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Essamoud S, Lahlou M, Benmazhar A, Bennani R, Ennachachibi Y, Khmou M, Elkhannoussi B, Zerhouni H. A Rare Case of Concomitant Duodenal and Gallbladder Perforation in a Pediatric Patient. Cureus 2025; 17:e82838. [PMID: 40416245 PMCID: PMC12101139 DOI: 10.7759/cureus.82838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2025] [Indexed: 05/27/2025] Open
Abstract
Concomitant perforation of the duodenum and gallbladder is exceptionally rare in the pediatric population. These conditions pose significant diagnostic and therapeutic challenges, particularly in critically ill or sedated children. We report the case of a five-year-old girl who was initially hospitalized for posterior fossa tumor resection and developed acute abdominal distension, anemia, and hematemesis in the postoperative period. Imaging was limited because of the hemodynamic instability. Emergency exploratory laparotomy revealed a large duodenal perforation and a concomitant gallbladder perforation. The surgical management included primary duodenal repair, cholecystectomy, and gastroduodenal bypass. Despite intensive supportive care, the patient succumbed to sepsis and multiorgan failure on postoperative day 2. This case highlights the diagnostic difficulty of gastrointestinal perforations in sedated intensive care unit patients, the possible pathophysiological link between duodenal ulcers and adjacent gallbladder inflammation, and the urgency for surgical intervention. Clinicians should maintain a high index of suspicion of stress-related gastrointestinal complications in critically ill children. Early surgical exploration may be life-saving when imaging is inconclusive and clinical deterioration is rapid.
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Affiliation(s)
- Soufiane Essamoud
- Department of Pediatric Surgery, Mohammed VI University of Sciences and Health, Casablanca, MAR
- Department of Pediatric Surgery, Mohammed VI International University Hospital of Bouskoura, Bouskoura, MAR
| | - Mohamed Lahlou
- Department of Pediatric Surgery, Mohammed VI University of Sciences and Health, Casablanca, MAR
- Department of Pediatric Surgery, Mohammed VI International University Hospital of Bouskoura, Bouskoura, MAR
| | - Achraf Benmazhar
- Department of Pediatric Surgery, Mohammed VI University of Sciences and Health, Casablanca, MAR
- Department of Pediatric Surgery, Mohammed VI International University Hospital of Bouskoura, Bouskoura, MAR
| | - Rania Bennani
- Department of Pediatric Surgery, Mohammed VI University of Sciences and Health, Casablanca, MAR
- Department of Pediatric Surgery, Mohammed VI International University Hospital of Bouskoura, Bouskoura, MAR
| | - Yannis Ennachachibi
- Department of Anatomical Pathology, Mohammed VI University of Sciences and Health, Casablanca, MAR
- Department of Anatomical Pathology, Cheikh Khalifa International University Hospital of Casablanca, Casablanca, MAR
| | - Mouna Khmou
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, MAR
- Department of Anatomical Pathology, National Institute of Oncology of Rabat, Rabat, MAR
| | - Basma Elkhannoussi
- Department of Anatomical Pathology, Mohammed VI University of Sciences and Health, Casablanca, MAR
- Department of Anatomical Pathology, Cheikh Khalifa International University Hospital of Casablanca, Casablanca, MAR
- Department of Anatomical Pathology, National Institute of Oncology of Rabat, Rabat, MAR
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, MAR
| | - Hicham Zerhouni
- Department of Pediatric Surgery, Mohammed VI University of Sciences and Health, Casablanca, MAR
- Department of Pediatric Surgery, Mohammed VI International University Hospital of Bouskoura, Bouskoura, MAR
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Singh AK, Gunjan D, Dash NR, Poddar U, Gupta P, Jain AK, Lahoti D, Nayer J, Goenka M, Philip M, Chadda R, Singh RK, Appasani S, Zargar SA, Broor SL, Nijhawan S, Shukla S, Gupta V, Kate V, Makharia G, Kochhar R. Short-term and long-term management of caustic-induced gastrointestinal injury: An evidence-based practice guidelines. Indian J Gastroenterol 2025:10.1007/s12664-024-01692-1. [PMID: 39982600 DOI: 10.1007/s12664-024-01692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 09/15/2024] [Indexed: 02/22/2025]
Abstract
The Indian Society of Gastroenterology has developed an evidence-based practice guideline for the management of caustic ingestion-related gastrointestinal (GI) injuries. A modified Delphi process was used to arrive at this consensus containing 41 statements. These statements were generated after two rounds of electronic voting, one round of physical meeting, and extensive review of the available literature. The exact prevalence of caustic injury and ingestion in developing countries is not known, though it appears to be of significant magnitude to pose a public health problem. The extent and severity of this preventable injury to the GI tract determine the short and long-term outcomes. Esophagogastroduodenoscopy is the preferred initial approach for the evaluation of injury and contrast-enhanced computed tomography is reserved only for specific situations. Low-grade injuries (Zargar grade ≤ 2a) have shown better outcomes with early oral feeding and discharge from hospital. However, patients with high-grade injury (Zargar grade ≥ 2b) require hospitalization as they are at a higher risk for both short and long-term complications, including luminal narrowing. These strictures can be managed endoscopically or surgically depending on the anatomy and extent of stricture, expertise available and patients' preferences. Nutritional support all along is crucial for all these patients until nutritional autonomy is established.
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Affiliation(s)
- Anupam Kumar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Deepak Gunjan
- Department of Gastroenterology and HNU, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Nihar Ranjan Dash
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ajay Kumar Jain
- Department of Gastroenterology, Choithram Hospital and Research Center, Indore, 452 014, India
| | - Deepak Lahoti
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, New Delhi, 110 017, India
| | - Jamshed Nayer
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Mahesh Goenka
- Institute of Gastrosciences and Liver Transplant, Apollo Multispeciality Hospitals, Kolkata, 700 054, India
| | | | - Rakesh Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rajneesh Kumar Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Sreekanth Appasani
- Department of Gastroenterology and Hepatology, Krishna Institute of Medical Sciences, Secunderabad, 500 003, India
| | - Showkat Ali Zargar
- Department of Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Sohan Lal Broor
- Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospitals, New Delhi, 110 076, India
| | - Sandeep Nijhawan
- Department of Gastroenterology and Hepatology, Sawai Man Singh Medical College, Jaipur, 302 004, India
| | - Siddharth Shukla
- Department of Medicine and Gastroenterology, Base Hospital, Guwahati, 781 028, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Vikram Kate
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605 006, India
| | - Govind Makharia
- Department of Gastroenterology and HNU, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rakesh Kochhar
- Department of Gastroenterology and Hepatology, Paras Hospital, Panchkula, 134 109, India.
