Latest papers on Intestinal Obstruction, ultrasonography
Department of General Surgery, Dicle University, Faculty of Medicine, Turkey.
Small bowel obstruction is rarely caused by bezoars. An important cause of phytobezoars are dried fruits. A 56 year old man presented to our department with symptoms of acute intestinal obstruction. Abdomen was distended and tender at the right and left lower quadrants. Bowel movements were decreased, and rectum was empty on digital examination. Upright plain films of the abdomen revealed multiple air-fluid levels and patient was immediately operated on. Due to the ischaemia of short small bowel segment, resection and end to end anastomosis were performed. After resection, bowel was opened and an apricot was found in the small bowel lumen. Although the dried apricot was small enough to pass through the pylorus spontaneously, it became swollen in fluid and started to obstruct the small bowel lumen especially in the terminal ileum. Obstruction by undigested food is rare and mostly seen in children, edentulous older people and patients with mental disorders. In conclusion, dried fruits, when swallowed without chewing, may cause intestinal obstruction.
Ann Emerg Med. 2011 Oct ;58 (4):e1-2 21943590
Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università degli Studi di Genova, Genova, Italy.
Department of Veterinary Medicine, School of Veterinary Medicine, Federal University of Paraná, Curitiba, Brazil.
OBJECTIVES To assess the accuracy of intestinal ultrasound for diagnosis of intestinal obstruction in dogs and cats. METHODS A prospective clinical study was performed. Inclusion criteria were dogs and cats with clinical signs suggestive of gastrointestinal obstruction. Animals with no obstruction detected on ultrasound were excluded if they could not be monitored for 48 hours to confirm absence of obstruction. Sonographic diagnosis of small intestinal obstruction was based on identification of at least two findings suggestive of intestinal obstruction. RESULTS Ninety-two patients suspected of having intestinal obstruction were included. Correct diagnosis of intestinal obstruction was made in 21 cases (23%), and in 68 (74%) this diagnosis was excluded. Interpretation of the images on prospective analysis had sensitivity, positive predictive, specificity and negative predictive values of 100%, 87.5%, 95.8% and 100%, respectively. CLINICAL SIGNIFICANCE Ultrasonography is an excellent method for investigation of animals with gastrointestinal disorders, and is particularly useful for excluding obstructive processes.
Is there a statistical correlation between ultrasonographic findings and definitive diagnosis in horses with acute abdominal pain?
Centro di Studi del Cavallo Sportivo, Dipartimento di Patologia, Diagnostica e Clinica Veterinaria, Ospedale Veterinario Universitario Didattico, Università degli Studi di Perugia, Italy. email@example.com
REASON FOR PERFORMING STUDY Abdominal ultrasonography has become a part of the diagnostic investigation for the acute abdomen in many equine clinics. There is limited information on the correlation between abnormalities detected on abdominal ultrasonography and the specific category of small intestine (SI) and large intestine (LI) diseases. OBJECTIVES To investigate the relationship between abdominal ultrasonographic findings and disease categories that cause abdominal pain requiring surgery. METHODS Medical records were reviewed for horses undergoing surgery or post mortem examination for colic. The ultrasound examination was performed to assess free peritoneal fluid, the left kidney, stomach, appearance and motility of the duodenum, identification, appearance, motility and thickness of small intestine loops, and the appearance and motility of the colon. Logistic regression analysis was used to identify associations between disease categories and ultrasonographic findings; a Chi-squared test was used to test for associations between each variable and disease categories. RESULTS The study included 158 horses. Distended and nonmotile SI loops were associated with strangulated obstruction (n = 45); increased free peritoneal fluid, completely distended SI loops with abnormal motility and thickened loops were associated with definitive diagnosis involving SI (n = 58). Failure to visualise the left kidney was associated with renosplenic entrapment (n = 16); thickened large colon (LC) was associated with LC strangulating volvulus (n = 9). CONCLUSION The use of abdominal ultrasonography can be used for the accurate definitive diagnosis involving SI and LI diseases. POTENTIAL RELEVANCE This retrospective study may be used as a basis for prospective studies to assess the ultrasonographic findings in horses with medical colic and to compare these with surgical findings.
