Angiography in lesions of the small bowel

Following the introduction of endoscopy and newer imaging techniques, such as ultrasonography, computer tomography and magnetic resonance imaging, the indications for angiography have been reduced mainly to the diagnosis and treatment of unexplained gastrointestinal hemorrhage and ischemia. Radiologic signs of hemorrhage include extravasations of contrast medium, irregular vessels and aneurysms. Vascular stenoses and occlusions are the main radiologic signs of ischemia.     

Ultrasonographic findings of small bowel intussusception, focusing on differentiation from ileocolic intussusception

The purpose of this study was to evaluate the typical ultrasonographic findings of transient small bowel intussusception (SBI) and to differentiate it from ileocolic intussusception (ICI) in paediatrics. 22 transient SBI (male:female = 13:9, age: 7-132 months (mean 38 months)) and 27 ICI (male:female = 19:8, age: 1-60 months (mean 13 months)) patients diagnosed on ultrasonography were retrospectively evaluated. The findings of location, diameter, thickness of outer rim, and inclusion of mesenteric lymph nodes within intussuscipiens were compared. In the transient SBI, the head of intussusception was located in the right lower quadrant (RLQ) in 11 (50%), the right upper quadrant (RUQ) in 2 (9.1%) and the periumbilical area in 9 (40.9%) cases. The anteroposterior (AP) diameter ranged from 0.84-2.4 cm (mean 1.38 cm), and thickness of outer rim ranged from 0.10-0.34 cm (mean 0.26 cm). No mesenteric lymph nodes were contained within the intussuscipiens. In the ICI, the head was located in the RUQ in 17 (63%), the epigastrium in 7 (25.9%) and the left upper quadrant in 3 (11.1%) cases. The AP diameter ranged from 1.89-3.32 cm (mean 2.53 cm), and the thickness of the outer rim ranged from 0.30-0.86 cm (mean 0.53 cm). Mesenteric lymph nodes were contained within the intussuscipiens in 26 (96.3%) cases. In conclusion, when compared with ICI, the transient SBI occurs predominantly in the RLQ or periumbilical region, has a smaller AP diameter, a thinner outer rim, and dose not contain mesenteric lymph nodes.     

Treatment of intussusception with small bowel obstruction: application of decision analysis

Although hydrostatic reduction of intussusception has been accepted as the most desirable method of treatment, there is still no consensus regarding its application on patients presenting with signs of small bowel obstruction. Decision analysis was used to consider alternative strategies of management, that is, the selective approach of not attempting hydrostatic reduction if there is radiographic evidence of small bowel obstruction, and an attempt at hydrostatic reduction even in the presence of intestinal obstruction, thus operating only when the noninvasive treatment fails. Estimates were based on the experience of one center and an extensive review of the literature. Analysis was performed several times so that the approach resulting in the lowest mortality and morbidity, number of days in the hospital, and monetary costs could be established. Although there is a small risk of perforation with hydrostatic reduction when there is evidence of small bowel obstruction, the attempt is not associated with increased mortality and is overall the best management regarding all other considerations.     

Case report: lymphoma causing small bowel intussusception in a patient with the acquired immune deficiency syndrome.

We present the case of a patient with the acquired immune deficiency syndrome (AIDS) who developed an ileo-ileal intussusception due to lymphoma of the small bowel. The clinical and radiographic findings are described.     

小儿暂时性小肠套叠的超声特征及临床特点分析

目的 探讨小儿暂时性小肠套叠的超声特征及临床特点。方法 分析了在本院经超声诊断的21例小儿暂时性小肠套叠的临床资料。结果 本组患儿均经过超声诊断后确诊,共发现25处暂时性小肠套叠,其中4例患儿存在两处暂时性小肠套叠。超声表现为横切面呈现＂靶环征＂或＂同心圆征＂,纵切面呈现＂套筒征＂或＂三明治征＂。21例患儿在超声检查过程中有5例患儿在超声检查过程中即发现小肠套叠自动复位,另外16例患儿在2～5h后复查超声发现自行复位。第二天复查超声的时无复发情况。结论 小儿暂时性小肠套叠具有自发复位的特性,采用重复超声检查可保守治疗,不需要手术治疗。     

Pathophysiology of enlargement of the small bowel fold.

Enlargement of the valvulae conniventes is an integral part of the pattern diagnosis of primary small bowel disease causing malabsorption. The pathophysiology underlying enlargement of the fold and the most typical diseases with prominent folds leading to malabsorption are discussed. Differential diagnosis is based on enlargement of the fold and on secondary signs.     

Ct evaluation of small bowel obstruction.

Although small bowel obstruction is a common occurrence, it is essential that this clinical condition be treated properly, that the site, level, and cause of obstruction be determined accurately, and that a tentative prognosis be formulated prior to surgery. The diagnosis of small bowel obstruction is based on a comprehensive approach that includes clinical background, patient history, and results of physical examination and laboratory tests. A variety of radiologic procedures are available to aid in the diagnosis of small bowel obstruction. Recent studies have demonstrated the superiority of CT in revealing the site, level, and cause of obstruction and in demonstrating threatening signs of bowel inviability. CT has proved useful in characterizing small bowel obstruction from extrinsic causes (adhesions, closed loop, strangulation, hernia, extrinsic masses), intrinsic causes (adenocarcinoma, Crohn disease, tuberculosis, radiation enteropathy, intramural hemorrhage, intussusception), intraluminal causes (eg, bezoars), or intestinal malrotation. Conventional radiography was the modality of choice for many years and should remain the initial imaging method in patients with suspected small bowel obstruction. However, the unique capabilities of CT in this setting make this modality an important additional diagnostic tool when specific disease management issues must be addressed.     

Imaging of the small bowel

Radiologic imaging continues to play an integral role in the diagnosis and management of diseases of the small bowel. Except for the most proximal jejunal loop, which may occasionally be reached during upper gastrointestinal tract panendoscopy, and the terminal ileum, which can frequently be examined by the colonoscope, the mesenteric small intestine is the only gastrointestinal tract segment for which diagnostic study is not principally dependent upon endoscopic viewing. To the extent that radiologists assume primary responsibility in the diagnostic evaluation of the small bowel, it is essential that methods capable of accurately demonstrating small bowel morphology are appropriately applied (Maglinte et al., Radiology 1987, 163:297-305). Barium contrast studies and enteroclysis in particular remain the primary diagnostic methods in the small bowel for most clinical indications. Cross-sectional imaging modalities often provide unique diagnostic information, but their role remains either complementary to the demonstration of surface details by barium contrast studies or directed toward specific clinical circumstances that require discrete evaluation of the small-bowel wall and the adjacent tissues and organs.     

An analysis of bowel perforation in patients with intussusception

A barium colon examination is recommended for the diagnosis and reduction of intussusception in children, except when bowel perforation is evident either radiographically or clinically. In our experience and contrary to recent reports neither radiographic evidence of bowel obstruction nor an age of less than six months is a contraindication. We reviewed 40 patients diagnosed as having had intussusception and found five children aged more than six months with perforations discovered at operation. Three of the five children had plain radiographic findings of small bowel obstruction as did nine other children. In four of the 12 children with evidence of small bowel obstruction a successful hydrostatic reduction of the intussusception was carried out. Barium studies were performed for diagnosis and therapy in eight children with ileo-colic intussusception aged six months or less, four of whom had evidence of small bowel obstruction. In five, including two with obstruction, reduction of the intussusception was successful. The major contraindication to barium examination is radiographic or clinical evidence of perforation.