Obstructive and enteropathic syndromes after jejunoileal bypass surgery

Small bowel bypass procedures for morbid obesity have been associated with many postoperative complications. With the use of the Scott procedure, the bypassed or excluded small bowel segment has recently been the focus of 2 syndromes — bypass enteritis and defunctioned bowel syndrome. We describe these postoperative complications and present their significant radiologic features.     

超声诊断小儿肠套叠与透视下空气灌肠复位的随诊分析

目的 对小儿肠套叠透视下空气灌肠复位进行随诊分析，并与超声检查结果对比，试图说明超声检查在小儿肠套叠诊断中的优越性及对空气灌肠复位的指导意义。方法 收集我院2005年7月-2006年1月经超声诊断并在透视下空气灌肠复位治疗成功的113例患者资料，按发病时间分为≤12h、12-24h、〉24h三组，分别记录各组平均套入部长度及空气灌肠复位平均压力，进行对照研究。结果 在诊断肠套叠部位上超声与透视下空气灌肠所见按回盲部、升结肠至肝曲、肝曲远端分组，诊断符合率分别为89．6％、98．0％及78．9％，超声所测套入部长度与空气灌肠平均复位压力及发病时间成正比。结论 超声对肠套叠可做到早期诊断，不仅能得出部位、血运等多方面的结论，还可通过超声测量套人部长度，对空气灌肠的风险做出评价，并对整复压力的估计有重要指导作用。     

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.     

B超在成人肠套叠中的诊断价值

目的 探讨B超对成人肠套叠中的诊断价值。方法 对8例成人肠套叠患进行术前B超检查，并与手术结果进行对照，分析总结。结果 B超能敏感地显示出套叠肠管特有的形态学改变，声像图反映出“靶环征”及“套筒征”，并可无损伤地动态观察。结论 超声检查肠套叠有重要的临床价值。     

Cirrhosis: Diagnosis by liver surface analysis with high-frequency ultrasound

To determine the sensitivity, specificity, and predictive values of the sonographic analysis of liver surface irregularities for the diagnosis of cirrhosis, the authors conducted a prospective and blinded study in 70 subjects with abnormal liver function tests. All patients included underwent liver biopsy within 15 days of the sonographic study. Twenty-three subjects with no signs or symptoms of liver disease were examined to assess the sonographic appearance of normal liver surface. Studies were performed with a small-parts probe, high-frequency transducer (7.5 MHz). Three basic patterns of liver surface were found: type I, normal; type II, focal abnormality; and type III, diffuse irregularity. Considering diffuse surface irregularity as an objective sonographic sign of cirrhosis, the study's sensitivity was 87.5%, specificity 81.5%, and positive and negative predictive values were 80% and 88.5%, respectively. Disease prevalence for cirrhosis was 45%. We conclude that sonographic analysis of the liver surface is a useful noninvasive test for the diagnosis of cirrhosis in the appropriate clinical setting.     

Duplex-Doppler evaluation of intestinal peristalsis in patients with bowel obstruction

Duplex-Doppler was used to visualize intestinal peristalsis in 30 patients with intestinal distension. The series included 12 patients with acute mechanical obstruction, 13 with long-standing mechanical obstruction, and five with paralytic ileus. The Duplex-Doppler recordings showed several patterns characterized by different degrees of intensity and frequency of the signals according to the type of obstruction, its duration, and the site of Doppler sampling relative to the obstructed segment. Duplex-Doppler evaluation provided both qualitative and quantitative data about intestinal peristalsis, allowing differentiation between mechanical and paralytic ileus. The visualization of intestinal segments having different degrees of peristaltic activity proved useful in localizing the site of mechanical obstruction.     

Intestinal pseudotumors: A problem in abdominal computed tomography solved by directed techniques

Differentiation of normal bowel loops from pathologic process by computed tomography is often difficult. Techniques are described for opacification of bowel loops via oral, rectal, and colostomy administration of contrast material. Examples of abdominal and pelvic pseudotumors which were proven not to be pathologic lesions are presented. By following simple techniques of bowel marking, one can avoid false positive diagnoses.     

Ultrasonographic evaluation of the bowel wall in inflammatory bowel disease: Comparison of in vivo and in vitro studies

To assist in the evaluation of inflammatory changes of the affected bowel, we classified the transabdominal ultrasonographic findings into types A-C. We compared the in vivo and in vitro sonographic images to the histopathologic findings of resected specimens. A total of 22 bowel specimens (five normal, 12 with Crohn's disease, five with ulcerative colitis) were examined sonographically with a 3.75-MHz curved and a 7.5-MHz linear array scanner; histologic examination of the same area of tissue was performed afterwards. These three examinations corresponded well to each other. Our classification scheme is useful in quantifying the severity of inflammatory changes in the affected bowel.An invited commentary on this article follows on pp. 403–404.     