Edward B Singleton Department of Pediatric Radiology, Baylor College of Medicine and Texas Children's Hospital, 6621 Fannin St., MC-2251, Houston, TX 77030, USA. firstname.lastname@example.org
Abdominal cocoon is a rare disorder that may pose a diagnostic conundrum in patients presenting with intermittent symptoms of small bowel obstruction. We describe the imaging findings of a unique case of abdominal cocoon that presented in infancy.
Department of Radiodiagnosis, GMCH, Chandigarh, India. email@example.com
Abdominal cocoon is a rare condition that results in an intestinal obstruction due to total or partial encapsulation of the small bowel by a fibrocollagenous membrane. Treatment is surgical resection of the membrane and free the bowel. Preoperative diagnosis is possible with combination of sonography and CT scan. We report two cases where the diagnosis of abdominal cocoon was suggested preoperatively based on the sonography and CT scan of abdomen.
Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, SC 29425, USA. firstname.lastname@example.org
Acute pelvic pain in women is a common presenting complaint that can result from various conditions. Because these conditions can be of gynecologic or nongynecologic origin, they may pose a challenge to the diagnostic acumen of physicians, including radiologists. A thorough workup should include clinical history, physical examination, laboratory data, and appropriate imaging studies, all of which should be available to the radiologist for evaluation. Ultrasound is the primary imaging modality in women with acute pelvic pain because of its high sensitivity, low cost, wide availability, and lack of ionizing radiation, particularly when a gynecologic disorder is suspected as the underlying cause. However, other modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) may be very helpful, especially when a nongynecologic condition is suspected.
Dept of General Medicine, Andhra Medical College.
A 48 year old woman presented with high grade fever, arthralgia and multiple tender papules and plaques over the face, neck, back, arms and forearms with distension of abdomen. Investigations revealed leukocytosis with neutrophilia, high ESR and increased C-reactive protein. Skin biopsy showed neutrophilic infiltration in the dermis. Plain x-ray abdomen is suggestive of subacute intestinal obstruction. We report this case of classic Sweet's syndrome with uncommon presentation.
Emerg Med J. 2011 Aug ;28 (8):676-8 20732861
Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Olive View Medical Center and UCLA Medical Center, 1000 W. Carson Street, D-9A, Torrance, California 90509, USA. email@example.com
BACKGROUND Plain film radiography (x-ray) is often the initial study in patients with suspected small bowel obstruction (SBO) to expedite patient care. OBJECTIVE To compare bedside ultrasonography (US) and x-ray for the detection of SBO. METHODS This was a prospective study using a convenience sample of patients presenting to the emergency department (ED) with abdominal pain, vomiting, or other symptoms suggestive of a SBO. Patients were evaluated with US prior to x-ray and CT. US was performed by emergency physicians (EPs) who completed a 10 min training module and five prior US exams for SBO. The criterion standard for the diagnosis of SBO was the results of CT read by board-certified radiologists. RESULTS In all, 76 patients were enrolled and evaluated with US for SBO. A total of 33 (43%) were diagnosed as having SBO. Dilated bowel on US had a sensitivity of 91%(95% CI 75 to 98%) and specificity of 84%(95% CI 69 to 93%) for SBO, compared to 27%(95% CI 14 to 46%) and 98%(95% CI 86 to 100%) for decreased bowel peristalsis on US. X-ray had a sensitivity of 46.2%(95% CI 20.4 to 73.9%) and specificity of 66.7%(95% CI 48.9 to 80.9%) for SBO when diagnostic, but was non-diagnostic 36% of the time. CONCLUSION EP-performed US compares favourably to x-ray in the diagnosis of SBO.
Department of Radiodiagnosis, Institute of Medical Sciences and Research, Ambala, Haryana, India.
Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California 94115, USA.
[Ultrasound of inguinal hernias: morphological classification for a potentially conservative treatment in asymptomatic patients].
Chirurgische Abteilung, Klinik Fleetinsel, Hamburg. firstname.lastname@example.org
Vet Rec. 2010 Jan 16;166 (3):79-81 20081179
Department of Farm Animals, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland. email@example.com
Cows with haemorrhagic bowel syndrome were examined by ultrasonography. A 5.0 MHz linear transducer was used to scan the right side of 63 standing, non-sedated cows. The small intestine was found to be dilated and had a diameter of 4.3 to 12.0 cm (mean [sd] 6.76 [1.78] cm), and there was markedly reduced or absent small intestinal motility in all the cows. In 22 (34.9 per cent) cows, empty poststenotic segments of small intestine were seen in addition to empty prestenotic intestine. In 12 (19 per cent) cows, the intestinal lumen contained localised hyperechoic material consistent with blood clots. Fluid with or without fibrin was seen between intestinal loops in 39 (61.9 per cent) cows. Accumulation of ingesta in the abomasum and sometimes in the omasum and rumen was seen in 14 (22.2 per cent) cows. Ultrasonography was considered to be a useful tool for the diagnosis of ileus. However, this imaging modality could be used to make a definitive diagnosis of haemorrhagic bowel syndrome only when a blood clot was seen in the intestinal lumen.
Academic Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK.
OBJECTIVE To assess the value of prenatal ultrasound in predicting bowel obstruction requiring surgery in fetuses with prenatal diagnosis of gastroschisis. METHODS The database of our center was searched for cases with an antenatal diagnosis of gastroschisis. The ultrasound images were reviewed blindly to assess the presence of intra- or extra-abdominal bowel dilatation. Details of surgical procedures were noted and the discharge letters were obtained. Pediatric follow-up was also obtained from pediatric surgeons, general practitioners or parents. RESULTS In the 10-year period between November 1998 and September 2008 there were 62 cases with a prenatal diagnosis of gastroschisis. Postnatal outcome was not available for five cases, four pregnancies underwent termination and intrauterine fetal demise occurred in five cases. A final population of 48 liveborn infants was available for analysis. Intra-abdominal bowel dilatation was identified in 14 of these 48 fetuses (29.2%) and extra-abdominal bowel dilatation in 30 (62.5%) fetuses on prenatal ultrasound images. Eight fetuses (16.7%) had bowel obstruction. The relative risk of bowel obstruction with intra-abdominal bowel dilatation was 4.05 (95% CI, 1.12-14.70). On the other hand, the relative risk of bowel obstruction with extra-abdominal bowel dilatation was 1.0 (95% CI, 0.37-3.70). Four babies died, two of whom had intra- and one had extra-abdominal bowel dilatation. CONCLUSIONS Intra-abdominal dilatation of the bowel on prenatal ultrasound examination appears to predict postnatal bowel obstruction and the need for surgical resection. Extra-abdominal bowel dilatation is observed frequently on prenatal ultrasound scans, but is not predictive of bowel obstruction.
Fetal Diagn Ther. 2010 ;27 (1):57-60 19940446
Robert Dankovcik, Stela Muranska, Eduard Kucera, Jan Evangelista Jirasek, Jaroslav Feyereisl, Milan Sudak, Marek Dudas
2nd Department of Obstetrics and Gynecology, P.J. Safarik University and L. Pasteur University Hospital, Rastislavova 43, SK-04001 Kosice, Slovak Republic. firstname.lastname@example.org
Annular pancreas is a rare developmental anomaly that accounts for 1% of neonatal intestinal obstructions. For the first time, we describe 3D sonographic findings associated with this condition. In addition to stringent diagnostic criteria based on 2D ultrasound, this case suggests the possible contribution of 3D ultrasound in rare cases of suspected annular pancreas. Verification of prenatal findings was performed during the postnatal surgery.
