patients with suspected (AA) specially for female because of its low associated morbidity and mortality and it affords a direct diagnosis of the problem, allowing determination of the appropriate treatment. It is concluded that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis.

Transvaginal Laparoscopy for Management of Low-Grade Endometrial Cancer

Study Objective to report on our experience with transvaginal laparoscopic management of low-grade endometrial cancer. Design a study of transvaginal natural orifice endoscopy to manage patients with grade 1 or grade 2 endometrial cancer. This is descriptive of the surgical findings and consequences. Setting a single institution academic center Patients or Participants 32 women with low-grade endometrial cancer were consented for hysterectomy, bilateral salpingo-oophorectomy (BSO) by a transvaginal approach utilizing laparoscopy. Interventions Anterior and Posterior cul-de-sacs were opened through the vagina. A gel point device was placed into these spaces, the patients reclined in slight Trendelenburg position, and the abdomen insufflated. A vessel sealing device was used under laparoscopic visualization to cauterize and cut the paracervical tissue, uterosacral ligaments, uterine vasculature, broad ligament and utero-ovarian pedicle. The uterus was removed and submitted to pathology for depth of invasion. The tubes and ovaries were then removed laparoscopically and the entire abdominal cavity was inspected. Patients with deep invasion underwent trans-abdominal laparoscopic lymphadenectomy. Measurements and Main Results a total of 32 women underwent the procedure. The mean age was 60(26 – 90). The mean BMI was 34(22 – 58). 19 had prior pelvic surgery including eight with one or more prior cesarean deliveries. The mean uterine weight was 119 g (27 – 436). 12 patients were discharged home that day and 20 stayed overnight. One patient had a thermal injury to the small bowel requiring over sewing. Two patients had bladder injury during entry to the Anterior cul-de-sac, both of whom had had two prior cesarean deliveries. One patient required lymphadenectomy. Patients did not require narcotic analgesia. Conclusion transvaginal laparoscopic hysterectomy, BSO is feasible and permits rapid recovery with minimal postoperative pain and is cosmetically appealing.

1671 Transumbilical Notes Pectopexy: Tips and Tricks

Video Objective Pectopexy is the most effective procedure to treat pelvic organ prolapse and can be used as an alternative to sacrocolpopexy. The minimally invasive access for pectopexy is divided into single-port and multi-port with or without robotic assistance. Transumbilical natural orifice transluminal endoscopic surgery (transumbilical laparoendoscopic single site surgery, transumbilical LESS) is an emerging minimally invasive approach, which reduces abdominal incision and enhances aesthetics. Pectopexy is an ingenious combination of the two approaches, which achieves a good clinical effect. These advantages outweigh the difficulties in learning the new technique. Our purpose was to show the surgical skills of the transumbilical LESS. Setting Xinxiang City Central Hospital Gynecologic Oncology, China Interventions Transumbilical single-site laparoendoscopic pectopexy was performed, which was a combination of laparoendoscopic and single-site surgeries. Conclusion Transumbilical LESS allows the surgeon to perform iliopectineal ligament after accessing the entire abdomen via a single port. This procedure can achieve a good clinical effect.

Innovative Robotic System for Transvaginal Surgical Procedures

Study Objective Determine the feasibility of a transvaginal single-port robotic system for gynecologic surgical procedures Design Three-stage trials using animal, cadaveric, and human models. Setting The animal trials were performed in a certified animal center. Cadaveric procedures were carried out in a cadaver laboratory. Surgery on humans were performed in hospitals. Patients or Participants Human patients who required a gynecologic procedure were given the option of traditional laparoscopy or single-port transvaginal surgery. Twenty-two patients were enrolled in the study and all 22 completed it. There were 10 adnexal procedures, ranging from salpingectomy to ovarian cystectomy to salpingo-oophorectomy, and 12 total hysterectomies. Interventions A new robotic system was inserted through the posterior vaginal fornix, first in a sheep model, where 17 oophorectomies, 17 salpingectomies, 18 tubal sterilizations and 15 hysterectomies were performed for a total of 67 procedures. Next, cadavers were utilized to perform 15 transvaginal oophorectomies, 15 salpingectomies, 18 sterilization procedures, and 12 total hysterectomies. Finally, single-incision, transvaginal surgery was performed on 22 human subjects - 10 adnexectomies and 12 vaginal hysterectomies. Immediate postoperative course as well as three-month follow-up was carried out in the human participants. Measurements and Main Results The patients were assessed for standard intraoperative as well as postoperative parameters, including operative time, blood loss, and complications. There were no intraoperative or postoperative complications, nor any significant problems encountered at the three-month follow-up. Conclusion Vaginal surgery is recommended as the surgical approach of choice for hysterectomy by the American College of Obstetricians and Gynecologists. However, it remains the route least utilized by practitioners because of technical challenges, ranging from difficulty in accessing the peritoneal cavity to a restricted visualization of abdominal and pelvic contents. A new robotic system has been developed that facilitates entry through a single vaginal incision under direct vision, and then allows 360 degree optics of the entire abdomen and pelvis.

