Plain Abdominal Radiography Research Articles

Measurement of Entrance Surface Air Kerma of plain abdominal radiography in some Nigerian health facilities

Background : Patient dose assessments in many Nigerian radiological departments have shown large inter- and intra-hospital variations for the same type of radiological examinations, hence, there is a need for regular monitoring of radiological equipment and measurement of patient dose in our health facilities. The main objective of this survey was to evaluate the Entrance Surface Dose Air Kerma (ESAK) of the patients who underwent abdominal (anteroposterior; AP) radiography in ten health facilities in Southern Nigeria.
 Material and Methods: A total of ten health facilities comprising private and public health facilities were included in this investigation. A total of 223 adult patients who weighed within 70±5kg `were considered in this survey. The ESAK was calculated from the tube output of the x-ray machines and the exposure parameters utilized during examinations according to the International Atomic Energy Agency code of practice.
 Results : The mean ESAK values obtained from the health centres ranged from 1.00 milligray (mGy) to 17.21mGy. The maximum/minimum ratio of individual ESAK which is the range factor (RF) varied from 1.3 to 6.1.
 Conclusion and Recommendation : Variations were observed in patient dose values among radiological units. The entrance surface air kerma (ESAK) obtained in the study were comparable with the dose values in the UK- 2010 review in most cases. The intra-radiological unit patient dose variations, as revealed by the range factor show that the operation technique employed was not fully optimized and that dose reduction is possible without degrading image quality. Therefore, there is a need for regular monitoring of radiographic equipment and periodic surveys of the patient dose.

Handheld metal detector versus conventional chest and abdominal plain radiography in children with suspected metallic foreign body ingestion: can we safely abandon X-rays?

Ingestion of metallic foreign bodies (MFBs) is a frequent occurrence in children and is commonly diagnosed via X-rays. In recent years, the handheld metal detector (HMD) has been increasingly adopted by several pediatric hospitals as it is considered an effective and accurate diagnostic tool that avoids exposure to ionizing radiations. Sensitivity of HMD has been reported high (99.4%) in case of coin ingestion, but significantly lower (46%) when considering the ingestion of other types of MFBs. We tested the effectiveness of the HMD in diagnosing ingested MFBs in children less than 14 years of age, in our Pediatric Emergency Department (PED). We prospectively evaluated all cases of MFBs ingestion that presented at the PED of our hospital from March 2015 to July 2017. Ninety-eight patients were included. The overall sensitivity was 63.2% (79.5% for coins, 25.5% for batteries and 56% for other objects) while the specificity was 95%. The HMD could have replaced the X-ray examination only if a MFB was detected below the xyphoid process. Based on our findings, a negative result of HMD is not sufficient to exclude an ingestion of MFBs. Therefore, in case of an evocative history and depending on type and size of the foreign body, a radiological investigation is still necessary.

Contribution of Imaging in the Diagnosis of Urinary Tract Lithiasis at the Fertilia Medical Clinic in Bamako

Aims: Urolithiasis is a common pathology which affects, depending on the country, from 4 to 20% of the population. Several epidemiological studies have shown over the last 30 years that the frequency of lithiasis continues to increase in industrialized countries. The objective of our study was to evaluate the contribution of imaging methods in the management of lithiasis of the urinary tree at the Fertilia medical clinic in Bamako. Subjects And Methods: This was a 24-month cross-sectional and prospective study, between January 2020 and January 2022, which involved 160 patients who came for imaging examinations looking for urinary tract lithiasis. Data were entered and analyzed using SPSS. Results: A total of 2,875 radiological examinations were carried out during our study period and we retained 160 cases of urinary tract lithiasis, i.e. a frequency of 05.56%. The most represented age group was 21-30 years old with 24.37%. The male sex represented 65%, pupils and students were the most numerous with 24.34%. 90.62% of our patients were referred to us by other doctors. The most common urological antecedent was urinary bilharziasis. The most cited reason for consultation was acute renal colic. The radiological examination that was performed the most was the combination of plain abdominal radiography and ultrasound. The ASP was normal in 28.75% of cases. The renal site was the most common location of lithiasis (63%) and mainly on the left (46.25%). The calyx location of lithiasis was the most common with 58.75%. The number of lithiasis was two or more in 54.38%. The most cited ureteral location was the terminal ureter (60%). The complication on the upper urinary tract was hydronephrosis (60%). Creatinine was normal in 76.87% of cases. Conclusion: Urolithiasis remains a fairly common condition in Gao. It is especially seen among the working population. It is common at all ages and more frequently in males. Urolithiasis is responsible for temporary professional ..........

