Examination Of Abdomen Research Articles

Umbilical bleeding during menstruation in status post laparoscopic cholecystectomy of unknown/ambiguous aetiology

Although umbilical endometriosis is a possible cause of cutaneous manifestation of retrograde menstruation during cyclical bleeding in status post laparoscopic surgery patient, Here in this case we presumed a diagnosis of endometriosis on the basis of its symptoms which couldn’t be proven in biopsy and on immune-histo-chemistry and casted a query that now what is the next possible aetiology which is responsible for umbilical bleeding specifically during menstruation in the patient with status post laparoscopic surgery. We report a case of presumed secondary umbilical port scar endometriosis in a 25-year-old lady nulliparous woman following laparoscopy-assisted cholecystectomy 6 months ago. Remarkably patient complained of peri umbilical pain and menstrual bleeding through umbilicus (retrograde) soon after surgery which was remarkably noticed only during her periodical cycle. History and clinical examination, haematology, ultrasound, computed tomography and MRI of abdomen and pelvis performed to rule out any primary lesions which all were found unremarkable. After counselling the patient about the presumptive causes and treatment options the umbilicus with its surgical scar mark excised and the tissue was sent for histopathological examination which was found inconclusive with no evidence of endometriosis at all. Remarkably it was further scrutinized by immune-histo-chemistry but remained fruitless. Fortunately, patient relieved her symptoms of retrograde menstrual bleeding after total excision of the umbilicus with scar mark post operatively but still left a diagnostic stigma for surgeons.

Evaluation of CT dose and establishment of local DRLs for abdomen and pelvis examinations in hospitals in Taif City, Saudi Arabia

This study measures the CT dose of the abdomen and pelvic examinations for adult patients, as well as establishes the provincial diagnostic reference level (DRL) for hospitals in Taif city, Saudi Arabia. A total of 200 patients who underwent pelvis and abdomen examinations in two main hospitals in Taif city were selected for this study. The data were collected in a spreadsheet that records patients’ demographic data, exposure parameters and dose indicators such as dose length product (DLP) and volume computed tomography dose index (CTDIvol) for each examination. The patients' average age and BMI were 37.3 years and 25.5 kg/m2, respectively. The mean DLP and CTDIvol for the pelvis were found to be 379.6 mGy-cm and 10.8 mGy, respectively, whereas the corresponding mean values for the abdomen were 369.5 mGy-cm and 11.5 mGy, respectively. The average effective dosages for the abdomen and pelvis in both hospitals were estimated to be 5.6 and 7.2 mSv, respectively. Based on the third quartile data of DLP and CTDIvol, this study suggests DRL for pelvic DLP and CTDIw are 402.5 mGy-cm and 21.8 mGy, respectively, whereas the respective values are 407.5 mGy-cm and 18.4 mGy for CT abdominal DLP and CTDIw. The present study reports lower values for effective dose and DRL when compared with earlier data available in the literature. However, this work suggests further studies with different kV stations on pediatric patients in the future.

Intraindividual difference between supraclavicular and subcutaneous proton density fat fraction is associated with cold-induced thermogenesis

Brown adipose tissue (BAT) activity is triggered by cold exposure resulting in an increased resting energy expenditure, called cold-induced non-shivering thermogenesis (CIT). Magnetic resonance (MR)-based proton density fat fraction (PDFF) of the supraclavicular fossa has been proposed as a surrogate marker of human BAT. The present study investigates supraclavicular PDFF in relation to CIT. For this prospective cross-sectional study 39 adults were recruited, from a cross-sectional study, exploring energy expenditure after cold exposure compared to thermoneutral conditions. Participants underwent additional MR examination of neck, pelvis, and abdomen. Supraclavicular and subcutaneous gluteal adipose tissue depots were segmented semi-automatically. Mean PDFF was assessed for each compartment and the delta PDFF was calculated as the difference of both. Correlation analysis of supraclavicular PDFF to CIT was performed for the whole cohort and subgroups, sorted by body mass index (BMI) and body fat percentage. Median age of participants (61.5% female) was 27 years. BMI ranged from 19.0 to 38.5 kg/m2, with body fat percentages from 4.6% to 45.3%. Median supraclavicular PDFF of 82.5% and median gluteal PDFF of 91.1%, were significantly different (P<0.0001). Median delta PDFF was 8.8% (3.9-21.9%). Mean CIT was 4.7%±9.0%. No statistically significant correlation of supraclavicular PDFF and CIT was found in the whole cohort and in most of the observed subgroups. Just the subgroup with normal body fat percentage revealed significant correlations between supraclavicular PDFF and CIT (rho =-0.59; P=0.003). Delta PDFF was significantly associated with CIT (rho =0.36; P=0.026). PDFF is influenced by adiposity. Therefore, if supraclavicular PDFF is used as approach to indirectly assess BAT presence, body composition should be considered. Delta PDFF, as the difference between gluteal and supraclavicular PDFF, may be a marker of CIT.