Intussusception after jejunoileal bypass.

We have described a case of intussusception of the defunctionalized loop of small bowel after jejunoileal bypass. This complication may be avoidable by suturing the free end of the proximal jejunum to the root of the transverse mesocolon. Diagnosis is aided by closely placing silver clips on these same structures and observing for their separation on radiographs of the abdomen.     

经腔内超声诊断成人肠套叠的价值

目的探讨经腔内超声对成人肠套叠的诊断价值。方法对7例成人下腹部肠套叠行腔内超声检查,并与手术病理结果对照分析。结果经腔内超声诊断成人下腹部肠套叠与手术结果对照符合率100%,声像图表现为套叠部呈具有特征性的＂靶环征＂及＂套筒征＂改变,套叠部及附近可以发现诱发本病的原发病变。结论经腔内超声对成人下腹部肠套叠有较高诊断价值。     

Enterolithiasis: A report of four cases

Enterolithiasis is a rarely encountered clinical and radiologic entity. Stasis of intestinal contents is the underlying cause of the stone formation. Four cases are presented, 3 in the colon and 1 in the small bowel. The chemical composition of these stones varies according to their site of origin. The clinical setting varies widely as does the radiologic differential diagnosis.     

Pseudoreduction of intussusception: Is ileal reflux the end point?

Two cases of unsuccessful hydrostatic reduction of intussusception are reported. Both were associated with barium filling multiple loops of distal ileum, despite lack of complete reduction of the intussusception. The presence of free ileal reflux does not guarantee successful reduction. Careful examination of the cecum for residual intussus-ceptum and of non-contrast-filled small-bowel loops for evidence of remaining small-bowel obstruction is essential to recognize unsuccessful reduction.     

Heterotopic pregnancy diagnosed by emergency ultrasound

We present a case of heterotopic pregnancy rapidly diagnosed by an emergency physician. To the best of our knowledge, this is the first report of an emergency physician using bedside ultrasound to diagnose an ectopic pregnancy present simultaneously with an intrauterine pregnancy. Other unique features of this case include the diagnosis being made on initial evaluation and the patient's lack of risk factors for heterotopic pregnancy. A review of the cases of heterotopic pregnancy reported in the emergency medicine literature, the rising prevalence of the disease, and factors that may facilitate in making the diagnosis are discussed as well.     

Paralysis of the small bowel resembling mechanical intestinal obstruction

In some instances, particularly in the neonate, paralytic ileus affects predominantly the small bowel, thus resembling intestinal obstruction. Localized paralysis of the small bowel occurs secondary to regional events in a segment of gut and resembles mechanical obstruction even more closely. In localized paralysis the bowel lumen is usually dilated without abrupt distal transition to collapsed intestines. If there is radiographic and clinical recognition of localized, transitory bowel paralysis, surgery is usually unnecessary.     

Peritoneal fluid in children with intussusception: Its sonographic detection and relationship to successful reduction

A retrospective review of the abdominal/pelvic ultrasound (US) examinations in 21 consecutive children with intussusception proven on barium enema was performed to determine what is the incidence of US detected peritoneal fluid in this population and to see if the rate of reduction was different in this subset. Twelve of the 21 children (57%) had free fluid demonstrated with US. Eight of these 12 (67%) had successful reduction. Six of the nine children (67%) without free fluid were also successfully reduced.     

Computed tomography of adult ileocolic intussusception

Computed tomographic evaluation of ileocolic intussusception in an adult is presented. Upper gastrointestinal series with orally administered water-soluble contrast agent suggested obstruction in the lower part of the small intestine, but computed tomography made a definitive diagnosis. Pathognomonic CT findings of ileocolic intussusception are presented.     

Evaluation of abdominal lymphoma by ultrasound

Ultrasonography was utilized in 13 patients with lymphoma of the bowel, the liver, spleen, and abdominal lymph nodes. The lymphomatous tumors were (except in one patient with Burkitt's lymphoma) ultrasonographically anechoic or hypoechoic and showed very good echo transmission. In 6 out of 13 patients, lymphography was negative, or there was no evidence of enlarged retroperitoneal lymph nodes by ultrasound or computed tomography. In these patients, abdominal lymphoma in other areas was shown by ultrasonography. After a base-line had been obtained, the therapeutic effect or progression of the tumor could be followed simply by ultrasound.     

Giant Meckel diverticulum containing enteroliths diagnosed by computed tomography and sonography

A 23-year-old male patient with giant Meckel diverticulum containing enteroliths is presented. Computed tomography (CT) and sonography were useful for correctly suggesting the diagnosis. The unique manifestations of this rare lesion are described.