Urinary Retention a Rare Cause of Bowel Obstruction: A Case Report

A 60-year-old man presented to the emergency department with diffuse abdominal pain without passing stool or gas since 4 days. The diagnostic work-up included a plain abdominal radiograph and an abdominal computed tomography scan that revealed small-bowel obstruction with a rare cause. The obstruction was secondary to external compression by a distended bladder. The immediate management was insertion of an indwelling urinary catheter. We suggested re-evaluation, and after several hours the symptoms resolved. Although rare, pressure from the distended bladder due to urinary retention can cause complete bowel obstruction.

Successful Thoracoscopic Excision of Left Middle Mediastinal Teratoma in a Girl

We wish to present a very unusual case of a toddler girl who presented with acute abdomen and features of peritonitis. Inflammatory markers were high but tumor markers were all within normal limits. The plain abdominal radiograph indicated suspicious small free air under the dome of diaphragm. Chest radiograph in standing position confirmed the suspicion but incidentally showed a well-defined soft tissue mass in the mediastinum over left hilar region. Contrast enhanced computed tomography of chest, abdomen and pelvis confirmed mature left mediastinal teratoma and appendicular abscess. The patient underwent laparoscopic drainage of appendicular abscess and appendicectomy and was discharged home after 6 days. An elective thoracoscopic resection of left mediastinal teratoma was performed uneventfully. The patient is asymptomatic with normal tumor markers and chest radiograph at 10 years follow up.

Chylolymphatic cyst as a rare cause of acute intestinal obstruction in infants

BackgroundChylolymphatic cysts are benign pathology in lymphatic vessels due to obstruction in the lymphatic system. Their incidence is still unknown. However, they account for approximately 3 to 9% of all pediatric lymphangiomas. Most of these lesions are asymptomatic and are discovered accidentally. They can be presented with nonspecific abdominal pain, vomiting, and changes in bowel habits. Rarely, chylolymphatic cysts can as intestinal obstruction, volvulus or even torsion.Case presentationA 3-month-old male presented to our unit with manifestations of acute intestinal obstruction. Abdominal examination revealed signs of generalized peritonitis and intestinal obstruction. Abdominal ultrasound revealed minimal turbid intraperitoneal collections and no motility of bowel loops. Plain erect abdominal radiograph revealed multiple small bowel air fluid levels. Abdominal exploration revealed a large chylolymphatic cyst causing acute intestinal obstruction. Excision of the cysts was done with preservation of adjacent bowel loop. The patient was discharged in good health on the 6th day postoperative. A chylolymphatic cyst with a diameter of 5 cm was identified by histological investigation.ConclusionsMost chylolymphatic cysts in infants are asymptomatic, but they can cause fatal complications such as intestinal obstruction, volvulus, or even torsion.

Role of Colonoscopy in Foreign Body (Needle) Ingestion in Children: A Case Report and Literature Review

Abstract: Foreign body (FB) ingestion is one of the most complex and serious emergency conditions for diagnosis that often occurs in children. Most ingested FBs, intentionally or unintentionally, pass through the gastrointestinal tract without complications, and only a small proportion require surgical intervention inter alia colonoscopy. However, if the patient complains of abdominal pain, complications may occur, especially perforation with peritonitis, and in this case a laparotomy is needed. We reported a case of a 13-year-old girl with the chief complaint of needle ingestion two weeks ago. Patient complained of abdominal pain and was unable to defecate. Plain abdominal radiographs showed needle-shaped metal density in the lower intestinal; therefore, the patient was referred to Prof. Dr. R. D. Kandou Hospital for further treatment. An endoscopy was initially performed but no foreign body was found because they might had been in the intestine. Colonoscopy revealed a foreign body in the proximal ascending colon, transverse position. Extraction of the foreign body, along with pulling the scope and evaluating the transverse, descending, sigmoid and rectum colon which were within normal limits was carried out. Monitoring after removal of the foreign body for two days found no complaints of abdominal pain and bowel movements were normal, therefore, the patient was discharged from the hospital. In conclusion, since a sharp foreign body (a needle) was still in the proximal ascending colon, a colonoscopy was performed with successful removal of the needle. Keywords: foreign body; needle; endoscopy; colonoscopy