Management of unusual rectal foreign body - Case report and literature review.

IntroductionRetained rectal objects represent a rare complaint in the emergency room, affecting mainly males between 20 and 40 years, with most objects of a sexual nature, but the examiner must be aware of objects of an unusual nature.Presentation of caseA 54-year-old male patient arrives at the surgical emergency department, with a report of an accident with the insertion of an object via the rectum, a gym dumbbell. Initially opted for transrectal object removal, but with difficulties due to its position.DiscussionRetained rectal objects are a rare complaint in the emergency department, but with an increasingly important occurrence in recent years. Physical examination should include an assessment of the abdomen and digital rectal examination. Imaging tests are mandatory for diagnosis, with abdominal and pelvis radiography being the most requested. Although there is no consensus on the most appropriate removal technique, less invasive initial approaches are recommended, with transanal removal with a 60–75% success rate under local anesthesia. The follow-up after the procedure depends on several factors, and in general, the patient should be kept under observation and attention should be paid to significant changes in the evolution and alterations in the imaging tests.ConclusionThe clinical history in these cases can be confusing, due to the patient's fear of reporting the complaints. Radiography is the best initial test, and CT is reserved for cases of suspected complications. Whenever possible, perform the extraction rectally.

A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE AND UTILIZATION OF ANTENATAL SERVICES AMONG PRIMIGRAVIDA WOMEN IN SELECTED HOSPITALS OF KAMRUP DISTRICT, ASSAM

Antenatal Care includes care before birth and encompasses education, counseling, screening and treatment to monitor and to encourage the well - being of both the mother and fetus. Utilization of Antenatal Care services and maternal and child health programmes were critically important in a country like India which is experiencing high infant and child mortality rate and maternal mortality rate. The objective of the study was to describe the knowledge of antenatal women on antenatal services and utilization of available health services in community. Data was collected from 160 samples by using consecutive sampling technique. Socio-demographic proforma, self-administered structured questionnaire on knowledge regarding antenatal services and using checklist utilization of antenatal services was used to collect data. Results showed that majority 101(63.1%) had moderate knowledge, 48(30%) had inadequate knowledge and 11(6.9%) had adequate knowledge regarding antenatal services. All the participants i.e. 160(100%) had adequate utilization of antenatal services with mean score was 8.27 and SD=1.277. Majority 160(100%) had received immunization, had received Iron and folic acid tablets, had attended screening sessions for abdomen and breast examination, had attended screening sessions of blood pressure measurement, height and weight recording, had attended screening sessions of blood and urine examination, 158(98.7%) had registered pregnancy within 1-3 months, 117(73.1%) had received vitamin supplements, 106(66.2%) had received health talk on nutrition and exclusive breast feeding, 76(47.5%) had received counselling on family planning, and 66(41.2%) had received health talk on personal and environmental hygiene. The ndings of the study show that there is signicant co-relation between knowledge and utilization of the antenatal services among primigravida women. The mean knowledge score was 9.42±2.064 and mean utilization score was 8.27±1.277. Study result shows that there is signicant association between knowledge on antenatal services with selected demographic variables with respect to educational status (p = 0.021), occupation (p = 0.014) and average family income per month (p = 0.049). The study ndings also shows that there is signicant association between utilization of antenatal services with selected demographic variables with respect to age (p = 0.036), educational status (p = 0.001), and occupation of primigravida women (p = 0.002). In this study it concludes that more awareness and education should be given by the health workers to the antenatal mothers to receive the full antenatal services.

