Multiple Fluid Levels Research Articles

Intussusception in children seen at Muhimbili National Hospital, Dar es salaam

To review infants and children with intussusception and assess its magnitude of concern and any seasonal variation in our environment. A retrospective study. Muhimbili National Hospital general paediatric and surgical wards from January 2000 to February 2004. The charts of all infants and children up to the age of 10 years diagnosed to have intussusception were reviewed. Demographic factors evaluated included age, incidence in up to one-year olds, sex, month of presentation to assess seasonal variation, clinical features, methods of diagnosis and management, aetiology and any recurrence. Twenty eight children were diagnosed to have intussusception. Sixteen were males and 12 females (M:F=l .3:1). Of these, 21(75%) were infants (up to the age of one year), nine were boys and 12 were girls( M.F=l:1.3). Incidence rate in this age group was approximately 1: 7557. Most cases presented in January-March(39.3%) and July to September(39.3%). No case was seen in the month of April during the 4-year period. Except in 2002, there has been a male preponderance. The aetiology was mainly idiopathic (85.7%), there were three cases suspected to be due to mesenteric adenitis and one case of intraluminal haemangioma. There were two recurrent cases, one was within a week with no known aetiology. All patients presented with vomiting and abdominal pain/distension. Preceding gastro-enteritis was common. The majority of the cases, 17(60.7%) presented with the classic triad of vomiting, rectal bleeding and abdominal pain/distension. Abdominal mass was often difficult to palpate due to gross or tense abdomen and was only palpated in four cases(14.3%). Air or barium reduction is not done at our institution due to apart from lack of facilities, majority of the children present late, >48 hours from the onset of symptoms and diagnosis was mainly based on clinical symptoms and signs of intestinal obstruction and confirmed with presence of multiple fluid levels on a plain erect abdominal X-ray. All children were then managed by surgery, 11(39.3%) underwent bowel resection. Histopathology reports of those available did not show cause of intussusception. Seven patients died postoperatively, hospital mortality of 25%. The approximate incidence of intussusception in less than one-year olds is 1:7557 in Dar es Salaam. It is a concern in our environment causing considerable morbidity and mortality due to late presentation and efforts should be made to improve sanitation and hygiene, referring health facilities, socio-economic factors and probably look into ways of preventing the problem occurring. Seasonal variation was seen, most cases(78.6%) presenting in the dry season when there is shortage of water in the city.

A CASE REPORT OF RICHTER'S HERNIA ASSOCIATED WITH INFLAMMATORY FIBROID POLYP OF THE ILEUM

We have experienced a case of Richter's her nia associated with inflammatory fibroid polyp (IFP) of the ileum. A 75-year-old woman was admitted to the hospital because of abdominal pain and vomiting. The patient was diagnosed as intestinal obstruction, because there were past histories of undergoing appendectomy and cholecystectomy: multiple fluid levels were observed on plain abdominal roentgenograms; and no tumor was palpated in bilateral inguinal regions. After depressurizing therapy with a long tube. X-ray examination of the small bowel demonstrated left femoral hernia of Richter's type. During an operation according to McVay's method, Richter's hernia and a polyp of tip of the small finger size were showed. The incarcerated intestine and small intestine by about 30 cm including the polyp were resected and end to end anastomosis was performed. Histopathologically the polyp was IFP. In this case, no causal relation between Richter's hernia and IFP was recognized. We reported a rare case of Richter's hernia associated with IFP.

A CASE OF ADULT IDIOPATHIC ILEOCOLIC INTUSSUSCEPTION DIAGNOSED PREOPERATIVELY

This report describes a case of adult ileocolic intussusception of unknown origin that was preoperatively diagnosed. A 56-year-old man was admitted to the hospital because of a sudden onset of pain in the right inguinal region. Plain abdominal X-ray on admission showed multiple fluid levels and dilatated intestines. Abdominal ultrasono-graphy showed target like appearance. From these findings ileus due to intussusception was suspected and the patient was immediately operated on. The operative findings revealed ileocolic intussusception and a tumor of 2cm by 2cm at the ileum outside the intussusception. Then the ileac and colonic segments involved were resected. Histopathological findings for the tumor were consistent with these of submucosal lipoma. In case of adult intussusception some organic changes such as the presence of a tumor are often associated with the intussusception. In that case the leading point is mostly the organic change. But in our patient the lipoma at the ileum was not the leading point. From these observations, it was thought that the intussusception in this case was idiopathic. Preoperative diagnostic ultrasonography appears very useful as a diagnostic measure, because it is not invasive and easy to use.

