Cecal bascule herniation into the lesser sac

Cecal bascule is a rare cause of bowel obstruction in which a mobile cecum folds anteriorly and superiorly over the ascending colon. Herein, we present the first case of internal herniation of a cecal bascule into the lesser sac through the foramen of winslow, aiming at discussing radiological findings, differential diagnosis, and surgical management of this uncommon condition. A 75-year-old female presented to the emergency room with an 18-h history of sudden onset sharp, progressively worsening abdominal pain associated with vomiting. Physical exam revealed abdominal distention and epigastric tenderness while initial laboratory tests were unremarkable. Computed tomography of her abdomen and pelvis showed a loop of distended colon within lesser sac without signs of bowel ischemia or perforation. On exploratory laparotomy, a cecal bascule was found herniating into lesser sac via foramen of winslow. Upon reduction, the cecum appeared viable therefore a cecopexy was performed without bowel resection. Unlike cecal volvulus, cecal bascule consists of no axial rotation of the bowel with no mesenteric vascular compromise and therefore ischemia would only occur from intraluminal tension or extraluminal compression from the borders of foramen of winslow. The management of internal herniation of a cecal bascule is always surgical including anatomic resection or cecopexy.     

Preoperative radiographic diagnosis of a Spigelian hernia containing large and small bowel

A case is reported in which the preoperative diagnosis of a Spigelian hernia containing both large and small bowel was made by radiographic means. The anatomy, clinical findings, and radiologic picture of this condition are discussed.     

Intraperitoneal fat focal infarction of the lesser omentum: case report

Intraperitonal fat focal infarction (IFFI) represents a relatively rare acute abdominal condition essentially characterized by infarction and/or torsion of the greater omentum or an epiploic appendage. The spontaneous clinical evolution is favorable under medical treatment, and the imaging findings have been proved sufficiently typical to avoid unnecessary surgery in the great majority of cases. To our kwownledge, we report the first case of IFFI of the lesser omentum. Despite the absence of definitive histologic proof, the diagnosis was possible through typical imaging findings extremely similar to those of more classic cases of IFFI but also through the spontaneous benign evolution.     

sciatic hernia with incarcerated ileum: CT and radiographic diagnosis

An elderly woman presented with postprandial cramps in the right lower abdomen and recurrent episodes of low back pain radiating down to the dorsal aspect of her right thigh. Computed tomography (CT) of the pelvis and barium enema with small bowel reflux demonstrated the herniation of an ileal loop through the greater sciatic foramen on the right side. The diagnosis and management of this case are herein described and previous publications on sciatic hernias are reviewed.     

Areae gastricae traversing the esophageal hiatus: A sign of hiatus hernia

The areae gastricae are often visible as a structural feature of the gastric mucosa during double-contrast studies of the stomach. In this paper, radiographic visualization of the areae gastricae traversing the esophageal hiatus is described as a sign of hiatus hernia. In most instances, other radiographic signs of hiatus hernia are also present or may be elicited.     

Pericecal hernia of the inferior ileocecal recess: CT findings

Internal abdominal herniations are rare. A 34-year-old healthy man was seen in the emergency room because of severe lower abdominal pain and episodic vomiting. Pericecal internal herniation of the inferior ileocecal recess was suspected by abdominal CT study and confirmed by exploratory laparotomy. Finally, the herniated ileal loops were reduced, and the redundant peritoneum was resected. In the present case, CT demonstrates the precise anatomic diagnosis and shows acute complications that should be recommended preoperatively. Urgent surgical intervention is necessary to prevent strangulation, which is responsible for high mortality. Early diagnosis and treatment had a good outcome.     

Adenocarcinoma in tubular duplication of the sigmoid colon

A rare case of mucus-secreting adenocarcinoma in a tubular duplication of the sigmoid colon is presented. The pertinent radiographic manifestations were: a calcium containing soft tissue mass located at the blind end of a 20 cm barium filled tubular duplication originating at the sigmoid colon.     

亲子并重同程式术前访视在疝囊腹腔镜高位结扎术患儿中的应用

目的 观察亲子并重同程式术前访视在疝囊腹腔镜高位结扎术患儿中的应用效果。 方法 选取亲子并重同程式术前访视实施前(2017年1-8月)和实施后(2017年9月-2018年4月)于我院接受疝囊腹腔镜高位结扎治疗的腹股沟疝患儿各40例为研究对象,实施前后分别设为对照组与试验组,对2组干预后的各观察指标进行比较。 结果 试验组焦虑评分与麻醉合作度评分均显著低于对照组(t=-8.001,P<0.001; t=-6.976,P<0.001),患儿家长对术前访视满意率显著高于对照组(χ²=13.067,P＜0.001)。 结论 采用亲子并重同程式术前访视模式对疝囊腹腔镜高位结扎术患儿施加干预,可显著改善该类患儿的术前焦虑程度,提升其麻醉合作度,是一种深受患方认可的术前访视模式。     

CT diagnosis of paraduodenal hernia

The computed tomographic (CT) findings of a right and left paraduodenal hernia are described. In the right paraduodenal hernia the major findings consist of encapsulation of small bowel loops in the right mid-abdomen with looping of arterial and venous jejunal branches behind the superior mesenteric artery. The findings of the left paraduodenal hernia are less specific and involve encapsulation of bowel loops at or above the level of the ligament of Treitz with intermittent dilatation.     

Colonic pseudo-obstruction: Value of prone lateral view of the rectum

Background Collection of fluid within the rectum of patients with gas-distended bowel can simulate as obstructive lesion.Methods In 12 patients with suspected distal colonic obstruction on plain radiographs, we obtained 2 additional films comprising a right lateral decubitus view of the abdomen followed by a prone lateral view of the pelvis.Results Significant gaseous distension of the rectum was achieved in 75% of the 8 patients with pseudo-obstruction. Gaseous filling of the rectum did not occur in any patient with a structural obstructive lesion.Conclusions In the appropriate clinical setting this approach could exclude the presence of obstruction and avoid unnecessary barium enemas in the majority of patients with colonic pseudo-obstruction.     