Elevated serum fatty acid-binding protein 4 level predicts all-cause and cardiovascular mortality in peritoneal dialysis patients: a five-year study

Background To explore the prospective role of serum fatty acid-binding protein 4 (FABP4) in the outcomes of peritoneal dialysis (PD) patients. Methods A prospective observational study was conducted with 159 patients on PD. Demographic and clinical data at baseline were collected from medical records. Biochemical data were recorded based on blood samples measured in a central laboratory. Serum FABP4 concentrations were determined using enzyme-linked immunosorbent assay. Body composition was measured using a Body Composition Monitor. Abdominal lateral plain radiography was used to evaluate vascular calcification. The primary endpoints were all-cause and cardiovascular death. Results The median of serum FABP4 concentration was 154.6 ng/mL (interquartile range, 132.8–269.7 ng/mL). Increased serum FABP4 was associated with increased vascular calcification proportion, time on dialysis, body mass index, high-sensitivity C-reactive protein (hs-CRP), intact parathyroid hormone (iPTH), triglycerides, body fat mass, and body fat percentage (p < 0.05). Increased serum FABP4 was associated with decreased residual kidney Kt/V urea (p < 0.05). Patients with hs-CRP≥ 3 mg/L had significantly higher serum FABP4 than those with hs-CRP< 3 mg/L (p < 0.05). Patients with vascular calcification had significantly higher serum FABP4 than those without vascular calcification (p < 0.05). During a median follow-up of 58.0 months, 58 all-cause deaths and 26 cardiovascular deaths occurred. High serum FABP4 levels were independently predictive for all-cause [hazard ratio (HR), 1.003; 95% confidence interval (CI), 1.001–1.005; p = 0.016] and cardiovascular death (HR, 1.005; 95% CI, 1.001–1.008; p = 0.006) in PD patients. Conclusions Increased serum FABP4 levels can independently predict all-cause and cardiovascular death in patients on PD.

Management of adhesive small bowel obstruction: the results of a large retrospective study

BackgroundPostoperative adhesive small bowel obstruction (SBO) is a frequent cause of hospital admission in a surgical department. Emergency surgery is needed in a majority of patients with bowel ischemia or peritonitis; most adhesive SBO can be managed nonoperatively. Many studies have investigated benefits of using oral water-soluble contrast to manage adhesive SBO. Treatment recommendations are still controversial.MethodsWe conducted an observational retrospective monocentric study to test our protocol of management of SBO using Gastrografin®, enrolling 661 patients from January 2008 to December 2021. An emergency surgery was performed in patients with abdominal tenderness, peritonitis, hemodynamic instability, major acute abdominal pain despite gastric decompression, or CT scan findings of small bowel ischemia. Nonoperative management was proposed to patients who did not need emergency surgery. A gastric decompression with a nasogastric tube was immediately performed in the emergency room for four hours, then the nasogastric tube was clamped and 100 ml of nondiluted oral Gastrografin® was administered. The nasogastric tube remained clamped for eight hours and an abdominal plain radiograph was taken after that period. Emergency surgery was then performed in patients who had persistent abdominal pain, onset of abdominal tenderness or vomiting during the clamping test, or if the abdominal plain radiograph did not show contrast product in the colon or the rectum. In other cases, the nasogastric tube was removed and a progressive refeeding was introduced, starting with liquid diet.ResultsSeventy-eight percent of patients with SBO were managed nonoperatively, including 183 (36.0%) who finally required surgery. Delayed surgery showed a complete small bowel obstruction in all patients who failed the conservative treatment, and a small bowel resection was necessary in 19 patients (10.0%): among them, only 5 had intestinal ischemia.ConclusionsOur protocol is safe, and it is a valuable strategy in order to accelerate the decision-making process for management of adhesive SBO, with a percentage of risk of late small bowel resection for ischemia esteemed at 0.9%.