AN ISOLATED MESENTERIC INJURY DUE TO BLUNT TRAUMA ABDOMEN CAUSINGGANGRENE OF SMALL BOWEL

Hollow viscous injury and mesenteric vascular injury after a blunt trauma abdomen although may be third most common injury , occurs only in 3 to 5 % of patients making it a rare entity. Significant mesentric injury includes disruption of mesenteric, active mesenteric bleeding, and mesenteric injury leading to gangrenous bowel.A 56 year old male was brought to the emergency room with history of road traffic accident with no external injuries.On presentation his vitals were stable , examination of abdomen revealed tense abdomen with guarding and rigidity. Given the hemodynamic stability of the patient CT scan of abdomen was done which revealed intraperitoneal free fluid , normal solid organs, abnormal bowel wall enhancement with extraluminal air pockets.Patient underwent emergency laparotomy to find out a massive hemoperitoneum with long segment gangrenous illeal bowel loop. Gangrenous bowel segment was resected and double barrel ileostomy was fashioned. The mechanism of injury involved is either direct compression forces or shearing and deceleration forces in Blunt trauma abdomen.Undiagnosed mesenteric injuries are associated with high morbidity and mortality rates due to life-threatening haemorrhage from disruption of mesenteric vessels, bowel infarction and peritonitis . This can be avoided by using imaging investigations af earliest and emergency surgical intervention.

Abdominal Aortic Calcification and Cardiovascular Outcomes in Chronic Kidney Disease: Findings from KNOW-CKD Study.

To investigate the association between abdominal aortic calcification score (AACS) assessed by plain radiograph of the lateral abdomen and the risk of cardiovascular (CV) events in patients with pre-dialysis chronic kidney disease (CKD), a total of 2090 pre-dialysis CKD patients from the Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease (KNOW-CKD) were categorized by AACS into 0, 1–2, 3–4, 5–6, and ≥7. The primary outcome of the study was the composite CV events, defined as a composite of non-fatal CV events and all-cause death. The risk of composite CV events was significantly higher in the subjects with AACS ≥ 7 (adjusted hazard ratio (HR) 1.888, 95% confidence interval (CI) 1.219 to 2.923), compared to that of the subjects with AACS 0. The risks of fatal and non-fatal CV events (adjusted HR 1.052, 95% CI 1.030 to 1.073) and all-cause death (adjusted HR 1.949, 95% CI 1.073 to 3.539) were also significantly higher in the subjects with AACS ≥ 7. In conclusion, AACS assessed by plain radiograph is independently associated with adverse CV outcomes in patients with pre-dialysis CKD. A simple radiographic examination of the lateral abdomen may help CV risk stratification in this population.

A rare case of unusual presentation of acute necrotising pancreatitis as a presenting feature of dengue haemorrhagic fever in a child

Background: Dengue fever is an acute viral infection seen commonly in developing countries. Its presentation varies in children starting from mild illness to severe complications. Acute necrotising pancreatitis is a serious form of pancreatitis which is a very rare entity in children. Here we are presenting a rare case of unusual presentation of acute necrotising pancreatitis as a presenting feature of dengue fever. Case details: A 15 years male child presented with history of pain, distension of abdomen and vomiting. Patient had history of fever off and on since one month. Per abdomen examination showed ascites, hepatomegaly. Dengue NS1 antigen and dengue serology IgM was positive. Serum amylase level and lipase level were 1540 U/Land 960 U/L respectively. Contrast enhanced CT scan and MRCP showed bulky pancreas with decreased enhancement with ascites. Patient was managed conservatively with intravenous fluids, antibiotics and octreotide and patient was discharged successfully. Acute necrotising pancreatitis as a presenting feature of dengue fever has not been reported in children to the best of my knowledge. Conclusion: Clinical presentation of dengue fever varies but when patient presents with pain in abdomen, vomiting and fever then acute pancreatitis should be ruled out. In such patient clinical suspicion is important and timely intervention may lead to complete recovery and good outcome.