The role of sonography for depiction of a whirlpool sign unrelated to midgut malrotation in neonates

The sonographic whirlpool sign of volvulus due to midgut malrotation is well recognized. However, variations of the whirlpool sign may be seen in other conditions, but this observation has received little attention in the literature. This study presents a series of neonates with a variety of causes of congenital intestinal obstruction, all associated with a whirlpool sign (unrelated to midgut volvulus), which was correctly recognized preoperatively on sonography. We also emphasize the pivotal role of sonography in managing congenital obstruction of the intestinal tract in neonates. This is a retrospective analysis of clinical, imaging and surgical findings in 11 neonates with congenital intestinal obstruction associated with a whirlpool sign (unrelated to midgut volvulus) that was recognized preoperatively on sonography and in whom the cause for the whirlpool was documented at surgery. Eleven neonates (eight male, three female) had clinical and radiographic evidence of intestinal obstruction in whom sonography depicted a whirlpool sign, which was recognized on the initial sonogram in nine and on a repeat sonogram in two. The whirlpool was located in the upper abdomen in only two, mid-abdomen in five and right lower quadrant in four. The whirlpool was only 1-2cm in diameter. An upper gastrointestinal series in three neonates failed to depict the cause of obstruction. Contrast enema in three cases had findings suggesting the site of obstruction was in the ileum but none depicted the exact cause of the obstruction. At surgery, the whirlpool sign correlated with a segmental volvulus of the small intestine in eight neonates and with the coiled distal small intestine associated with apple-peel atresia in the other three. This study illustrates neonates in whom a whirlpool sign (unrelated to midgut volvulus) was correctly recognized on sonography before surgery. Sonography proved more useful than an upper gastrointestinal series or contrast enema in depicting the exact cause of the obstruction. Pediatric radiologists must make the effort to search throughout the entire abdomen and pelvis for a small whirlpool sign on sonography, even in the absence of midgut malrotation, in neonates with congenital intestinal obstruction. Its recognition preoperatively will facilitate a rapid diagnosis and will obviate the necessity for contrast examinations of the gastrointestinal tract, which require ionizing radiation.

Splenic artery aneurysm rupture in the pregnant patient: The importance of utilising ultrasound to differentiate the acute abdomen from obstetric causes of abdominal pain

AbstractAlthough splenic artery aneurysm (SAA) rupture in the pregnant patient is considered a rare occurrence, its consequences can be catastrophic for both mother and fetus. The mortality rate from this entity in pregnancy is disproportionately high when compared with that of the general population, with multiparity thought to be a contributing factor. Potential reasons for this may be explained by its non‐specific abdominal symptoms often misdiagnosed as common obstetric differentials, combined with a rapid deterioration of patient condition post rupture. For these reasons, SAA rupture should have a high index of suspicion when a pregnant women presents with an acute abdomen, as a favourable outcome is dependent on prompt diagnosis and appropriate medical intervention. This article reviews the incidence of SAA rupture in pregnancy, outlines the pathophysiological processes that contribute to this entity being more prevalent in the gravid population, and displays the pivotal role ultrasound can play in expediting this diagnosis. In the emergency situation, ultrasound examination of a pregnant patient should be extended from a focussed pelvic study to encompass the entire abdominal cavity. Its portability combined with its nonionising nature makes ultrasound the modality of choice to reduce the time to diagnosis and thus influence treatment pathways.

A fast volumetric 4D-MRI with sub-second frame rate for abdominal motion monitoring and characterization in MRI-guided radiotherapy.

To propose a fast volumetric 4D-MRI based on 3D pulse sequence acquisition for abdominal motion monitoring and characterization in MRI-guided radiotherapy (MRgRT). A 3D spoiled gradient echo sequence volumetric interpolated breath-hold examination (VIBE) [repetition time/echo time (TR/TE) =0.53/1.57 ms, flip-angle =5°, receiver bandwidth (RBW) =1,400 Hz/voxel] based 4D-MRI acquisition, accelerated by 4-fold controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA), named CAIPIRINHA-VIBE 4D-MRI, was implemented on a 1.5T MRI simulator (MR-sim) and applied for abdominal imaging of nine healthy volunteers under free breathing. One hundred and forty-four dynamics of the entire abdomen volume (56 slices), in total 8,064 (144×56) images with a voxel size of 2.7×2.7×4.0 mm3, were acquired in 89 s for 4D-MRI. This CAIPIRINHA-VIBE 4D-MRI was qualitatively compared with a 2D half-Fourier acquisition single-shot turbo spin-echo (2D-HASTE) based 4D-MRI. The motions of liver dome, kidney and spleen were analyzed using the CAIPIRINHA-VIBE 4D-MRI data. The kidney motion was quantitatively characterized in terms of motion range and the correlations between left and right kidneys. CAIPIRINHA-VIBE 4D-MRI was successfully conducted in all subjects. CAIPIRINHA-VIBE 4D-MRI exhibited much higher effective volumetric temporal resolution (0.615 vs. ~5 s/volume) and better reconstructed volume consistency than 2D-HASTE 4D-MRI. CAIPIRINHA-VIBE 4D-MRI was able to characterize the respiratory motion of abdominal organs simultaneously in three orthogonal directions, and could potentially be used for whole abdomen deformable motion tracking. Renal motion range was most pronounced in superior-inferior (SI) direction (L: 10.03±2.65 mm; R: 10.38±2.80 mm), significantly larger (P<0.001) than that in anterior-posterior (AP) and the least in left-right (LR) directions. Right kidney had significantly larger mobility (4.18±2.19 vs. 2.32±1.34 mm, P=0.045) than left kidney in AP, but not in LR and SI directions. The Pearson correlation coefficients r between left and right kidney motion were 0.5063 (P=0.164), 0.6624 (P=0.052) and 0.5752 (P=0.105) in LR, AP and SI correspondingly. The correlation of renal motion in SI and AP was found significant in right kidney (r=0.843, P=0.004) but not in left kidney (r=0.467, P=0.205). A fast volumetric 4D-MRI was implemented for abdominal motion monitoring in MRgRT. A sub-second volumetric temporal resolution of 0.615 s, covering the entire abdomen, was demonstrated for respiratory motion monitoring and characterization. This technique holds potentials for MRgRT applications.