Retroperitoneal duodenal perforation during endoscopic sphincterotomy: sonographic findings

We present the sonographic findings in 5 cases of retroperitoneal duodenal perforation during endoscopic sphincterotomy. In each case, sonography showed hyperechoic areas associated with shadowing and ring-down artifacts between the liver and the right kidney correlating with the retroperitoneal air seen on plain x-ray films. This brightly echogenic area with shadowing surrounded and obscured the kidney. In 4 patients, resolution was documented on follow-up sonographic examinations in agreement with other radiologic findings; the other patient died.     

Retroperitoneal perforation during ERCP and endoscopic sphincterotomy: causes, clinical features and management

Eleven patients with retroperitoneal perforation complicating endoscopic management of bile duct obstruction were seen over a seven-year period. In nine patients endoscopic sphincterotomy or pre-cut papillotomy had been performed, but in two who had not undergone sphincterotomy perforation occurred because of the penetration of a guidewire during attempts to negotiate a malignant bile duct stricture. Eight out of eleven patients remained asymptomatic, and all recovered with conservative management. Asymptomatic retroperitoneal perforation can complicate therapeutic ERCP even when sphincterotomy is not performed, but conservative management is usually effective if the complications is recognized immediately.     

Retroperitoneal malignant mesenchymoma: imaging findings in five cases

. Background: To describe computed tomographic (CT), magnetic resonance (MR), ultrasonographic (US), and angiographic findings of retroperitoneal malignant mesenchymoma with emphasis on CT findings. Methods: Five CT, four US, four angiography, and two MR studies were obtained in five patients with pathologically proven retroperitoneal malignant mesenchymoma. Results: Tumors were larger than 10 cm (n = 4), well-cimcumscribed and heterogeneous (n = 4), and with massive intratumorous calcifications (n = 3) on plain CT or US. Tumors showed heterogeneous enhancement on contrast-enhanced CT scans (n = 4) and moderate hypervascularity with heterogeneous staining on angiography (n = 3). Tumors were essentially hypointense on T1-weighted MR images (n = 2) and heterogeneous hyperintense on T2-weighted MR images (n = 2). Plain CT showed a fat-dense structure in a tumor in one patient. Conclusions: The radiologic findings of large expansile heterogeneous masses in the retroperitoneum, especially with massive calcifications, were considered to be typical of malignant mesenchymomas.      

Retroperitoneal liposarcoma: sonographic findings

This study, based on sonographic (US) results of 10 cases with histologically proven retroperitoneal liposarcoma (eight well-differentiated and two pleomorphic types), shows that the presence of fine echogenic lines within the tumor is a useful sign for diagnosing a well-differentiated liposarcoma. Presence of numerous fine fibrous septa in the lipomatous tumor tissue is thought to be responsible for this interesting phenomenon. Of interest is the fact that the direction of these lines changed according to the probe format used: parallel horizontal lines when using a linear probe and concentric lines converging toward the probe when using a sector or curved linear probe. In contrast, pleomorphic liposarcoma does not show this US sign. Knowledge of these US findings is useful for the diagnosis of retroperitoneal liposarcoma. Received: 10 January 2000/Accepted: 9 February 2000     

Retroperitoneal cyst: sonographic findings

Background: Retroperitoneal cyst (RC) is a relatively rare disease, and its sonographic (US) findings have not been analyzed sufficiently. Methods: We studied US findings of five patients with RC, with special attention to location, size, shape, internal echoes, the presence or absence of lateral shadowing, and the mode of back echoes. Results: In all cases, the cyst was situated behind (four cases) or lateral to (one case) the pancreas: behind or lateral to the pancreatic head in two cases, behind the pancreatic body in one case, and behind the pancreatic tail in two cases. Four cases showed a round mass (three cases) or multiple round mass (one case). Internal echoes were present in those cases and showed a “pseudo-solid” pattern. In those cases, M-mode US confirmed the movement of those internal echoes. In the remaining case, the lesion was imaged as an irregularly shaped multilocular mass. No case showed posterior echo enhancement, and no case showed lateral shadowing. No blood flow signals from the lesion were seen. Conclusion: Unlike ordinary cysts, RC usually is imaged as a round mass behind the pancreas, with dense internal echoes without lateral shadowing or posterior echo enhancement, which presents a “pseudo-solid” pattern. A diagnosis of RC should be considered when encountering a mass with such US findings. Received: 6 June 2001/Accepted: 25 July 2001     

Advanced periampullary carcinoma: endoscopic palliation by sphincterotomy

We have described a 50-year-old woman with periampullary carcinoma with extensive infiltration of the duodenal wall arising from advanced tumor of the pancreatic head. Endoscopic sphincterotomy induced complete relief from jaundice and pruritus before definitive surgical therapy was done. This procedure should not be restricted to small tumors confined to the ampulla itself, since it may also be of palliative or preoperative value in certain patients with advanced cancer of the pancreatic head.     