Aneurysmal bone cyst. A clinicopathologic study of 238 cases.

Aneurysmal bone cyst (ABC) is a nonneoplastic expansile bone lesion that mainly affects children and young adults. Primary ABC is relatively rare, with an incidence one half that of giant cell tumor of bone. In 238 patients with ABC studied in the Mayo Clinic files, more than 80% of the lesions were in long bones, flat bones, or the spinal column. Of the lesions initially treated at the Mayo Clinic, 95% were typical ABC; the rest were "solid" variants. Except for the absence of obvious cavernous channels and spaces, there was no significant histologic difference between solid variant and typical ABC. Radiographically, ABC is an eccentric expansile lesion commonly located at the metaphysis of long bones. Computed tomography and magnetic resonance imaging may show multiple internal septations or fluid levels. In the 153 patients treated, 19% had recurrence after curettage (intralesional excision). Recurrence was most common during the first 2 postoperative years.

The plain abdominal radiograph in acute pancreatitis

The radiographs of 100 patients with acute pancreatitis were reviewed and compared with 100 controls by two radiologists and a surgeon. Our aim was to assess the frequency and usefulness of the signs described in the literature. Calcification of the pancreas was seen in one case only. Abnormalities of the biliary tree (visible gallbaldder, biliary gas and gallstones) were seen in 10%. The left psoas shadow was more frequently absent in the pancreatitis series. Paucity of gastrointestinal gas although observed in 12 cases was ascribed to vomiting. A more important sign was the gaseous outline of an adynamic duodenal loop which was seen in half of the patients examined in the left lateral decubitus position. Dilated jejunum was seen in 31 cases, associated with sentinel loops in 10 and multiple fluid levels in 25 patients. Dilatation of thet ransverse colon was the most constant colonic sign (18%), but the colon 'cut-off' sign was not seen. It was concluded that the most prominent signs in order of importance are a gaseous distension of the duodenal loop, gas in the duodenal cap, a dilated transverse colon and the sentinel loop. The gasless abdomen is a striking but rare sign and in our series was always associated with severe pancreatitis.

Hernia through the Foramen of Winslow, Hernia Traversing the Lesser Sac and Allied Conditions

A review of the general features is given based on a study of 62 cases from the literature; a further case showing previously undescribed clinical and radiological features is reported. The cases are subdivided according to hernial contents and the X-ray appearances for each type are given. When, as is common, there is intestine in the sac, the stomach is displaced forwards and to the left by a circumscribed collection of gas which projects above the lesser curvature. Incarcerated small intestine shows as multiple fluid levels within the limits of the sac; if barium is given, bunched and dilated bowel is seen confined as if in a bag on the left side, and a loop may be seen crossing over the duodenum to enter the gas-filled area. Stretching and great dilatation of the duodenum is a very striking feature. In colonic hernia a single fluid level is seen in the plain film and the duodenum is not stretched. Oral barium studies are not advised in this type. The less common varieties are described and the differential diagnosis is discussed. The distinction from hernia traversing the lesser sac is indicated and a possible case is described briefly.

Multiple small bowel diverticula.

History: Epigastric pain and flatulent dyspepsia for two months. Patient's condition improved by medical treatment. Barium meal examination revealed multiple fluid levels situated throughout the abdomen.

X-Ray Diagnosis of Ileus. Comparison of Results Obtained by Roentgenograms in Horizontal and Upright Positions

The value of plain roentgenograms of the abdomen without the administration of contrast substances in the diagnosis of ileus has been repeatedly emphasized by clinicians. Goehl, Lynch, Borman, and Wangensteen1 found experimentally that roentgenologic evidence was of less value in the presence of strangulation than in simple obstruction. The roentgen diagnosis of ileus is based upon the fact that in obstruction there is an accumulation of gas and fluid proximal to the point of obstruction which can be visualized roentgenological. Whereas the presence of gas visualized in the roentgen plate is of diagnostic value, it is considered by many observers2 that the finding of multiple fluid levels (demonstrated by obtaining the roentgenogram in such a way that the junction between gas above and fluid below may be visualized) is of greater diagnostic importance.The present investigation was undertaken to compare the results obtained with roentgenograms taken in the horizontal position and those taken in the upright...