Entero-colonic Fistula Secondary to Necrotizing Enterocolitis in Premature Infant: A Case Report

Necrotizing enterocolitis is a severe inflammatory disease of the intestine and is the main cause of death in infants, mostly occurring in premature infants. Intestinal obstruction may occur during the medical treatment of necrotizing enterocolitis. A common cause of intestinal obstruction is intestinal stricture, and entero-enteric fistulas may form in the proximal portion of the intestinal stricture. Several mechanisms may be suggested for the development of entero-enteric fistula. Intestinal ischemia and subsequent necrosis do not become intestinal perforation over time, causing an inflammatory reaction, and are attached to the adjacent intestine, forming a fistula. Alternatively, a subacute perforation may be sealed off by the adjacent intestine, resulting in fistula formation. Entero-enteric fistulas are closely related to distal stricture and occurs when there is a localized perforation rather than a generalized perforation. Fistulas can be diagnosed via contrast enema examination or distal loopogram, and surgical resection is required. Here, I report a case of a preterm infant with an entero-colonic fistula secondary to necrotizing enterocolitis. The patient had abdominal distention and bloody stool and was confirmed to have rotavius enteritis. Plain abdominal radiographs showed pneumatosis intestinalis. The patient received medical treatment for necrotizing enterocolitis. While the symptoms were improving, he vomited again, and intestinal obstruction was suspected. Gastrografin enema was performed due to intestinal obstruction, and an enterocolonic fistula was found.

Clinical indications for plain abdominal radiographs: A survey study among radiographers.

Abdominal pain is a common complaint in the Emergency Department. Radiographers' knowledge and practices regarding clinical indications for performing abdominal examinations are crucial in the results radiographs produced. To determine the knowledge and practices of radiographers regarding the clinical indications for performing radiographic examinations of the abdomen. Four public hospitals in the Eastern Cape province, South Africa. A cross-sectional study was conducted, using a convenience, all-inclusive sample of n = 85 radiographers. A hard copy self-administered questionnaire was distributed between February and June 2020. Descriptive (mean and standard deviations) and inferential (chi² test) statistics were generated using IBM® SPSS® version 26.0 software package. Knowledge of clinical indications had a mean of 59.41. All four demographics (age, years of experience, attended a short course and attended pattern recognition course) were significantly associated with overall knowledge. Additionally, short course attendance was significantly associated with most practice items, and two knowledge items (which views are done for perforation; and which view(s) demonstrate a stab abdomen). Pattern recognition was significantly associated with one knowledge item (which views are regarded as an acute abdomen). Despite the lack of short courses and pattern recognition courses, radiographers' knowledge of clinical indications was good (>50%). Continuous training, accessible protocols for performing clinical indications for plain abdominal radiographic examinations for radiographers, audit, feedback and reminders to enhance protocol adherence are recommended. The study findings could be used to enhance knowledge and practices regarding clinical indications for plain abdominal radiographic examinations among radiographers.

Gastric Inflation in Prehospital Cardiopulmonary Resuscitation: Aspiration Pneumonia and Resuscitation Outcomes.

Gastric inflation (GI) can induce gastric regurgitation and subsequent aspiration pneumonia, which can prolong intensive care unit stay. However, it has not been verified in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the incidence of GI during prehospital resuscitation and its effect on aspiration pneumonia and resuscitation outcomes in patients with out-of-hospital cardiac arrest. This was a multicenter, retrospective, observational study. Patients with non-traumatic OHCA aged 19 years who had been admitted to the emergency department were enrolled. Patients who received mouth-to-mouth ventilation during bystander cardiopulmonary resuscitation (CPR) were excluded from the evaluation owing to the possibility of GI following bystander CPR. Patients who experienced cardiac arrest during transportation to the hospital who were treated by the emergency medical service (EMS) personnel, and those with a nasogastric tube at the time of chest or abdominal radiography were also excluded. Radiologists independently reviewed plain chest or abdominal radiographs immediately after resuscitation to identify GI. Chest computed tomography performed within 24 h after return of spontaneous circulation was also reviewed to identify aspiration pneumonia. Of 499 patients included in our analysis, GI occurred in approximately 57% during the prehospital resuscitation process, and its frequency was higher in a bag-valve mask ventilation group (n = 70, 69.3%) than in the chest compression-only cardiopulmonary resuscitation (n = 31, 55.4%), supraglottic airway (n = 180, 53.9%), and endotracheal intubation groups (n = 3, 37.5%) (p = 0.031). GI was inversely associated with initial shockable rhythm (adjusted odds ratio [OR] 0.53; 95% confidence interval [CI]: 0.30-0.94). Aspiration pneumonia was not associated with GI. Survival to hospital discharge and favorable neurologic outcomes were not associated with GI during prehospital resuscitation. GI in patients with OHCA was not associated with the use of different airway management techniques.