Department of Radiology, Tripoli Medical Center, Tripoli, Libya. email@example.com
Traditionally, gastrointestinal contrast studies have been the mainstay of evaluating infantile gastrointestinal problems. Because of technological advancements, good ultrasonography (USG) machines can provide high-resolution images with graphic anatomical clarity, especially in infants and children and thus change the traditional diagnostic trends. In this article, we illustrate the USG appearances of various causes of gastrointestinal obstruction in infants and discuss the role of USG in their evaluation.
NC Jaycee Burn Center, Department of Surgery, University of North Carolina, Chapel Hill, NC 27599, USA.
Innere Medizin 2, Uhlandstr. 7, D-97980 Bad Mergentheim, Germany. firstname.lastname@example.org
Ultrasound has been established as a routine work-up imaging method in abdominal diseases. It assesses the morphology of intra-abdominal organs and depicts the normal and pathological anatomy of the gastrointestinal tract as well as of the biliopancreatic system. Ultrasound is the method of choice for visualisation of motion sequences since it is, in contrast to other imaging methods, a real-time method. The non-invasiveness and the repeatability of the method are important advantages when performing investigations of functional processes. Therefore, ultrasound is most suited for functional studies. Up to now, functional ultrasound and its potential have been undervalued. Functional ultrasound provides a widely available method to increase our understanding of functional processes and motility. The authors review the options of functional ultrasound and discuss its practical relevance.
Queensland Veterinary Specialists, Stafford Heights, Qld 4053, Australia. Inar.Swift@qldvetspecialists.com.au
The clinical and ultrasonographic features of postoperative intestinal entrapment were assessed in five dogs. Four had vomiting and lethargy, and one had peracute collapse and hematochezia. Ultrasonographic findings in four of five dogs were similar, being characterized by focally hyperechoic mesentery and abdominal effusion, surrounding a single loop of amotile and dilated intestine. In some dogs, the affected intestinal loop had a thickened or corrugated wall, or alteration of wall layering. In one dog, the site of entrapment could be directly visualized. In the most severely affected dog, a large volume of echogenic peritoneal effusion was present, as well as fluid dilation of multiple intestinal loops. The ultrasonographic appearance of intestinal entrapment is similar to that of intestinal perforation or infarction by other causes.
Signalment, history, and outcome of cats with gastrointestinal tract intussusception: 20 cases (1986-2000).
Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
OBJECTIVE To determine signalment, history, and outcome of cats with gastrointestinal tract intussusception and to identify physical examination, diagnostic imaging, surgical, histologic, and necropsy findings in affected cats. DESIGN Retrospective case series. ANIMALS 20 cats with intussusception. PROCEDURES Medical records were evaluated for information on signalment; history; physical examination, diagnostic imaging, surgical, histologic, and necropsy findings; and outcome. RESULTS Ten cats were < 1 year old, and 9 were >or= 6 years old. Anorexia (14/17), lethargy (12/17), and vomiting (12/17) were the most common reasons for examination. Dehydration (13/18), poor body condition (12/18), signs of abdominal pain (8/18), and an abdominal mass (8/18) were the most common physical examination findings. Abdominal radiography revealed intestinal obstruction in all 10 cats in which it was performed; abdominal ultrasonography revealed intussusception in all 7 cats in which it was performed. The most common intussusception was jejuno-jejunal (8/20), and no intussusceptions were found proximal to the duodenum. Eleven of 13 cats that underwent laparotomy required intestinal resection and anastomosis. Histologic examination revealed intestinal lymphoma or inflammatory bowel disease in 7 of 8 cats >/= 6 years old and idiopathic intussusception in 7 of 8 cats < 1 year old. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that in cats, intussusception has a bimodal age distribution, is most commonly jejuno-jejunal, often requires surgical resection and anastomosis, is often associated with alimentary lymphoma or inflammatory bowel disease in older cats, and is readily diagnosed by means of ultrasonography.