内镜下乳头括约肌切开加大球囊扩张与常规乳头括约肌切开治疗胆总管结石的比较研究

目的 比较应用十二指肠乳头括约肌切开(EST)加大球囊扩张(LBD)与常规十二指肠乳头括约肌切开(EST)对较大胆总管结石治疗效果.方法 200个直径大于1 cm的胆总管结石患者纳入研究并随机分配于EST+LBD组和常规EST组.两种方式分别治疗胆总管结石100例.比较两种术式的取石成功率、取碎石时间、采用机械碎石的机率、术后并发症情况.结果 EST+LBD组与常规EST组取净结石成功率分别为98％和97％(P ＞0.05);EST组+LBD组与常规EST组平均取碎石时间分别为21、46 min(P ＜0.05).EST组+LBD组与常规EST组术中采用机械碎石的几率分别为18％和43％(P ＜0.05).EST+LBD组与常规EST组术后并发症分别为3％和5％(P＞0.05),其中,出血发生率分别为1％和2％,胰腺炎的发生率分别为2％和3％.两组均无穿孔并发症.结论 对于较大的胆总管结石,EST+LBD术可以缩短取碎石时间和减少采用机械碎石的几率,其取石成功率和术后并发症的发生率与常规EST相当,是一种安全有效的胆总管结石的内镜治疗方式.     

Complications of endoscopic retrograde sphincterotomy: Computed tomographic evaluation

Although the reported complication rate of endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is low, patients often experience abdominal pain postprocedure. When pain persists, or fever and leukocytosis develop, a procedure-related complication should be suspected. The authors reviewed a series of 36 patients referred to computed tomography (CT) for evaluation of possible complications following ERCP with sphincterotomy. Initial CT scans were obtained within 24 h in 19 patients, and during the second to seventh day in the remainder. Complications detected by CT included acute pancreatitis (23), duodenal perforation (11), retroperitoneal dissection of air (4), pneumoperitoneum (4), and development of retroperitoneal abscess (4). Eight patients had normal CT scans except for air and contrast material in the biliary tree. The severity and extent of injury were readily assessed by CT, and response to therapy effectively monitored by serial CT examinations. Thirty-one cases (31 of 36) were successfully managed conservatively with antibiotics, intravenous hydration, and restriction of oral intake. Four patients required surgical intervention for drainage of a retroperitoneal abscess (3) or a pseudocyst (1). A fifth patient required intensive care resuscitation for septic shock. We conclude that CT is the study of choice for evaluating the patient with suspected complication following ERCP and sphincterotomy.     

Gallbladder perforation: color Doppler findings

Gallbladder (GB) perforation is a life-threatening complication of acute cholecystitis, and early diagnosis prevents delay in patient management. We present two cases of GB perforation diagnosed by color Doppler ultrasonography. Each clearly showed a flow signal passing through the perforated site, leading to prompt and successful surgical treatment. This interesting observation suggests that color Doppler ultrasonography is useful in the diagnosis of GB perforation. Received: 20 February 2001/Accepted: 21 March 2001     

Sonographic and magnetic resonance imaging findings of pelvic abscess following uterine perforation sustained during office endometrial sampling

Pipelle endometrial sampling, an outpatient, office-based procedure, provides comparative successful endometrial sampling in comparison with other techniques including conventional dilatation and curettage. We present an unusual occurrence in which office Pipelle endometrial sampling in a perimenopausal patient was complicated 10 days later by lower abdominal pain and intermittent fever. Sonography depicted findings consistent with a large pelvic abscess overriding the uterine fundus. Sonography and magnetic resonance imaging confirmed the presence of the unusual pelvic abscess and, in addition, noted findings consistent with perforation of the uterus during endometrial sampling.     

内镜下乳头括约肌切开的护理

目的 探讨乳头括约肌切开术的护理.方法 将十二指肠镜插入十二指肠降部找到乳头,在X线透视下插入切开刀、导丝,推注造影剂,选择好合适位置后行乳头括约肌切开.结果 53例病人治疗中采用了此技术,52例达到治疗目的,1例术后穿孔.结论 此技术具有创伤小、康复快的优点,术中配合作用重要,可使病人有满意的疗效.     

Gastrointestinal tract lymphangiomas: findings at CT and endoscopic imaging with histopathologic correlation

Objective  To evaluate and describe CT and endoscopic imaging findings in patients with pathologically confirmed gastrointestinal tract lymphangiomas. Methods  Findings from imaging examinations in 6 patients with pathologically confirmed lymphangioma were retrospectively reviewed (computed tomographic images obtained in 6 patients and endoscopic images obtained in 4 patients were available for review). Two radiologists evaluated lesion location, size, shape, edge, number, attenuation, the thickness of capsule wall and the degree of enhancement through PACS or workstation. Results  Lymphangiomas in gastrointestinal tract showed similar features in CT imaging: Contrast-enhanced CT scan showed the oval submucosal masses with homogeneous low attenuation. The lymphangioma appeared as a well-defined, smoothly marginated and non-enhancing cystic mass with intact overlying intestinal mucosa. In one case, the lymphangiomas were multiple with volvulus. Remarkably, CT imaging showed 2 patients with intussusception due to the mass. Endoscopic photographs manifested multiple colplanate mucosal protrusions in the gastric wall or intestinal wall. One case showed submucosal pedunculated proliferative lesion with adenomatous surface. Conclusions  Lymphangiomas exhibited typical appearances that reflected their cystic pathologic features. They showed similar features in CT imaging: well-demarcated, non-enhancing, homogeneous low attenuation cystic masses with intact overlying mucosa. Endoscopic photographs showed submucosal masses with distension of overlying mucosal vessels.