Comparative Analysis of Short-Course Vs Long Course Antibiotic Therapy among Patients with Complicated Intra-Abdominal Infections

Background: Complicated intra-abdominal infections have become a major health challenge that merits safe and efficacious therapy. Antibiotic therapy is the treatment of choice, however the duration of antibiotic use is debatable.&#x0D; Objective: To compare the safety and efficacy of the short course and long course antibiotic therapy towards the treatment and the progressive outcome of patients presented with complicated intra-abdominal infections.&#x0D; Methodology: This comparative study was carried out on 94 subjects (chosen via non-probability, consecutive sampling), who presented with complicated intra-abdominal infections, had signs and symptoms of infection along with ultrasound abdomen examination consistent with infective foci and routine blood test showing raised total leukocyte count, at the Department of Surgery - Liaquat University Hospital, Hyderabad. Subjects were divided into two groups (47 in each) through a random assignments. Group-A was kept on a short course (5-7-days) while Group-B was kept on a long course (7-10 days) antibiotic therapy. Data were documented using a structured questionnaire, including inquiries related to sociodemographic details, disease specifics, and observed for the outcome variables (mainly postoperative early resolution of infection and long hospital stay).&#x0D; Results: In Group A, resolution of infection was achieved in 59.57%, 29.79% and 10.64% patients on day 5, 6 and 7, espectively. In Group B, esoluation of infection was only reported as 42.55%, 36.17% and 21.28% on day 5, 6 and 7, respectively. The median duration of taking antibiotic was almost half in short course group than the long. Surgical site infections were commonly observed in Group B patients. There was no mortality observed in both groups. There is no significance difference observed in primary outcome of clinical cure among the groups.&#x0D; Conclusion: It can be concluded that the short course antibiotic therapy has good efficacy to treat CIAI when the primary foci of infection are surgically extracted with adequate source control.

Abdominal tuberculosis in children

To determine the features of diagnosis and clinical course of abdominal tuberculosis in children. Eighteen children aged from 5 days to 16 years with abdominal tuberculosis have been followed-up throughout 50 years. Diagnostic process implied anamnesis, objective examination, laboratory data and specific samples, ultrasound, X-ray examination, MRI, CT and morphological examination of specimens. Intestinal form was diagnosed in 2 children with abdominal tuberculosis, mesadenitis - 3 patients, liver tuberculosis - 4 ones, tuberculosis of uterine appendages - 3 patients, peritonitis - 6 ones. CT of the abdomen, diaskintest and morphological examination were the most important diagnostic methods. Laparotomy was performed in 16 children. Five cases are decsribed. Abdominal tuberculosis in children is mostly secondary. Several anatomical regions are simultaneously involved in specific process. Isolated lesion of one abdominal organ is rare. Active tuberculosis of respiratory organs in pregnant women has a significant negative impact on the fetus and newborns.

Establishing local diagnostic reference levels for adult computed tomography in Morocco

In Morocco, the radiation doses received by adult patients are increasing due to the number of CT examinations performed and the larger number of computed tomography (CT) scanners installed. The aim of this study was to evaluate the radiation doses received by patients for the most common adult CT examinations in order to establish local diagnostic reference levels (DRLs). Data from 1016 adult patients were collected during 3 months from four Moroccan hospitals. Dose length product (DLP) and volumetric computed tomography dose index (CTDIvol) were evaluated by determining the 75th percentile as diagnostic reference levels for the most common examinations including head, chest and abdomen. The DRL for each examination was compared with other studies. The established DRLs in Morocco in terms of CTDIvol were 57.4, 12.3 and 10.9 for CT examinations of the head, chest, abdomen, respectively. For DLP, they were 1020, 632 and 714, respectively. These established DRLs for CTDIvol were almost similar to the UK DRLs at all examinations, higher than the Egyptian DRLs and lower than the Japanese DRLs at the head CT examination, lower than the DRLs from Egypt and Japan at the CT abdomen examination. In terms of DLP, the DRLs were higher than those of the British studies, lower than those of the Egyptian and Japanese studies at the head CT examination were higher at chest CT and lower at abdominal CT than those of all selected studies. The higher level of established DRLs in our study demonstrates the requirement of an optimization process while keeping a good image quality for a reliable diagnosis.