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Pooyan A, Mansoori B, Wang C. Imaging of abdominopelvic oncologic emergencies. Abdom Radiol (NY) 2024; 49:823-841. [PMID: 38017112 DOI: 10.1007/s00261-023-04112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 11/30/2023]
Abstract
With advancements in cancer treatment, the survival rates for many malignancies have increased. However, both the primary tumors and the treatments themselves can give rise to various complications. Acute symptoms in oncology patients require prompt attention. Abdominopelvic oncologic emergencies can be classified into four distinct categories: vascular, bowel, hepatopancreatobiliary, and bone-related complications. Radiologists need to be familiar with these complications to ensure timely diagnosis, which ultimately enhances patient outcomes.
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Affiliation(s)
- Atefe Pooyan
- Department of Radiology, UW Radiology-Roosevelt Clinic, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
| | - Bahar Mansoori
- Department of Radiology, Section of Abdominal Imaging, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195-7115, USA
| | - Carolyn Wang
- Department of Radiology, Section of Abdominal Imaging, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195-7115, USA.
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Russo A, Patanè V, Zaccaria C, Verolino P, Cioce F, Stanzione F, Reginelli A. Imaging diagnosis of a rare case of intermittent intestinal pneumatosis: A consequence of ileocecal valve clip dysfunction? Radiol Case Rep 2024; 19:780-784. [DOI: 10.1016/j.radcr.2023.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2025] Open
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Scaglione M, Masala S, Tamburrini S, Lassandro G, Barbuto L, Romano L, Iacobellis F, Sica G, Crivelli P, Turilli D, Sandomenico F, Granata V, Patlas MN. Abdominal Emergencies in Cancer Patients. Can Assoc Radiol J 2024; 75:161-170. [PMID: 37192390 DOI: 10.1177/08465371231175521] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Abdominal emergencies in cancer patients encompass a wide spectrum of oncologic conditions caused directly by malignancies, paraneoplastic syndromes, reactions to the chemotherapy or often represent the first clinical manifestation of an unknown malignancy. Not rarely, clinical symptoms are the tip of an iceberg. In this scenario, the radiologist is asked to exclude the cause responsible for the patient's symptoms, to suggest the best way to manage and to rule out the underlying malignancy. In this article, we discuss some of the most common abdominal oncological emergencies that may be encountered in an emergency department.
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Affiliation(s)
| | | | | | | | - Luigi Barbuto
- Department of General and Emergency Radiology, Naples, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, Naples, Italy
| | | | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Naples, Italy
| | | | | | - Fabio Sandomenico
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Michael N Patlas
- Department of Radiology, McMaster University, Hamilton, ON, Canada
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Russo A, Patanè V, Faggioni L, Pinto A, Fusco L, Urraro F, Neri E, Reginelli A. Conventional Radiology Evaluation of Neonatal Intravascular Devices (NIVDs): A Case Series. Diagnostics (Basel) 2024; 14:157. [PMID: 38248034 PMCID: PMC10814514 DOI: 10.3390/diagnostics14020157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Our radiology department conducted an assessment of 300 neonatal radiographs in the neonatal intensive care unit over almost two years. The purpose was to evaluate the correct positioning of intravascular venous catheters. Our case series revealed that out of a total of 95 cases with misplaced devices, 59 were umbilical venous catheters and 36 were peripherally inserted central catheters. However, all of the central venous catheters were found to be properly positioned. Misplacements of neonatal intravascular devices were found to occur more frequently than expected. The scientific literature contains several articles highlighting the potential complications associated with misplaced devices. Our goal is to highlight the potential misplacements and associated complications that radiologists may encounter while reviewing conventional radiology imaging. Based on our experience, which primarily involved placing UVCs and PICCs, we discovered that conventional radiology is the most effective method for assessing proper device placement with the lowest possible radiation exposure. Given the high number of neonatal vascular device placement procedures, it is essential for radiologists to maintain a high level of vigilance and stay updated on the latest developments in this field.
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Affiliation(s)
- Anna Russo
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.P.); (L.F.); (F.U.); (A.R.)
| | - Vittorio Patanè
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.P.); (L.F.); (F.U.); (A.R.)
| | - Lorenzo Faggioni
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56126 Pisa, Italy; (L.F.); (E.N.)
| | - Alessandro Pinto
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.P.); (L.F.); (F.U.); (A.R.)
| | - Luigia Fusco
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.P.); (L.F.); (F.U.); (A.R.)
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.P.); (L.F.); (F.U.); (A.R.)
| | - Emanuele Neri
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56126 Pisa, Italy; (L.F.); (E.N.)
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.P.); (L.F.); (F.U.); (A.R.)
