Colorectal carcinoma: Etiology, diagnosis, and screening

Colorectal carcinoma is a leading cause of death in the United States. Risk factors include genetic predisposition, diet, obesity, and inflammatory bowel disease. Early detection and chemoprevention can lead to a lower death rate. Future developments will include sensitive and specific large-scale screening.     

A unique sonographic presentation of prenatal volvulus associated with malrotation

This is a unique case of prenatal diagnosis of bowel malrotation suspected by an abnormal course of the duodenum. Early detection of volvulus was enabled, leading to timely intervention and a favorable outcome.     

肠系膜静脉血栓形成性缺血性肠病临床病理观察

目的 探讨肠系膜静脉血栓形成性缺血性肠病的临床表现、病理形态特征、治疗及预后。方法 对3例肠系膜静脉血栓形成性缺血性肠病进行临床、病理学分析，并复习文献。结果 肠系膜静脉血栓形成性缺血性肠病少见，早期症状不明显，后期表现为腹痛、休克，临床给予手术切除坏死肠段并用抗凝药物治疗。结论 缺血性肠病症状无特异性，易误诊，早期诊断、早期手术是治疗的关键。     

Early cervical cancer coexistent with idiopathic inflammatory bowel disease

Early invasive carcinoma of the cervix may be treated by surgery or radiation therapy. Two patients with early cervical cancer are presented whose concomitant inflammatory bowel disease figured significantly in the selection of surgery as treatment. The use of radiotherapy in the face of inflammatory bowel disease, however, is not clearly addressed in the literature.     

Evaluation of small bowel tumors: MR enteroclysis

Magnetic resonance imaging (MRI) of the small bowel has become widely accepted at centers dedicated to the diagnosis and treatment of inflammatory bowel disease, due to the method’s diagnostic efficacy. MR enteroclysis is an imaging modality that combines the advantages of enteroclysis and multiplanar MR and allows the detection and the manifestations of small bowel diseases wherever they are located (intraluminal, intramural, or extramural). Magnetic resonance enteroclysis (MRE) is an emerging technique used for the detection and evaluation of small bowel neoplasms. This article illustrates the imaging appearances of small bowel tumors on MRI and the usefulness of MR enteroclysis in the diagnosis and categorization of these tumors, also discussing the role of MRE in comparison with other diagnostic modalities.     

小儿先天性肠旋转不良——附63例报告

目的：总结小儿先天性肠旋转不良的临床特点。探讨合理的诊断及治疗措施。方法：对63例小儿先天性肠旋转不良的临床资料进行回顾性分析。结果：63例中新生儿40例（63%）,非新生儿23例（37%）;合并畸形17例（27%）。49例行传统的拉德（Ladd)手术;11例出现肠坏死,行肠外置或造瘘5例,肠切除肠吻合6例;1例肠反向旋转病儿因结肠梗阻行升结肠与横结肠侧侧吻合;2例盲肠位置正常的保留阑尾,切断松解十二指肠周围粘连的索带,手术中发现肠扭转45例,其中新生儿占31例,63例中56例痊愈,5例死亡,2例病情危重自动出院,7例行2次手术。结论：先天性肠旋转不良是发病率较高,复杂的消化道畸形,其临床表现常因发病年龄而异,出现小肠扭转,肠坏死是死亡的主要原因,早期诊断,掌握诊治要点及合理处理并发畸形是提高治愈率的关键。     

An Obscure Cause of Hip Pain

Background: We describe the case of a 53-year-old woman with hip pain secondary to an obturator hernia. Obturator hernia is uncommon, and the most lethal of all abdominal hernias. The high mortality rate of this disease requires an acute clinical awareness to facilitate rapid diagnosis and surgical intervention for improved prognosis. Objectives: This case highlights a vitally important diagnosis that is rarely discussed in the emergency medicine literature. Case Report: Our patient presented without symptoms typical of a bowel obstruction, although a computed tomography scan of her pelvis revealed an incarcerated obturator hernia and a small bowel obstruction. Conclusions: Early diagnosis and expeditious surgical management resulted in a good outcome.     

An Update on Managing Diverticulitis

The complex nature of diverticulitis causes multifaceted treatment options and makes the disease difficult to manage. Early diagnosis and treatment are crucial because complications such as peritonitis, bowel perforation, or fistula may occur. Diagnostic imaging is needed to guide treatments. This article outlines an update on managing diverticulitis for nurse practitioners.     

Crohn's disease and ulcerative colitis. Evaluation with double-contrast barium examination and endoscopy

Double-contrast barium examination of the colon can demonstrate the changes associated with inflammatory bowel disease more completely and specifically than the single-contrast barium study. However, endoscopy is slightly more sensitive than double-contrast examination for detection of disease. In general, between 18% and 20% of patients with Crohn's disease or ulcerative colitis may be expected to have normal radiographic findings but endoscopically detectable disease. However, most false-negative double-contrast colon studies are associated with mild or minimal findings at proctosigmoidoscopy. Although double-contrast radiography may be less sensitive than endoscopy in detection of inflammatory bowel disease, it has similar accuracy for classification and differentiation. Most studies indicate an accuracy of 95% to 98% in differentiating Crohn's disease and ulcerative colitis, due to the fact that morphologic changes detected by the double-contrast mucosal study rarely overlap in the two diseases. Double-contrast barium examination and endoscopy are complementary studies, and the use of both may provide valuable information for evaluation of patients with suspected inflammatory bowel disease.     