Case of congenital ureteropelvic junction obstructive nephrolithiasis with acute urinary retention-X-ray abdomen (KUB view)

 A 36-year-old male patient was brought to casualty with complaints of colicky left sided flank pain, nausea, hematuria and difficulty in urination since 3 months. The patient came with no passage of urine since last 12 hours and sudden onset of pain. Per abdomen examination reveals tenderness at costovertebral angle with tachycardia and tachypnea. Patient was advised for X-ray abdomen KUB. Large left calculus in lower calyx with hydronephrosis as shown in (A) with mild tenderness over left flank. Catheterization was done. The patient was further advised for routine blood investigations, renal ultrasound, urine examination. The emergency surgery decision was taken on next day. Open pyelolithotomy with anderson-hynes pyeloplasty under general anesthesia was done. Post operatively patient was managed by Inj. Ceftriaxone 700 mg IV 12 hourly, Inj. Gentamycin 60 mg IV 8 hourly, Inj. Pantoprazole 40 mg IV 12 hourly and Inj. Neomol 1g IV 8 hourly. Liquid tolerated diet was advised to patient on post-operative day 2. Patient suggested to take very low calcium diet. After 7 days patient vitals was normal and shifted to normal diet and oral medication. The patient was advised to increase liquid diet and water intake. The final diagnosis was congenital ureteropelvic junction obstructive large (2.6 cm) nephrolithiasis with acute urinary retention, while the differentials included renal cell carcinoma, renal vein thrombosis, polycystic kidney disease.

Term Pregnancy with Septate Uterus and Longitudinal Vaginal Septum – A Case Report

Herein a case of 22-year-old primigravida women has been reported who was diagnosed with septate uterus along with longitudinal vaginal septum. Her antenatal period was uneventful, routine ultrasound scan during antenatal period detected no abnormalities. On per abdomen examination uterus was term size, heart rate of fetus was 144 beats per minute. Examination of vagina showed longitudinal vaginal septum of 0.5 cm thick, and cervical dilatation of 4 cm. Intraoperative findings recorded were; (i) Gravid uterus harbouring singleton intrauterine gestation in longitudinal lie & cephalic presentation. (ii) Dimple at the uterine fundus, uterine septum that extends to cervix from fundus, enlarged left horn containing the present pregnancy & the other is smaller. Women underwent emergency ceasarean section mode of delivery on account of longitudinal vaginal septum. The case described here is the unique case report wherein 22-year-old primigravida women detected with a complaint of septate uterus along with longitudinal vaginal septum was successfully delivered live male baby weighing 2.70 Kg following emergency ceasarean section. Keywords: Septate uterus; Longitudinal vaginal septum; Caesarean section

Elimination of biological and physical artifacts in abdomen and brain computed tomography procedures using filtering techniques

IntroductionMedical images are usually affected by biological and physical artifacts or noise, which reduces image quality and hence poses difficulties in visual analysis, interpretation and thus requires higher doses and increased radiographs repetition rate. ObjectivesThis study aims at assessing image quality during CT abdomen and brain examinations using filtering techniques as well as estimating the radiogenic risk associated with CT abdomen and brain examinations. Materials and MethodsThe data were collected from the Radiology Department at Royal Care International (RCI) Hospital, Khartoum, Sudan. The study included 100 abdominal CT images and 100 brain CT images selected from adult patients. Filters applied are namely: Mean filter, Gaussian filter, Median filter and Minimum filter. In this study, image quality after denoising is measured based on the Mean Squared Error (MSE), Peak Signal-to-Noise Ratio (PSNR), and the Structural Similarity Index Metric (SSIM). ResultsThe results show that the images quality parameters become higher after applications of filters. Median filter showed improved image quality as interpreted by the measured parameters: PSNR and SSIM, and it is thus considered as a better filter for removing the noise from all other applied filters. DiscussionThe noise removed by the different filters applied to the CT images resulted in enhancing high quality images thereby effectively revealing the important details of the images without increasing the patients’ risks from higher doses. ConclusionsFiltering and image reconstruction techniques not only reduce the dose and thus the radiation risks, but also enhances high quality imaging which allows better diagnosis.

Simplified approach to estimation of organ absorbed doses for patients undergoing abdomen and pelvis CT examination