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Lu P, Luo Y, Ying Z, Zhang J, Tu X, Chen L, Chen X, Cao Y, Huang Z. Prediction of injury localization in preoperative patients with gastrointestinal perforation: a multiomics model analysis. BMC Gastroenterol 2024; 24:6. [PMID: 38166815 PMCID: PMC10759549 DOI: 10.1186/s12876-023-03092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The location of gastrointestinal perforation is essential for severity evaluation and optimizing the treatment approach. We aimed to retrospectively analyze the clinical characteristics, laboratory parameters, and imaging features of patients with gastrointestinal perforation and construct a predictive model to distinguish the location of upper and lower gastrointestinal perforation. METHODS A total of 367 patients with gastrointestinal perforation admitted to the department of emergency surgery in Fujian Medical University Union Hospital between March 2014 and December 2020 were collected. Patients were randomly divided into training set and test set in a ratio of 7:3 to establish and verify the prediction model by logistic regression. The receiver operating characteristic curve, calibration map, and clinical decision curve were used to evaluate the discrimination, calibration, and clinical applicability of the prediction model, respectively. The multiomics model was validated by stratification analysis in the prediction of severity and prognosis of patients with gastrointestinal perforation. RESULTS The following variables were identified as independent predictors in lower gastrointestinal perforation: monocyte absolute value, mean platelet volume, albumin, fibrinogen, pain duration, rebound tenderness, free air in peritoneal cavity by univariate logistic regression analysis and stepwise regression analysis. The area under the receiver operating characteristic curve of the prediction model was 0.886 (95% confidence interval, 0.840-0.933). The calibration curve shows that the prediction accuracy and the calibration ability of the prediction model are effective. Meanwhile, the decision curve results show that the net benefits of the training and test sets are greater than those of the two extreme models as the threshold probability is 20-100%. The multiomics model score can be calculated via nomogram. The higher the stratification of risk score array, the higher the number of transferred patients who were admitted to the intensive care unit (P < 0.001). CONCLUSION The developed multiomics model including monocyte absolute value, mean platelet volume, albumin, fibrinogen, pain duration, rebound tenderness, and free air in the peritoneal cavity has good discrimination and calibration. This model can assist surgeons in distinguishing between upper and lower gastrointestinal perforation and to assess the severity of the condition.
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Affiliation(s)
- Pingxia Lu
- Department of Laboratory Medicine, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, Fujian Province, 350122, China
| | - Yue Luo
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, Fujian Province, 350122, China
| | - Ziling Ying
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, Fujian Province, 350122, China
| | - Junrong Zhang
- Department of Emergency Surgery, Fujian Medical University Union Hospital, No.29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
| | - Xiaoxian Tu
- Department of Medical records management room, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
| | - Lihong Chen
- Department of Radiology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China
| | - Xianqiang Chen
- Department of Emergency Surgery, Fujian Medical University Union Hospital, No.29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
| | - Yingping Cao
- Department of Laboratory Medicine, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China.
| | - Zhengyuan Huang
- Fujian Medical University, No.1 Xuefu bei Road, Fuzhou, Fujian Province, 350122, China.
- Department of Emergency Surgery, Fujian Medical University Union Hospital, No.29 Xin quan Road, Fuzhou, 350001, Fujian Province, China.
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Weinstein S, Kim DH, Fowler KJ, Birkholz JH, Cash BD, Cilenti E, Dane B, Horvat N, Kambadakone AR, Korngold EK, Liu PS, Lo BM, McCrary M, Mellnick V, Pietryga JA, Santillan CS, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Left Lower Quadrant Pain: 2023 Update. J Am Coll Radiol 2023; 20:S471-S480. [PMID: 38040465 DOI: 10.1016/j.jacr.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
The differential diagnosis for left lower quadrant pain is wide and conditions range from the benign and self-limited to life-threatening surgical emergencies. Along with patient history, physical examination, and laboratory tests, imaging is often critical to limit the differential diagnosis and identify life-threatening abnormalities. This document will discuss the guidelines for the appropriate use of imaging in the initial workup for patients who present with left lower quadrant pain, patients with suspected diverticulitis, and patients with suspected complications from diverticulitis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California, San Diego, San Diego, California
| | - James H Birkholz
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Elizabeth Cilenti
- MedStar Georgetown University Hospital, Washington, District of Columbia, Primary care physician
| | - Bari Dane
- NYU Grossman School of Medicine, New York, New York
| | - Natally Horvat
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Marion McCrary
- Duke Signature Care, Durham, North Carolina; American College of Physicians
| | - Vincent Mellnick
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri; Committee on Emergency Radiology-GSER
| | - Jason A Pietryga
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Katherine Zukotynski
- McMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Scaglione M, Masala S, Iacobellis F, Tonerini M, Sica G, Liguori C, Saba L, Tamburrini S. Imaging in Non-Traumatic Emergencies. Tomography 2023; 9:1133-1136. [PMID: 37368545 DOI: 10.3390/tomography9030093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
"Emergency" is a scenario that every medical professional must face since the first day of her/his career [...].
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Affiliation(s)
- Mariano Scaglione
- Radiology Department of Surgery, Medicine and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy
- Department of Radiology, James Cook University Hospital & Teesside University, Marton Road Marton Rd., Middlesbrough TS4 3BW, UK
| | - Salvatore Masala
- Radiology Department of Surgery, Medicine and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Via Cardarelli 9, 80100 Napoli, Italy
| | - Michele Tonerini
- Department of Emergency Radiology, Cisanello Hospital, Via Cisanello, 56124 Pisa, Italy
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, 80131 Naples, Italy
| | - Carlo Liguori
- Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo, 11, 80147 Napoli, Italy
| | - Luca Saba
- Department of Medical Sciences, University of Cagliari, 09124 Cagliari, Italy
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10
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Brillantino A, Iacobellis F, Brusciano L, Abu-Omar A, Muto G, Amadu AM, Foroni F, Antropoli M, Antropoli C, Castriconi M, Renzi A, Pirolo L, Giuliani A, Scarano E, Docimo L, Scaglione M, Romano L. Accuracy of computed tomography in staging acute appendicitis and its impact on surgical outcome and strategy: a multi-center retrospective case-control study. LA RADIOLOGIA MEDICA 2023; 128:415-425. [PMID: 36940006 DOI: 10.1007/s11547-023-01619-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/07/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION The aims of this study were to evaluate the concordance between AAST-CT appendicitis grading criteria, first published in 2014, and surgical findings and to assess the impact of CT staging on the choice of surgical approach. METHODS This was a multi-center retrospective case-control study including 232 consecutive patients undergoing surgery for acute appendicitis and who had undergone preoperative CT evaluation between 1 January 2017 and 1 January 2022. Appendicitis severity was classified in 5 grades. For each degree of severity, the surgical outcome between patients undergoing open and surgical approach was compared. RESULTS An almost perfect agreement (k = 0.96) was found between CT and surgery in staging acute appendicitis. The vast majority of patients with grade 1 and 2 appendicitis underwent laparoscopic surgical approach and showed low morbidity rate. In patients with grade 3 and 4 appendicitis, laparoscopic approach was adopted in 70% of cases and was associated, if compared to open, with a higher prevalence of postoperative abdominal collections (p = 0.05; fisher's exact test) and a significantly lower prevalence of surgical site infections (p = 0.0007; fisher's exact test). All the patients with grade 5 appendicitis were treated by laparotomy. CONCLUSIONS AAST-CT appendicitis grading system seems to show a relevant prognostic value and a potential impact on the choice of surgical strategy, directing toward a laparoscopic approach in patients with grade 1 and 2, an initial laparoscopic approach, replaceable by the open one, for grade 3 and 4 and an open approach in patients with grade 5.