Twisted Right Ovarian Teratoma Mimicking Ruptured Inflamed Appendix in a Young Woman

Abstract A 27-year-old female was referred to our health facility with a working diagnosis of a ruptured appendix on account of sudden onset of severe right iliac fossa and pelvic pain. Abdominal ultrasound scan, plain abdominal radiograph, and abdominal computed tomographic scans done in our health facility revealed a fairly rounded poorly vascularized right ovarian mass containing a tooth, fat, and Rokitansky nodule. A radiological diagnosis of matured poorly vascularized right ovarian teratoma with possible torsion was made. She had laparotomy with excision of the right ovarian mass, and the histology of the excised specimen confirmed the diagnosis of matured right ovarian teratoma. She responded well postoperatively, and subsequent follow-up assessment was satisfactory.

Primary small bowel volvulus in adult: an unusual case report

Small bowel volvulus (SBV) is an uncommon case which the small intestine rotates around its own mesenteric axis. SBV generally occurs in newborns. We report the case of a 69-year-old man who has been coming with complaints of pain all over his abdomen, vomiting, no bowel movement, and flatus since 2 days ago. The patient underwent plain abdominal radiography and was found to have a high-lying obstructive ileus. The patient was treated with exploratory laparotomy surgery and found to have necrotic bowel sections. During the 5 days postoperative, the complaints improved.

Fatal Bowel Obstruction Due to Paraduodenal Hernia: A Case Report.

A paraduodenal hernia is a rare type of hernia, however it is the most common type of internal hernias. It can develop after surgery, trauma, or be congenital. Paraduodenal hernias are rare in children. Clinical presentation is nonspecific. Patients range from being asymptomatic to presenting with clinical symptoms associated with small bowel obstructions. Diagnostic tools such as X-ray, plain abdominal radiography, and computed tomography may be used to diagnose paraduodenal hernias. Described is the case of a 5-year-old female who died suddenly of a bowel obstruction due to a paraduodenal hernia found at postmortem examination. In the hours prior to death, she reported stomach pain, vomiting, and later developed a fever. Postmortem CT study showed free fluid in the abdomen and bowel distention. Internal examination showed an obstructed bowel with ischemic sections extending from the distal portions of the small bowel up to the proximal portions of the transverse colon. The ischemic portions were entrapped within a clear membranous sac within the abdominal cavity. The sac was concluded to be a paraduodenal hernia. Paraduodenal hernias are rare and difficult to diagnose but they must be considered in the diagnostic process, as without surgical intervention the mortality rate can be high.

Pneumoperitoneum – Can It Be Diagnosed by Ultrasound?

Hollow organ perforation is a life-threatening condition and early diagnosis of perforation is important in improving the prognosis of these patients. The physical phenomenon that then occurs in the abdominopelvic cavum is the presence of extraluminal gas. The basic methods of detecting free gas in the peritoneal cavity are radiological: plain abdominal radiography, ultrasound and computed tomography. In the radiological literature, there is still no clear consensus which technique is optimal for the detection of pneumoperitoneum – plain abdominal radiography, ultrasound or computed tomography. CT is the gold standard for diagnosis but is often preceded by long wait times and unnecessary radiation exposure. Abdominal ultrasound can also be used as an adjunct in decision-making for justifying the risks of transporting a critically ill patient for further imaging. Based on the data presented, it can be assumed that ultrasonography should be treated as the basic method in diagnosing pneumoperitoneum. CT is the gold standard for the diagnosis of pneumoperitoneum, which can also help detect the cause of pneumoperitoneum.

An unusual rectal foreign body: A sundried corn-stick

Though common, the extraction of rectal foreign bodies is still a great challenge for surgeons. The foreign body's position can usually be verified by plain abdominal radiography. Given the potential of sexually transmitted disease, screening for HIV, hepatitis, and syphilis is warranted prior to intervention. The utilization and selection of surgical instruments need to be flexible, ingenious, and innovative.