The volumetric computed tomography (CT) dose index (CTDIvol) is the measure of output displayed on CT consoles relating to dose within a standard phantom. This gives a false impression of doses levels within the tissues of smaller patients in Southeast Asia. A size-specific dose estimate (SSDE) can be calculated from the CTDIvol to provide an assessment of doses at specific positions within a scan using size-specific conversion factors. SSDE is derived using the water equivalent diameter (D w) of the patient, but calculation of D w requires sophisticated computer software. This study aimed to evaluate relationships between D W and effective diameter (D Eff), which can be measured more readily, in order to estimate SSDE at various positions within a routine clinical abdomen and pelvis CT examination for Thai patients. An in-house ImageJ algorithm was developed to measure D w, effective diameter (D Eff), and SSDE on CT slices located at the heart, liver, kidneys, colon, and bladder, on 181 CT examinations of abdomen and pelvis. Relationships between D Eff and D w were determined, and values of organ absorbed dose using D Eff were estimated. This approach was validated using a second cohort of 54 patients scanned on a different CT scanner. The results revealed that ratios between D Eff and D w at the heart level were 1.11–1.13 and those for the others were about 1.00. Additionally, the SSDE/CTDIvol ratio was estimated for each organ in terms of exponential functions using the relationships between D w and D Eff for individual organs. In summary, this study proposed a simple method for estimation of organ absorbed doses for Southeast Asian patients undergoing abdomen and pelvis CT examinations where sophisticated computer software is not available.

Challenges experienced in establishing clinical indication based diagnostic reference levels: Pilot study

PurposeThe objective of this study is to establish clinical-indication based Diagnostic Reference Levels (DRLs) for the Computed Tomography (CT) examinations of Head, Abdomen & Pelvis + Contrast, and Kidney Ureter Bladder (KUB). Further, is to investigate the cases that register high-end doses to enable dose optimization. Material and methodsDose length product total (tDLPs) and scan acquisition parameters of a total of 715 patients who underwent CT Head, CT Abdomen & Pelvis + Contrast, and CT KUB studies were obtained and retrospectively examined. An electronic patient radiation dose monitoring system DOSE-TQM linked with the existing PACS was used to randomly generate patient dose information. Patient’s demographics, clinical indications and scan acquisitions were also collected. ANOVA and Tukey’s multiple comparison tests were used to check statistical differences between tDLPs per clinical indications. ResultsThe data exhibited 341 CT Head, 109 patients for CT Abdomen & Pelvis + Contrast, and 265 CT KUB examinations. The DRLs proposed using total DLP (mGy.cm) for clinical indications; abdominal pain for both CT Abdomen & Pelvis + Contrast and CT KUB (441 and 311 mGy.cm, respectively), appendicitis /acute appendicitis (484 mGy.cm), head trauma (544 mGy.cm), stroke (544 mGy.cm) and renal colic (308 mGy.cm). These values were concluded to be below or in close proximity with the total DLP based indication reported internationally. Patient weight is a significant dose contributor. ConclusionDLP differences exists not only between the same anatomical based CT studies but also across the same clinical indications. DLPs based on clinical indications provide a tool for CT dose optimisation that is better adapted to clinical practices and to the variability of patient’s morphology.

Gallstone ileus: Rare Entity for Mechanical Small Bowel Obstruction

Gallstone ileus is common in elderly female population. To obtain a diagnosis of gallstone ileus is a challenge requiring clinical and radiological assistance. It’s a rare cause of intestinal obstruction, accounts approximately 1-4%. Here we report a case of 56 years old lady presented with intestinal obstruction sign and symptoms. Per abdomen examination revealed generalised tenderness with sluggish bowel sound. Abdominal X-ray revealed prominent small bowel with presence of gas till rectum. CT abdomen noted intraluminal mass over distal small bowel loops mimickering intusseption. Exploratory laparotomy with small bowel enterotomy was performed. Intra-operative finding noted impacted gallstone measuring 2x3cm, 360cm from duodenal-jejunal flexure and 50cm from terminal ileum. Post-operative patient had speedy recovery and discharged home. Here we emphasize in elderly female patient presented with sign and symptoms of intestinal obstruction, diagnosis of gallstone ileus should be one of differential diagnosis.

Forgotten DJ stent presenting with emphysematous pyelonephritis: A life threatening complication.