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Affiliation(s)
- Antonio Brillantino
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Luigi Brusciano
- Division of General, Mininvasive and Obesity Surgery, University of Study of Campania Luigi Vanvitelli Naples, Via Luigi Pansini N° 5, 80131, Naples, Italy
| | - Ahmad Abu-Omar
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Gianluca Muto
- Diagnostic Imaging Department, Hospitaux Universitaires de Genève, Geneva, Switzerland
| | - Antonio Matteo Amadu
- Diagnostic Imaging 1 Unit, University Hospital of Sassari, 07100, Sassari, Italy
| | - Fabrizio Foroni
- Surgery Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Massimo Antropoli
- Surgery Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Carmine Antropoli
- Surgery Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Maurizio Castriconi
- Surgery Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Adolfo Renzi
- Surgery Department, "Buonconsiglio Fatebenefratelli" Hospital, Naples, Italy
| | - Luigi Pirolo
- Radiology Department, "Buonconsiglio Fatebenefratelli" Hospital, Naples, Italy
| | | | - Enrico Scarano
- Radiology Department, "San Carlo" Hospital, Potenza, Italy
| | - Ludovico Docimo
- Division of General, Mininvasive and Obesity Surgery, University of Study of Campania Luigi Vanvitelli Naples, Via Luigi Pansini N° 5, 80131, Naples, Italy
| | - Mariano Scaglione
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.,Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 112, 07199, Sassari, Italy
| | - Luigia Romano
- Radiology Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
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Iacobellis F, Dell’Aversano Orabona G, Brillantino A, Di Serafino M, Rengo A, Crivelli P, Romano L, Scaglione M. Common, Less Common, and Unexpected Complications after Bariatric Surgery: A Pictorial Essay. Diagnostics (Basel) 2022; 12:2637. [PMID: 36359480 PMCID: PMC9689585 DOI: 10.3390/diagnostics12112637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/27/2024] Open
Abstract
Bariatric surgery has demonstrated a higher rate of success than other nonsurgical treatments in selected patients with obesity; however, like all medical procedures, postoperative complications may occur, ranging between 2 and 10% and, although rare, they can be life threatening. Complications may be unspecific (any surgery-related complications) or specific (linked to the specific surgical procedure) and can be distinguished as common, less common, and unexpected. According to the onset, they may be acute, when occurring in the first 30 days after surgery, or chronic, with a presentation after 30 days from the procedure. The aim of this pictorial essay is to review the radiological aspects of surgical techniques usually performed and the possible complications, in order to make radiologists more confident with the postsurgical anatomy and with the normal and abnormal imaging findings.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | | | - Antonio Brillantino
- Department of Emergency Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Alessandro Rengo
- Department of Radiology, Pineta Grande Hospital, Via Domitiana KM 30, 81030 Castel Volturno, Italy
| | - Paola Crivelli
- Department of Surgery, Medicine and Pharmacy, University of Sassari, Via Roma 151, 07100 Sassari, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Mariano Scaglione
- Department of Surgery, Medicine and Pharmacy, University of Sassari, Via Roma 151, 07100 Sassari, Italy
- Department of Radiology, The James Cook University Hospital, Middlesbrough TS4 3BW, UK
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
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Silangruz K, Shah P, Fujii-Lau L, Furuta S. Gastric Perforation: A Rare Presentation of Malignant Gastric Outlet Obstruction. Cureus 2022; 14:e22242. [PMID: 35340499 PMCID: PMC8930494 DOI: 10.7759/cureus.22242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/05/2022] Open
Abstract
Mechanical gastric outlet obstruction (GOO) due to malignancy can occur with cancers in the stomach and duodenum. GOO can cause perforation of the stomach or the esophagus. We present a 65-year-old female with newly diagnosed metastatic pancreatic cancer who presented with acute onset abdominal pain. She was taken for emergent exploratory laparotomy where she was found to have gastric perforation and duodenal obstruction from an invasive large pancreatic head mass. This is a rare case report of gastric perforation due to a malignant gastric outlet obstruction secondary to invasive pancreatic cancer.
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13
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Iacobellis F, Narese D, Berritto D, Brillantino A, Di Serafino M, Guerrini S, Grassi R, Scaglione M, Mazzei MA, Romano L. Large Bowel Ischemia/Infarction: How to Recognize It and Make Differential Diagnosis? A Review. Diagnostics (Basel) 2021; 11:998. [PMID: 34070924 PMCID: PMC8230100 DOI: 10.3390/diagnostics11060998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022] Open
Abstract
Ischemic colitis represents the most frequent form of intestinal ischemia occurring when there is an acute impairment or chronic reduction in the colonic blood supply, resulting in mucosal ulceration, inflammation, hemorrhage and ischemic necrosis of variable severity. The clinical presentation is variable and nonspecific, so it is often misdiagnosed. The most common etiology is hypoperfusion, almost always associated with generalized atherosclerotic disease. The severity ranges from localized and transient ischemia to transmural necrosis of the bowel wall, becoming a surgical emergency, with significant associated morbidity and mortality. The diagnosis is based on clinical, laboratory suspicion and radiological, endoscopic and histopathological findings. Among the radiological tests, enhanced-CT is the diagnostic investigation of choice. It allows us to make the diagnosis in an appropriate clinical setting, and to define the entity of the ischemia. MR may be adopted in the follow-up in patients with iodine allergy or renal dysfunctions, or younger patients who should avoid radiological exposure. In the majority of cases, supportive therapy is the only required treatment. In this article we review the pathophysiology and the imaging findings of ischemic colitis.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (L.R.)