Imaging diagnosis of inflammatory bowel disease

The term "chronic inflammatory bowel disease" represents a spectrum of diseases out of which ulcerous colitis and Crohn's disease are the far most common. Large bowel enemas have lost their relevance compared to colonoscopy over the past years and small bowel enteroclysis has also been widely replaced by CT- and especially MR-enteroclysis meanwhile. The diagnostic value of computed tomography and MR-tomography in chronic inflammatory bowel disease is based on the excellent visualization and documentation of extent and severity of bowel wall inflammation, estimation of inflammatory activity of the disease and of detection of potential extraintestinal complications and/or additional diagnoses by these two methods. Nevertheless, conventional radiological techniques as well as sonography may still be valuable under certain conditions. Furthermore, nowadays imaging of chronic inflammatory bowel diseases includes also White Blood Cell scintigraphy as well as Positrone Emission Tomography which provide informations about extent and especially activity of the disease. The presented article provides an overview of the possibilities and limitations of the available imaging modalities in inflammatory bowel diseases and helps the reader to decide under what conditions which one of the available examinations should be regarded as the most appropriate and promising one.     

Role of Bowel Ultrasound in the Diagnosis and Follow-up of Patients with Crohn's Disease

Crohn's disease (CD) is an inflammatory chronic bowel disorder; it can involve the whole gastrointestinal tract, but its localization in the ileum or colon is most common. The reference standard for the diagnosis of CD is ileocolonoscopy with histologic assessment. The reference standard for the detection of any complications is surgery. However, imaging techniques have an important role both in the detection/localization of CD and in the follow-up of CD patients. In the last few years, the technical development of ultrasound equipment, the advent of new technologies such as elastography and mostly the increased expertise of sonographers have boosted the role of bowel ultrasound in assessment of the gastrointestinal tract. In fact, bowel ultrasound is particularly attractive thanks to its widespread availability, non-invasiveness, low cost and good reproducibility, as it can be easily repeated during follow-up. The aim of this article is to provide an extensive overview of the actual role of bowel ultrasound in the detection and follow-up of patients with CD.     

足月新生儿坏死性小肠结肠炎的临床特点

１８例足月新生儿坏死性小肠结肠炎（ＮＥＣ）的临床分析表明，ＮＥＣ的发生虽与各种危险因素有关，但亦可发生于完全正常的足月新生儿；发病时间早和病变以结肠受累为主是足月新生儿ＮＥＣ的特点；足月新生儿ＮＥＣ的预后明显优于早产儿ＮＥＣ。     

Contrast-enhanced MRI of the small bowel in Crohn��s disease

Recently, magnetic resonance imaging has emerged as a valuable tool in evaluation of small bowel Crohn’s disease. MRI provides several advantages to other imaging modalities, including the lack of ionizing radiation, multiplanar capability, and functional information. Intravenous contrast administration is a routine portion of MR enterography protocol, and aids in detection of disease extent, extramural complications such as fistula and abscess, and assessment of activity. Additionally, promising techniques such as dynamic contrast-enhanced MRI may provide quantitative measures to assess bowel perfusion, which may enhance evaluation of disease activity. This article will provide an overview of the technical aspects of contrast-enhanced MR enterography, describe common pathologic findings involving the small bowel in Crohn’s disease, summarize its role in determination of activity with an emphasis on endoscopic and histologic correlation, and compare its efficacy with other imaging modalities.     

Significance of endoscopy in inflammatory bowel diseases in childhood

Endoscopy makes an essential contribution as diagnostic tool in the clarification of unspecific inflammatory bowel disease in childhood. Important advantages of this method are detection of early lesions, classification of the type of inflammation, sight-guided biopsies and no exposure to X-rays. In 36 patients the diagnosis of Crohn's disease was proven by endoscopy alone in 66.6% of cases, by histology as sole criterion in 69.4%, and by X-ray examination alone in only 8.3% of cases. All 3 patients in whom the diagnosis of Crohn's disease was made exclusively by radiological means showed manifest involvement limited to the small bowel. However, even upper gastrointestinal endoscopy led to the detection of lesions characteristic of Crohn's disease in some cases. 36 colonoscopies were performed in 28 patients with ulcerative colitis. Typical lesions were detected endoscopically in 91.7%; corresponding histological changes were found in only 63.6%.     