IntroductionEmphysematous pyelonephritis (EPN) is an uncommon suppurative infection of renal parenchyma and perirenal tissue characterized by production of gas within renal parenchyma, collecting system or perinephric tissue.Case presentationWe report a case of young non diabetic female with past history of extracorporeal shock wave lithotripsy (ESWL) who presented with intermittent lower abdominal pain, dysuria and left lower limb swelling. Abdomen examination was notable for tenderness at left iliac fossa and fullness at left renal angle. Blood investigation showed leukocytosis and deranged creatinine levels. Urine analysis showed pyuria. Transabdominal ultrasound revealed left nephrolithiasis with moderate hydronephrosis, vesical calculus and double J (DJ) stent in situ. Patient was diagnosed as acute pyelonephritis and started on intravenous antibiotics. Despite on medical management, the condition deteriorated and progressed to septic shock. Computed tomography of kidneys, ureters and bladder (CT KUB) showed air fluid level in calyceal system with perinephric collection and confirmed diagnosis as emphysematous pyelonephritis. Patient underwent surgical drainage to control the sepsis. Few days later after control of sepsis and optimization, left nephrectomy and removal of retained DJ stent was done.Clinical discussionThis case report highlights the need to consider emphysematous pyelonephritis as a possible diagnosis in patients harbouring DJ stents even in young non diabetics. Early aggressive medical management coupled with urological intervention is a valuable alternative to upfront emergent nephrectomy. However, surgery should not be delayed in patient with fulminant infection at presentation or who failed on conservative management.ConclusionEmphysematous pyelonephritis warrants high index of suspicion for timely diagnosis and can be fatal if not recognized early and promptly treated.

Laparoscopic Treatment of Liver Abscess by a Fishbone Impaction: A Case Report

Bacterial liver abscesses caused by ingested bodies are very uncommon. In the current report, a unique case of a 50-year-old man associated with diabetes mellitus who suffered from sepsis and a liver abscess because of the migration of a fishbone that lodged in the left hepatic lobe is presented. The diagnosis was confirmed by enhanced computed tomography examination of the upper abdomen. The patient subsequently underwent laparoscopic surgery, and was discharged on postoperative day 12 without any complications. The present study discusses the clinical features and treatment of this case. J Curr Surg. 2021;11(3):65-68 doi: https://doi.org/10.14740/jcs444

Impact of four kVp combinations available in a dual-source CT on the spectral performance of abdominal imaging: A task-based image quality assessment on phantom data.

PurposeTo compare the spectral performance of four combinations of kVp available in a third generation dual‐source CT (DSCT) on abdominal imaging.MethodsAn image‐quality phantom was scanned with a DSCT using four kVp pairs (tube “A” voltage/tube “B” voltage): 100/Sn150 kVp, 90/Sn150 kVp, 80/Sn150 kVp, and 70/Sn150 kVp, classic parameters and dose level for abdomen examination (CTDIvol: 11 mGy). The noise power spectrum (NPS) and the task‐based transfer function (TTF) of two inserts were computed on virtual monochromatic images (VMIs) at 40/50/60/70 keV and for mixed, low‐, and high‐kVp images. Detectability index (d’) was computed on VMIs and mixed images to model the detection task of liver metastasis (LM) and hepatocellular carcinoma (HCC). Iodine quantification accuracy was assessed using the Root Mean Square Deviation (RMSDiodine) and the iodine bias (IB).ResultsNoise magnitude decreased by −55%± 0% between 40 and 70 keV for all kVp pairs. Compared to 70/Sn150 kVp, noise magnitude was increased by 9% ± 0% with 80/Sn150 kVp, by 16% ± 1% with 90/Sn150 kVp and by 24%± 1% with 100/Sn150 kVp. The average NPS spatial frequency (fav) shifted toward higher frequencies as energy level increased for all kVp pairs. Lowest fav values were found for 70/Sn150 kVp and highest for 100/Sn150 kVp. The value of TTF at 50% (f50) shifted toward lower frequencies with increasing energy level. The highest f50 values occurred for 100/Sn150 kVp and the lowest for 80/Sn150 kVp. For both lesions, d’ was highest for 70/Sn150 kVp and lowest for 100/Sn150 kVp. Compared to 70/Sn150 kVp, d’ decreased by −6% ± 3% with 80/Sn150 kVp, by −11% ± 2% with 90/Sn150 kVp and by −13%± 2% with 100/Sn150 kVp. For all acquisitions, the RSMDiodine and IB were the lowest for 100/Sn150 kVp (0.29 ± 0.10 mg/ml and 0.88 ± 0.30 mg/ml, respectively) and increased when the tube “A” voltage decreased (2.34 ± 0.29 mg/ml for 70/Sn150 kVp and 7.42 ± 0.51 mg/ml respectively).Conclusion70/Sn150 kVp presented the lowest image noise and highest detectability in VMIs of two small focal liver lesions. 100/Sn150 kVp presented the lowest image noise on mixed images and highest accuracy of iodine quantification in iodine images.