Minipercutaneous Nephrolithotomy in the Management of Large and Complex Renal Calculi in Children: How Effective Is It?

Purpose: To evaluate the efficacy and safety of minipercutaneous nephrolithotomy (PCNL) in the management of large and complex calculi in children. Patients and Methods: From May 2017 to April 2021, a total of 41 pediatric cases were diagnosed with large/complex renal stones (partial-total staghorn) and following a detailed biochemical evaluation and thorough radiological examination (plain abdominal radiograph, urinary ultrasound, noncontrast and/or computed tomography), all cases underwent mini-PCNL procedure for the minimal invasive management of these calculi. Preoperative, intraoperative, and postoperative data were analyzed and reported in detail. Results: A total of 41 procedures were performed in 26 boys and 15 girls (male/female = 1.73). While the age of the kids ranged from 2.5 to 10 years (mean 6.74 ± 2.76), mean size of the stones was 16.28 ± 3.43 mm (range 11-24) with a mean stone density value of 816 HU (range 550-1350). Evaluation of the success rates in terms of complete stone clearance on postoperative day 1 revealed that while 73.2% (30/41), residual fragments have been noted in 11 cases (26.8%). Size of the residual fragments ranged from 2 to 7 mm (mean 4.3). Of those children, 10 cases required flexible ureteroscopy for stone removal, and in 1 case, placement of Double-J was adequate for spontaneous passage. During a 3-month follow-up, the stone-free rate (SFR) increased to 100% without any residual fragment left. Conclusions: Mini-PCNL with holmium laser lithotripsy is an effective and safe treatment alternative in the minimal invasive management of large/complex kidney stones in children with high SFRs.

Idiopathic Mesenteric Phlebosclerosis: A Single-Institute Experience in Taiwan.

Idiopathic mesenteric phlebosclerosis is a rare condition with unclear pathogenesis. This study aimed to investigate the clinical features, diagnostic modalities, treatments, and outcomes of idiopathic mesenteric phlebosclerosis patients in Taiwan. Idiopathic mesenteric phlebosclerosis patients diagnosed by the typical characteristic of tree-like mesenteric venous calcifications on plain abdominal radiography or computed tomography between January 1992 and July 2021 were retrospectively analyzed. Totally, 36 idiopathic mesenteric phlebosclerosis patients were enrolled (50% females; mean age, 61.6 years). Among the included patients, 26 (72.2%) and 10 (27.7%) were symptomatic and asymptomatic, respectively. Abdominal pain (61.1%) accounted for the majority of all symptoms, followed by fever, diarrhea, and bloody stools. Our results showed that 83.3% of patients had at least 1 risk factor, whereas 16.6% of patients had none. Moreover, among the included patients, 36.1%, 44.4%, 50.0%, 38.8%, and 8.3% had cardiovascular disease, chronic renal disease, cancer, chronic liver disease, and diabetes mellitus, respectively. Our findings showed 94.4% of patients were diagnosed via abdominal computed tomography and plain abdominal radiography, whereas 5.6% of patients were diagnosed via plain abdominal radiography. The ascending colon was the most commonly involved site (100%). Our findings showed that 91.6% of patients experienced good recovery after conservative treatment, except for the 3 who died of sepsis and respiratory failure. By contrast, 8.3% of idiopathic mesenteric phlebosclerosis patients underwent colectomy. The average follow-up duration was 62.5 months. Idiopathic mesenteric phlebosclerosis remains a rare disease in Taiwan. Plain abdominal radiography and computed tomography can be utilized for establishing a definite diagnosis. Conservative treatment is usually adequate for most patients, with surgical treatment only indicated for severe cases.

Endoscopic removal of an appendiceal foreign body using a disposable pancreaticobiliary imaging catheter.

A 30-year-old man was admitted to our hospital following ingestion of a peg-like foreign body 6 days earlier. The patient reported no significant abnormalities. Physical examination showed a soft abdomen, without tenderness or rebound pain. Plain abdominal radiography revealed a peg-like object with high density in the right inferior abdomen ([Fig. 1]). Computed tomography confirmed that the object was at the appendiceal cavity, with no signs of perforation ([Fig. 2]). Endoscopic removal of the object was performed for this patient.