The “Hay-fork” sign in the ultrasonographic diagnosis of intussuception

Ultrasonography was used to evaluate a palpable abdominal mass in a woman. The characteristic hay-fork image led to the correct diagnosis of colocolic intussusception, which had not been suspected. This sign appears to be highly specific for intussusception.     

Iliopsoas hypertrophy mimicking acute abdomen in a bodybuilder

Marked hypertrophy of the psoas muscle in a bodybuilder produced a unilateral extrinsic mass effect upon the medial cecum and adjacent small bowel. The patient had presented with right lower quadrant pain and leukocytosis. Routine contrast studies of the abdomen were misleading, but a computed tomogram suggested the correct diagnosis.     

Sonographic findings in Richter's hernia

Richter's hernia can present as a diagnostic challenge because of its usually small size and eccentric bowel wall involvement with limited luminal compromise. This article describes a case of Richter's hernia in the femoral canal and illustrates its sonographic features.     

超声诊断羊膜囊膨出至阴道1例

患者女,21岁.主因"停经4个月、下腹疼痛伴阴道流血半天"入院.阴道流血量中等,未见肉样组织流出,无肛门坠胀感,无头晕等不适.有性生活史.急诊行彩色多普勒超声检查示:宫内胎儿,双顶径3.0 cm,颅骨光环完整,脊柱排列整齐,胸腹壁完整,无胎心搏动及胎动,胎盘位于宫底后壁,宫腔无羊水回声.另于宫颈下方可探及一大小约7.4 cm×8.1 cm的无回声区,其内可见纡曲管状的脐带样回声,CDFI无血流信号.     

Brachycolon in the differential diagnosis of colitis

The authors present an illustrative case of progressive and severe shortening of the colon complicating chronic ulcerative colitis. The term brachycolon is defined and proposed as a useful differential diagnostic sign of ulcerative colitis.     

多排螺旋CT诊断小网膜囊病变的价值

目的 探讨小网膜囊正常解剖及病变的多排螺旋CT（MDCT）表现,评价小网膜囊病变的CT 诊断价值.方法 对24 例小网膜囊病变进行上腹部CT 平扫及三期增强扫描检查,均经手术病理证实.结果 小网膜囊病变中：原发肿瘤6 例（神经鞘瘤2 例,平滑肌瘤1 例,血管瘤1 例,脂肪肉瘤1 例,淋巴瘤1 例）,CT 表现为小网膜囊内边界清晰肿块.邻近脏器的良、恶性肿瘤8 例（胰头癌4 例,肝左叶肝细胞癌2 例,胃间质瘤2 例）,CT 表现为小网膜囊肿块与邻近相应肿瘤边界不清.转移性肿瘤2 例.结核1 例,CT 表现多个病灶融合,内见钙化.积液（腹水漏出液、炎性渗出液、脓液、血液、胆汁、淋巴液）6 例;假性囊肿1 例;CT 均表现为小网膜囊内液性密度灶.结论 多排螺旋CT对小网膜囊病变具有重要的诊断价值.     

Massive gas embolism inE. coli septicemia

The case of an elderly woman with radiographic evidence of gas within her portal vein as well as the iliac and femoral arteries is presented. The underlying cause proved to beE. coli septicemia. Differential diagnosis and clinical significance of intravascular gas are reviewed.     

Primary lymphoma of the colon and rectum: CT and barium enema correlation

This paper presents the computed tomographic (CT) and barium enema (BE) findings in seven patients with proven primary lymphoma of the colon and rectum. CT and BE examination are complimentary studies in the evaluation of primary lymphoma of the colorectum, and certain relevant findings may be missed when radiographic evaluation does not include both modalities. Both CT and barium studies are very accurate in detecting bulky endoexoenteric tumor masses, although CT may suggest features which can differentiate primary lymphoma from adenocarcinoma. The real utility of obtaining both a CT and BE examination may lie more in diagnosing complications, such as fistula formation and in the evaluation of subtle infiltrative lesions. While CT is necessary for staging purposes, BE examination may be invaluable for detecting subtle mucosal filling defects which could be missed on CT.     

Sonographic features of internal hernia.

OBJECTIVE: The purpose of this series is to describe the sonographic findings in 4 patients with intestinal obstruction due to internal hernia. METHODS: Four patients had clinical features of intestinal obstruction. Sonography was performed with broadband convex and linear array transducers in these patients. RESULTS: In all 4 patients, there were features of intestinal obstruction with a zone of transition between dilated and nondilated bowel. There was a cluster of crowded, compressed, and aperistaltic small-bowel loops, as if they were tightly packed within a sac, by the side of this zone in 3 patients. This appearance was due to obstruction of the afferent loop caused by compression. In the last patient, there were 2 loops of dilated bowel within a sac outlined by fluid due to obstruction of the efferent loop. All 4 patients had obstructed internal hernias at laparotomy. CONCLUSIONS: Sonographic features of internal hernia are described.     

Computed tomography of the abdomen: Initial experience

Computed tomography has provided a new dimension in the roentgenologic evaluation of the abdomen. Normal structures not visible on conventional examinations are clearly identified. Abnormalities are recognized by their alterations in anatomic form or by their effect on tissue absorption values. Our early experience suggests that in the abdomen computed tomography will be most valuable in detecting lesions in those sites least accessible to conventional roentgenographic methods such as the liver, spleen, pancreas and retroperitoneum.