Brain magnetic resonance imaging findings and radiologic review of maple syrup urine disease: Report of three cases

BACKGROUNDMaple syrup urine disease (MSUD) is a rare autosomal-recessive disorder that affects branched-chain amino acid (BCAA) metabolism and is named after the distinctive sweet odor of affected infants’ urine. This disease is characterized by the accumulation of BCAAs and corresponding branched-chain ketoacids of leucine, isoleucine, and valine in the plasma, urine, and cerebrospinal fluid. However, the mechanisms of MSUD-induced brain damage remain poorly defined. The accumulation of BCAAs in the brain inhibits the activity of pyruvate dehydrogenase and α-ketoglutarate, disrupting the citric acid cycle and consequently impacting the synthesis of amino acids, causing cerebral edema and abnormal myelination.CASE SUMMARYWe report three neonates admitted to our hospital with the classic subtype of MSUD. All three patients, with a transient normal period, presented with poor feeding, vomiting, poor weight gain, and increasing lethargy after birth. Laboratory testing revealed metabolic acidosis. The serum tandem mass spectrometry amino acid profile showed elevated plasma levels of BCAAs (leucine, isoleucine, and valine). Brain magnetic resonance imaging (MRI) presented abnormal signals mainly involving the globus pallidus, thalamus, internal capsule, brainstem, and cerebellar white matter, which represent the typical myelinated areas in normal full-term neonates.CONCLUSIONIn our patients, MRI showed typical features, in concordance with the available literature. Early detection and timely treatment are very helpful for the prognosis of MSUD patients. Therefore, we discuss the neuroimaging features of MSUD to enhance the knowledge of pediatricians about this disease.     

Imaging of peritoneal carcinomatosis with FDG PET-CT: diagnostic patterns,case examples and pitfalls

Early diagnosis of peritoneal spread in malignant disease is essential to prevent unnecessary laparotomies and to select the patients in whom complete cytoreduction is feasible. Although anatomic imaging is the mainstay for evaluating peritoneal seeding, small neoplastic implants can be difficult to detect with CT and MR imaging. FDG PET-CT has the potential to improve detection of peritoneal metastases as lesion conspicuity is high at PET due to low background activity and fused PET-CT offers the combined benefits of anatomic and functional imaging. Correlation of uptake modalities with the pathogenesis of intraperitoneal spread of malignancies, provides a rational system of analysis and is essential to define disease. Distinct patterns appear to predict the presence of either nodular or diffuse peritoneal pathology. Main pitfalls are related to normal physiologic activity in bowel loops and blood vessels or focal retained activity in ureters and urinary bladder. PET-CT is most suitable in patients with high tumor markers and negative or uncertain conventional imaging data and in selecting patients for complete cytoreduction. FDG PET-CT adds to conventional imaging in the detection and staging of peritoneal carcinomatosis and is a useful diagnostic tool in monitoring response to therapy and in long term follow-up.     

Echogenic foci in the dilated fetal colon may be associated with the presence of a rectourinary fistula.

Intraintestinal meconium calcification in the fetus and newborn is a rare finding, occurring in patients with intestinal obstruction. The intraluminal location of the enterolithiasis enables differentiation from calcifications that are secondary to bowel perforation and meconium peritonitis. We report on a term male neonate with VACTERL (vertebral defects, imperforate anus, cardiac anomalies, tracheoesophageal fistula, renal anomalies, limb anomalies) association and rectourethral fistula, in whom enterolithiasis was documented by prenatal ultrasound imaging at 21 weeks' gestation. A review of the literature and a summary of all previously described cases of neonates with intraluminal meconium calcifications are provided. Prenatal ultrasonographic detection of enterolithiasis in fetuses with anal atresia may indicate the presence of an enterourinary fistula.     

CT colonoscopy in inflammatory bowel disease

Virtual colonoscopy is used worldwide for the detection of colon polyps, but this technique has not been used much for the evaluation of inflammatory bowel diseases. The advent of multidetector-computed tomography and the use of high quality 3D and virtual images opened up the opportunity to assess these patients with this non-invasive technique. Early and late colonic changes are illustrated.     

From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography

Gastrointestinal (GI) tract perforation is a life-threatening condition that can occur at any site along the alimentary tract. Early perforation detection and intervention significantly improves patient outcome. With a high sensitivity for pneumoperitoneum, computed tomography (CT) is widely accepted as the diagnostic modality of choice when a perforated hollow viscus is suspected. While confirming the presence of a perforation is critical, clinical management and surgical technique also depend on localizing the perforation site. CT is accurate in detecting the site of perforation, with segmental bowel wall thickening, focal bowel wall defect, or bubbles of extraluminal gas concentrated in close proximity to the bowel wall shown to be the most specific findings. In this article, we will present the causes for perforation at each site throughout the GI tract and review the patterns that can lead to prospective diagnosis and perforation site localization utilizing CT images of surgically proven cases.     

Laboratory diagnosis in inflammatory bowel disease

The assessment of disease activity in inflammatory bowel disease is done using clinical parameters and various biological disease markers. Classical disease markers including erythrocyte sedimentation rate, acute phase proteins, such as orosomucoid and CRP, leukocyte and platelet counts, play an important role in the monitoring of disease activity. Furthermore, the determination of zinc, iron, ferritin, vitamin B12, and folic acid is important to avoid deficiencies in patients with severe disease or after surgeries. Stool cultures are helpful to detect bacterial or parasitic infections mimicking inflammatory bowel disease. The detection of specific antibodies such as pANCA, PAB and ASCA is helpful for the differential diagnosis Crohn's disease--ulcerative colitis.