| | - Donatella Narese
- Department of Radiology, University of Campania “L. Vanvitelli”, Miraglia 2 Sq., 80138 Naples, Italy; (D.N.); (R.G.)
| | - Daniela Berritto
- Department of Radiology, Hospital “Villa Fiorita”, Appia St., km 199,00, 81043 Capua, Italy;
| | - Antonio Brillantino
- Department of Emergency Surgery, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy;
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (L.R.)
| | - Susanna Guerrini
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Bracci St. 10, 53100 Siena, Italy;
| | - Roberta Grassi
- Department of Radiology, University of Campania “L. Vanvitelli”, Miraglia 2 Sq., 80138 Naples, Italy; (D.N.); (R.G.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Mariano Scaglione
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK;
- Teesside University School of Health and Life Sciences, Middlesbrough TS1 3BX, UK
- Department of Radiology, Pineta Grande Hospital, Domitiana St. km 30/00, 81030 Castel Volturno, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Bracci St. 10, 53100 Siena, Italy;
| | - Luigia Romano
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (L.R.)
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14
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Merzouqi B, El Bouhmadi K, Zouhair N, Oukessou Y, Rouadi S, Abada RL, Roubal M, Mahtar M. A rare cause of cervicomediastinal cellulitis: Oesophageal perforation case report. Ann Med Surg (Lond) 2021; 64:102195. [PMID: 33747496 PMCID: PMC7970054 DOI: 10.1016/j.amsu.2021.102195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 10/27/2022] Open
Abstract
Esophageal perforation following an impacted foreign body (FB) is a rare and potentially life-threatening condition. Early clinical suspicion and imaging are important for a targeted management to achieve a good outcome. Endoscopic extraction of esophageal FB is a good and safe treatment alternative while the surgical procedure remains a necessary option for many patients. We present the case of a 50 years old woman, with no relevant medical history, who accidently ingested a chicken bone during a meal causing mild dysphagia. The patient consulted immediately but was reassured after normal clinical examination. We received the patient 9 days later with severe dysphagia and cervicomediastinal cellulitis. The cervical CT scan showed the significant collection and the FB impacted in the cervical esophagus wall. A first endoscopic exploration drained the pus and allowed the placement of a nasogastric tube. However, the removal of the FB required an open cervical surgery with the evacuation of the collection and the suture of the esophageal perforation followed by the placement of a drainage tube. The patient medical state improved rapidly and no further incidents were noted. The diagnosis of esophageal FB should be meticulous in order to avoid such life-threatening complications.
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Affiliation(s)
- Boutaina Merzouqi
- Department of Otolaryngology, Head and Neck Surgery, 20 August 1953 Hospital, Casablanca, Morocco
| | - Khadija El Bouhmadi
- Department of Otolaryngology, Head and Neck Surgery, 20 August 1953 Hospital, Casablanca, Morocco
| | - Najib Zouhair
- Department of Otolaryngology, Head and Neck Surgery, 20 August 1953 Hospital, Casablanca, Morocco
| | - Youssef Oukessou
- Department of Otolaryngology, Head and Neck Surgery, 20 August 1953 Hospital, Casablanca, Morocco
| | - Sami Rouadi
- Department of Otolaryngology, Head and Neck Surgery, 20 August 1953 Hospital, Casablanca, Morocco
| | - Redallah Larbi Abada
- Department of Otolaryngology, Head and Neck Surgery, 20 August 1953 Hospital, Casablanca, Morocco
| | - Mohamed Roubal
- Department of Otolaryngology, Head and Neck Surgery, 20 August 1953 Hospital, Casablanca, Morocco
| | - Mohamed Mahtar
- Department of Otolaryngology, Head and Neck Surgery, 20 August 1953 Hospital, Casablanca, Morocco
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Bini R, Ronchetta C, Picotto S, Scozzari G, Gupta S, Frassini S, Chiara O. Importance of CT-scan predicting clinical outcomes in gastro-intestinal perforation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1421. [PMID: 33313166 PMCID: PMC7723637 DOI: 10.21037/atm-20-2184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Gastrointestinal (GI) perforations are an acute surgical dilemma, with diagnostic workup often requiring abdominal imaging. Post-operative care for these patients may vary and oftentimes includes ICU care for sepsis, but not always. We evaluated if free fluid and air on computed tomography (CT) could be associated with sepsis, septic shock and mortality in GI perforations. The aim of our study was a correlation between a new CT-scan scoring system and septic complications in GI perforations. Methods We conducted an observational retrospective study about patients who underwent emergency surgery for intestinal perforation between January 2014 and June 2017. Inclusion criteria were a CT-scan positive for free fluid and air, and an intestinal perforation confirmed intraoperatively. A CT-score was created to evaluate location and extent of free fluid and air related to clinical outcome and prognosis. Univariate analysis between the CT score and the various clinical outcomes was conducted with the non-parametric Mann-Whitney test for continuous variables and with the chi-square test for categorical variables. Results One-hundred and fifty-one patients were evaluated. The mortality was 23.18% and the complications were present in 45.95%. The median CT score for patients who developed complications was 3, compared with a value of 2 in the absence of complications (P=0.008). A CT score of 4 or greater had a sensitivity and specificity for predicting pre-operative sepsis of 73.33% and 64.42% respectively, and for pre-operative septic shock of 35.56% and 93.27%. Looking at post-operative sepsis, sensitivity and specificity were 57.45% and 70.19%, and for septic shock 36.17% and 85.85%. Spearman correlation analysis revealed that at higher scores at CT score corresponded higher scores at the P-POSSUM morbidity, P-POSSUM mortality and WSES Sepsis Severity Score. Conclusions Our CT score shows a significant correlation with validated predictive scoring systems with regards to predicting sepsis, septic shock and complications—and seems to be a useful outcome predictor in GI perforation.
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Affiliation(s)
- Roberto Bini
- University of Milan, General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Silvia Picotto
- General Surgery Unit, Ospedale San Giovanni Bosco, Turin, Italy
| | - Gitana Scozzari
- AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Shailvi Gupta
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - Simone Frassini
- University of Milan, General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Osvaldo Chiara
- University of Milan, General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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16
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Inoue A, Furukawa A, Takaki K, Imai Y, Ota S, Nitta N, Watanabe Y. Noncontrast MRI of acute abdominal pain caused by gastrointestinal lesions: indications, protocol, and image interpretation. Jpn J Radiol 2020; 39:209-224. [PMID: 33034849 DOI: 10.1007/s11604-020-01053-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
Gastrointestinal tract lesions are major causes of acute abdominal pain. A rapid, accurate, and reliable diagnosis is required to manage patients. Magnetic resonance imaging (MRI) is a nonionizing modality that is beneficial for pregnant women, children, and young adults who are sensitive to ionizing radiation. For patients with renal impairment who are not accurately diagnosed with noncontrast computed tomography, noncontrast MRI can serve as an alternative diagnostic modality. MRI protocols used for acute abdominal pain are supposed to be optimized and prioritized to shorten scanning times. Single-shot T2-weighted and fat-suppressed T2-weighted imaging are important pulse sequences that are used to reveal pathology and inflammation in the gastrointestinal tract. Diffusion-weighted imaging clearly depicts inflammation and abscesses as hyperintense lesions. Most acute gastrointestinal tract lesions, including inflammation, ischemia, obstruction, and perforation, demonstrate bowel wall thickening. Bowel obstruction and adynamic ileus present bowel dilatation, and perforation and penetration show bowel wall defects. MRI can be used to reveal these pathological findings with some characteristics depending on their underlying pathophysiology. This review article discusses imaging modalities for acute abdominal pain, describes a noncontrast MRI protocol for acute abdominal pain caused by gastrointestinal tract lesions, and reviews MRI findings of acute gastrointestinal tract lesions.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, National Hospital Organization, Higashi-ohmi General Medical Center, 255 Gochi-cho, Higashiomi, Shiga, 527-8505, Japan.
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Akira Furukawa
- Department of Radiological Science, Tokyo Metropolitan University, 7-2-10, Higashioku, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Kai Takaki
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Yugo Imai
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Shinichi Ota
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
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17
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Galgano SJ, McNamara MM, Peterson CM, Kim DH, Fowler KJ, Camacho MA, Cash BD, Chang KJ, Feig BW, Gage KL, Garcia EM, Kambadakone AR, Levy AD, Liu PS, Marin D, Moreno C, Pietryga JA, Smith MP, Weinstein S, Carucci LR. ACR Appropriateness Criteria ® Left Lower Quadrant Pain-Suspected Diverticulitis. J Am Coll Radiol 2020; 16:S141-S149. [PMID: 31054740 DOI: 10.1016/j.jacr.2019.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 12/18/2022]
Abstract
This review summarizes the relevant literature regarding imaging of suspected diverticulitis as an etiology for left lower quadrant pain, and imaging of complications of acute diverticulitis. The most common cause of left lower quadrant pain in adults is acute sigmoid or descending colonic diverticulitis. Appropriate imaging triage for patients with suspected diverticulitis should address the differential diagnostic possibilities and what information is necessary to make a definitive management decision. Patients with diverticulitis may require surgery or interventional radiology procedures because of associated complications, including abscesses, fistulas, obstruction, or perforation. As a result, there has been a trend toward greater use of imaging to confirm the diagnosis of diverticulitis, evaluate the extent of disease, and detect complications before deciding on appropriate treatment. Additionally, in the era of bundled payments and minimizing health care costs, patients with acute diverticulitis are being managed on an outpatient basis and rapid diagnostic imaging at the time of initial symptoms helps to streamline and triage patients to the appropriate treatment pathway. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Samuel J Galgano
- Research Author, University of Alabama at Birmingham, Birmingham, Alabama.
| | | | | | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Kathryn J Fowler
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | - Marc A Camacho
- The University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | | | - Barry W Feig
- The University of Texas MD Anderson Cancer Center, Houston, Texas; American College of Surgeons
| | - Kenneth L Gage
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | | | - Angela D Levy
- Medstar Georgetown University Hospital, Washington, District of Columbia
| | | | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | - Jason A Pietryga
- The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Martin P Smith
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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18
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Morani AC, Hanafy AK, Marcal LP, Subbiah V, Le O, Bathala TK, Elsayes KM. Imaging of acute abdomen in cancer patients. Abdom Radiol (NY) 2020; 45:2287-2304. [PMID: 31758230 DOI: 10.1007/s00261-019-02332-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The pattern of disease causing acute abdominal pain has changed over last few decades, some of this has been attributed to intraabdominal cancers. The most common acute abdominal complaints in cancer patients are related to the gastrointestinal system. Abdominal emergencies in cancer patients can result from the underlying malignancy itself, cancer therapy and/or result from the standard pathologies causing acute abdomen in otherwise healthy population. Therapy-related or disease-related immunosuppression or high dose analgesics often blunt many of the findings which are usually expected in non-cancer general population. This complicates the clinical picture rendering the clinical exam less reliable in many cancer patients, and resulting in different pathologies which clinicians and the radiologists should remain aware of. This article focuses on imaging illustrations with differential diagnosis for various emergency scenarios related to acute abdomen specifically in oncologic settings.
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Affiliation(s)
- Ajaykumar C Morani
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA.
| | - Abdelrahman K Hanafy
- Diagnostic Radiology, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, 78229, USA
| | - Leonardo P Marcal
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Vivek Subbiah
- Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Ott Le
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Tharakeshwara K Bathala
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Khaled M Elsayes
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
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19
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Tau N, Cohen I, Barash Y, Klang E. Free abdominal gas on computed tomography in the emergency department: aetiologies and association between amount of free gas and mortality. Ann R Coll Surg Engl 2020; 102:581-589. [PMID: 32233866 DOI: 10.1308/rcsann.2020.0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Free abdominal gas is an important finding with major clinical implications. However, data on the aetiologies and prognosis of patients with free gas are scarce. Our primary aim was to describe the sources of free abdominal gas on emergency department (ED) computed tomography (CT). The secondary aim was to evaluate the association between the amount of free gas and all-cause mortality. METHODS All patients who underwent CT in the ED between February 2012 and February 2019 with free abdominal gas were included in the study. A scoring system was used to assess the amount of free gas: small - gas bubbles; medium - any gas pocket ≤2cm in diameter; large - any gas pocket >2cm. Data were collected from laboratory and clinical assessment regarding the source of free gas and all-cause mortality. RESULTS A total of 372 patients had free abdominal gas. Colonic diverticulitis was the most common aetiology among those with a small or medium amount of free gas (81/250 [32.4%] and 12/71 [16.9%] respectively). For patients with a large amount of gas, peptic disease was the most common aetiology (11/51 [21.6%]). Three-quarters of the patients (280/372, 75.2%) had the source of free gas identified during ED admission. Ninety-day mortality rates were 7.2%, 9.9% and 21.6% for patients with small, medium and large amounts of gas respectively (p=0.007). CONCLUSIONS Colonic diverticulitis was the most common source of free abdominal gas and peptic disease was the most common cause of a large amount of free gas. Mortality rates correlated with the amount of gas and were significantly higher in patients with a large amount.
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Affiliation(s)
- N Tau
- Sheba Medical Center, Ramat Gan, , Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Cohen
- Sheba Medical Center, Ramat Gan, , Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Barash
- Sheba Medical Center, Ramat Gan, , Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Klang
- Sheba Medical Center, Ramat Gan, , Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Pouli S, Kozana A, Papakitsou I, Daskalogiannaki M, Raissaki M. Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology. Insights Imaging 2020; 11:31. [PMID: 32086627 PMCID: PMC7035412 DOI: 10.1186/s13244-019-0823-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/29/2019] [Indexed: 12/11/2022] Open
Abstract
Gastrointestinal tract (GIT) perforation is a common medical emergency associated with considerable mortality, ranging from 30 to 50%. Clinical presentation varies: oesophageal perforations can present with acute chest pain, odynophagia and vomiting, gastroduodenal perforations with acute severe abdominal pain, while colonic perforations tend to follow a slower progression course with secondary bacterial peritonitis or localised abscesses. A subset of patients may present with delayed symptoms, abscess mimicking an abdominal mass, or with sepsis. Direct multidetector computed tomography (MDCT) findings support the diagnosis and localise the perforation site while ancillary findings may suggest underlying conditions that need further investigation following primary repair of ruptured bowel. MDCT findings include extraluminal gas, visible bowel wall discontinuity, extraluminal contrast, bowel wall thickening, abnormal mural enhancement, localised fat stranding and/or free fluid, as well as localised phlegmon or abscess in contained perforations. The purpose of this article is to review the spectrum of MDCT findings encountered in GIT perforation and emphasise the MDCT and clinical clues suggestive of the underlying aetiology and localisation of perforation site.
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Affiliation(s)
- Styliani Pouli
- Department of Radiology, University Hospital of Heraklion, Faculty of Medicine-University of Crete, Stavrakia, Voutes 21110, Heraklion, Crete, Greece
| | - Androniki Kozana
- Department of Radiology, University Hospital of Heraklion, Faculty of Medicine-University of Crete, Stavrakia, Voutes 21110, Heraklion, Crete, Greece
| | - Ioanna Papakitsou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Maria Daskalogiannaki
- Department of Radiology, University Hospital of Heraklion, Faculty of Medicine-University of Crete, Stavrakia, Voutes 21110, Heraklion, Crete, Greece
| | - Maria Raissaki
- Department of Radiology, University Hospital of Heraklion, Faculty of Medicine-University of Crete, Stavrakia, Voutes 21110, Heraklion, Crete, Greece.
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21
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Rustagi T, Yilmaz E, Alonso F, Schmidt C, Oskouian R, Tubbs RS, Chapman JR, Hopkins S, Schildhauer TA, Fisahn C. Iatrogenic Bowel Injury Following Minimally Invasive Lateral Approach to the Lumbar Spine: A Retrospective Analysis of 3 Cases. Global Spine J 2019; 9:375-382. [PMID: 31218194 PMCID: PMC6562219 DOI: 10.1177/2192568218800045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Anterior approaches are often used during lumbar interbody fusion procedures. Visceral injuries (bowel injuries) are rare but represent a primary risk during anterior approaches to the lumbar spine. Left untreated, these injuries can result in significant complications. The aim of this study was to investigate the presentation and management of bowel injury cases following anterior approaches to the lumbar spine to raise the surgeon's awareness of this rare complication. METHODS All direct anterior, oblique anterior, and transpsoas lumbar interbody fusion surgeries performed at our institution between 2012 and 2016 were analyzed retrospectively. Charts were screened for cases requiring return to the operating room owing to a suspected bowel injury and details of the case were extracted for illustrative purposes. RESULTS A total of 775 anterior lumbar surgeries were conducted at a single tertiary care institution between July 2012 and June 2017. A total of 590 transpsoas lumbar interbody fusion (TPIF) surgeries were performed. Four patients, each having undergone TPIF, were suspected of bowel injury and underwent an exploratory laparotomy. At surgery, 3 patients were confirmed to have a bowel injury, giving a procedure-specific incidence of 0.51% and overall incidence of 0.39%. Among the 3 confirmed bowel injury cases, average delay between surgery and visceral injury diagnosis was 4.7 days (range 3-7 days). CONCLUSIONS We noted abdominal pain, distention, and fever as the most common findings in the setting of a visceral injury. A high index of suspicion and computed tomography imaging remain critical for identifying postoperative bowel injuries.
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Affiliation(s)
- Tarush Rustagi
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA,Indian Spinal Injuries Centre, New Delhi, India,Seattle Science Foundation, Seattle, WA, USA
| | - Emre Yilmaz
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA,Seattle Science Foundation, Seattle, WA, USA,BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany,Emre Yilmaz, Swedish Neuroscience Institute, Swedish
Medical Center, 550 17th Avenue, Suite 500 James Tower, 5th Floor, Seattle, WA 98122, USA.
| | - Fernando Alonso
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA
| | - Cameron Schmidt
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA,Seattle Science Foundation, Seattle, WA, USA
| | - Rod Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA,Seattle Science Foundation, Seattle, WA, USA
| | - R. Shane Tubbs
- Seattle Science Foundation, Seattle, WA, USA,St George’s University, St George’s, Grenada
| | - Jens R. Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA
| | - Sarah Hopkins
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA
| | | | - Christian Fisahn
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA,
USA,Seattle Science Foundation, Seattle, WA, USA,BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany
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22
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Eroğlu A, Aydın Y, Yılmaz Ö. Minimally invasive management of esophageal perforation. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2018; 26:496-503. [PMID: 32082789 PMCID: PMC7018280 DOI: 10.5606/tgkdc.dergisi.2018.15354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/07/2017] [Indexed: 02/07/2023]
Abstract
Esophageal perforation is a medical emergency associated with high morbidity and mortality. There is no consensus on the optimal treatment of this life-threatening condition. Conventional treatment of esophageal perforation is surgical. However, more recently, endoscopic treatment has become the treatment of choice given its less invasive nature compared to surgical treatment. This includes endoscopic clip administration, endoscopic stent placement, endoscopic suturing, endoscopic vacuum therapy and tissue sealants which are all administered via the endoluminal route. Whilst small defects (<2 cm) may be closed with endoscopic clips, larger defects require stent placement or suturing. Removable esophageal stent is an effective method of treatment in cases with esophageal perforation as they allow minimal invasive repair of perforation and rapid nutrition. Endoscopic suturing can be used both to fix the stent to prevent migration and to primarily close the perforation. If perforation is associated with a mediastinal collection, drainage is mandatory and this procedure can be performed by computed tomography guided percutaneous drainage, thoracoscopy or endoscopic vacuum therapy. In some cases, a combination of these minimally invasive methods is required. Since endoscopic methods provide better quality of life and outcomes and shorten length of hospitalization, such methods have become the treatment of choice for esophageal perforation.
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Affiliation(s)
- Atilla Eroğlu
- Department of Thoracic Surgery, Medicine Faculty of Atatürk University, Erzurum, Turkey
| | - Yener Aydın
- Department of Thoracic Surgery, Medicine Faculty of Atatürk University, Erzurum, Turkey
| | - Ömer Yılmaz
- Department of Gastroenterology, Medicine Faculty of Atatürk University, Erzurum, Turkey
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23
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Kolar M, Pilkington M, Winthrop A, MacDonald H, Justinich C, Soboleski D, Sly L, Hurlbut D. Free intestinal perforation in children with Crohn's disease. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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24
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Eroglu A, Aydin Y, Yilmaz O. Thoracic perforations-surgical techniques. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:40. [PMID: 29610732 PMCID: PMC5879524 DOI: 10.21037/atm.2017.04.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/10/2017] [Indexed: 12/29/2022]
Abstract
Esophageal perforation may occur spontaneously, iatrogenically or in connection with traumas. Sepsis may develop in connection with mediastinal and pleural exposure in a very short time as a consequence of disintegration of the esophagus. Esophageal perforation is an emergency accompanied with a high level of mortality and morbidity. Rate of mortality for the perforations in the thoracic region is higher than that in the cervical and abdominal regions. Delay in diagnosis and treatment is the most important factor to affect the mortality. A quick and true diagnosis of esophageal perforation is prerequisite for a successful treatment. There is no certain consensus in relation with the optimal treatment of that life-threatening condition. However, in the event that perforation is detected early in a healthy esophagus, then primary repair is recommended. When it is detected late, nonoperative conservative treatment would be appropriate. The rates of mortality for the operations following a period of 24 h after rupture formation are higher than 50%. Esophagectomy is a type of an operation that is to be considered in the event of an end stage benign esophageal disease or of a large esophageal damage that does not allow primary repair. Significant decrease has been observed in the morbidity and mortality of esophageal perforation due to the improvements in the endoscopical techniques today. Minimally invasive techniques, in which drug eluting stents come first, will become an important step for the treatment of esophageal perforations in the forthcoming years.
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Affiliation(s)
- Atilla Eroglu
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Yener Aydin
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Omer Yilmaz
- Department of Gastroenterology, Medical Faculty, Ataturk University, Erzurum, Turkey
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25
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Iacobellis F, Perillo A, Iadevito I, Tanga M, Romano L, Grassi R, Nicola R, Scaglione M. Imaging of Oncologic Emergencies. Semin Ultrasound CT MR 2017; 39:151-166. [PMID: 29571552 DOI: 10.1053/j.sult.2017.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Oncologic emergencies can be either the result of the primary tumor, its metastasis, a paraneoplastic syndrome or reaction to the chemotherapy. Imaging plays a crucial role in ensuring a prompt diagnosis as well as assisting in the therapeutic management. In this article, we discuss the common thoracic and abdominal oncological emergencies that may be encountered in an emergency department.
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Affiliation(s)
- Francesca Iacobellis
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy; Department of Radiology, "A. Cardarelli" Hospital, Naples, Italy; Department of Radiology, University of Campania "L. Vanvitelli", Naples, Italy
| | - Alessandra Perillo
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy; Department of Radiology, University of Campania "L. Vanvitelli", Naples, Italy
| | - Isabella Iadevito
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy
| | - Michela Tanga
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy
| | - Luigia Romano
- Department of Radiology, "A. Cardarelli" Hospital, Naples, Italy
| | - Roberto Grassi
- Department of Radiology, University of Campania "L. Vanvitelli", Naples, Italy
| | - Refky Nicola
- Department of Radiology, SUNY-Upstate University and Medical Center, Syracuse, NY
| | - Mariano Scaglione
- Department of Radiology, "Pineta Grande" Hospital, Castel Volturno (CE), Italy; Department of Radiology, Sunderland Royal Hospital, NHS, Sunderland, UK.
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